Ketogenic Diet: Burning Fat Or Burning Out?
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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:
- About 45% said “It has its benefits, but they don’t outweigh the risks”
- About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
- About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”
So what does the science say?
First, what is the ketogenic diet?
There are two different stories here:
- Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
- Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.
Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.
The ketogenic diet works by forcing the body to burn fat for energy: True or False?
True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.
See: The Ketogenic Diet: One Decade Later | Pediatrics
Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:
Source: Dietary Therapies for Epilepsy
The ketogenic diet is good for weight loss: True or False?
True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:
❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.
Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞
~ Dr. Shadan Khdher et al.
On which note…
The ketogenic diet is bad for the heart: True or False?
True! As Dr. Joanna Popiolek-Kalisz concluded recently:
❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.
Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞
~ Dr. Joanna Popiolek-Kalisz
Read in full: Ketogenic diet and cardiovascular risk: state of the art review
The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?
True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:
❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.
Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞
~ Ibid.
The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?
False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.
That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:
- At first, the body is running out of glucose, and so naturally feels weak and tired.
- Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
- Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.
Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:
- Bad breath
- Weight loss
- Appetite loss
- Increased focus and energy
- Increased fatigue and irritability
- Digestive issues
- Insomnia
The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.
Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:
The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?
True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.
One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.
Other things are more specific to the keto diet, such as the problems with the kidneys:
However, kidney stones aren’t the worst of the problems:
Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure
We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:
❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞
~ Dr. Ida Heikura et al.
A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise
Want a healthier diet?
We recommend the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean
(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)
Enjoy!
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How community health screenings get more people of color vaccinated
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U.S. preventive health screening rates dropped drastically at the height of the COVID-19 pandemic. They have yet to go back to pre-pandemic levels, especially for Black and Latine communities.
Screenings, or routine medical checkups, are important ways to avoid and treat disease. They’re key to finding problems early on and can even help save people’s lives.
Community health workers say screenings are also a key to getting more people vaccinated. Screening fairs provide health workers the chance to build rapport and trust with the communities they serve, while giving their clients the chance to ask questions and get personalized recommendations according to their age, gender, and family history.
But systemic barriers to health care can often keep people from marginalized communities from accessing recommended screenings, exacerbating racial health disparities.
Public Good News spoke with Dr. Marie-Jose Francois, president and chief executive officer, and April Johnson, outreach coordinator, at the Center for Multicultural Wellness and Prevention (CMWP), in Central Florida, to learn how they promote the benefits of screening and leverage screenings for vaccination outreach among their diverse communities.
Here’s what they said.
[Editor’s note: This content has been edited for clarity and length.]
PGN: What is CMWP’s mission? How does vaccine outreach fit into the work you do in the communities you serve?
Dr. Marie-Jose Francois: Since 1995, our mission has been to enhance the health, wellness, and quality of life for diverse populations in Central Florida. At the beginning, our main focus was education, wellness, and screening for HIV/AIDS, and we continue to do case management for HIV screening and testing.
When the issue of COVID-19 came into the picture, we included COVID-19 information and education and stressed the importance of screening and receiving vaccinations during all of our outreach activities.
We try to meet the community where they are. Because there is so much misconception—and taboo—in regard to immunization.
April Johnson: So our job is to disperse accurate information. And how we do that is we go into rural communities. We build partnerships with local apartment complexes, hair salons, nail salons, laundromats, and provide a little community engagement, where people just hang out in different areas.
We build gatekeepers in those communities because you first have to get in there. You have to know that they trust you. Being in this field for about 30 years, I’ve [learned that] flexibility is key. Because sometimes you can’t get them from 9 to 5, or [from] Monday through Friday. So, you have to be very flexible in doing the outreach portion in order to get what you need.
I’ve built collaborations with senior citizen centers, community centers, schools, clinics, churches in Orlando and [in] different areas in Orange, Osceola, Seminole, and Lake counties. And we also partner with other community-based organizations to try to make it like a one-stop shop. So, partnership is a big thing.
PGN: How do you promote the importance of preventive screenings in the communities you serve?
M.F.: We try to make them view their health in a more comprehensive way, for them to understand the importance of screening. [That] self care is key, and for them to not be afraid.
We empower them to know what to ask when they go to the doctor. We ask them, ‘Do you know your status? Do you know your numbers?’
For example, if you go to the doctor, do you know your blood pressure? If you’re diabetic? Do you know your hemoglobin (A1C)? Do you know your cholesterol levels?
And now, [we also ask them]: ‘Have you received your flu shot for the year? Have you received all of your vaccine doses for COVID-19?’ We are even adding the mpox vaccine now, based on risk factors.
[We recommend they] ask their provider. For women, [we ask], ‘When do you need to have your mammogram?’ For the men, ‘You need to ask about your PSA and also about when and when to have your colonoscopy based on your age.’
We also try to explain to the community that the more they know their family history, the more they can engage in their own health. Because sometimes you have mom and dad who have a history of cancer. They have a history of diabetes or blood pressure—and they don’t talk to their children. So, we try to [recommend they] talk to their children. Your own family needs to know what’s going on so they can be proactive in their screenings.
PGN: What strategies or methods have you found most effective in getting people screened?
M.F.: Not everybody wants to be screened, not everybody wants to receive vaccines.
But with patience, just give them the facts. It goes right back to education, people have to be assured.
When you talk to them about COVID, or even HIV, you may hear them say, ‘Oh, I don’t see myself at risk for HIV.’ But we have to repeat to them that the more they get screened to make sure they’re OK, the better it is for them. ‘The more you use condoms, [the] safer it is for you.’
In Haitian culture, they listen to the radio. So we use the radio as a tool to educate and deliver information [to] get vaccinated, wash your hands. ‘If you’re coughing, cover your mouth. If you have a fever, wear your masks. Call your doctor.’
In our target population, we have people who have chronic conditions. We have people with HIV. So, we have to motivate them to receive the flu vaccine, to receive the COVID vaccine, to receive that RSV [vaccine], or to get the mpox vaccine. We have people with diabetes, high blood pressure, high cholesterol, depressed immune systems. We have people with lupus, we have people with sickle cell disease.
So, this is a way to [ensure that] whomever you’re talking to one-on-one understands the value of being safe.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Long COVID is real—here’s how patients can get treatment and support
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What you need to know
- There is still no single, FDA-approved treatment for long COVID, but doctors can help patients manage individual symptoms.
- Long COVID patients may be eligible for government benefits that can ease financial burdens.
- Getting reinfected with COVID-19 can worsen existing long COVID symptoms, but patients can take steps to stay protected.
On March 15—Long COVID Awareness Day—patients shared their stories and demanded more funding for long COVID research. Nearly one in five U.S. adults who contract COVID-19 suffer from long COVID, and up to 5.8 million children have the disease.
Anyone who contracts COVID-19 is at risk of developing long-term illness. Long COVID has been deemed by some a “mass-disabling event,” as its symptoms can significantly disrupt patients’ lives.
Fortunately, there’s hope. New treatment options are in development, and there are resources available that may ease the physical, mental, and financial burdens that long COVID patients face.
Read on to learn more about resources for long COVID patients and how you can support the long COVID patients in your life.
What is long COVID, and who is at risk?
Long COVID is a cluster of symptoms that can occur after a COVID-19 infection and last for weeks, months, or years, potentially affecting almost every organ. Symptoms range from mild to debilitating and may include fatigue, chest pain, brain fog, dizziness, abdominal pain, joint pain, and changes in taste or smell.
Anyone who gets infected with COVID-19 is at risk of developing long COVID, but some groups are at greater risk, including unvaccinated people, women, people over 40, and people who face health inequities.
What types of support are available for long COVID patients?
Currently, there is still no single, FDA-approved treatment for long COVID, but doctors can help patients manage individual symptoms. Some options for long COVID treatment include therapies to improve lung function and retrain your sense of smell, as well as medications for pain and blood pressure regulation. Staying up to date on COVID-19 vaccines may also improve symptoms and reduce inflammation.
Long COVID patients are eligible for disability benefits under the Americans with Disabilities Act. The Pandemic Legal Assistance Network provides pro bono support for long COVID patients applying for these benefits.
Long COVID patients may also be eligible for other forms of government assistance, such as Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Medicaid, and rental and utility assistance programs.
How can friends and family of long COVID patients provide support?
Getting reinfected with COVID-19 can worsen existing long COVID symptoms. Wearing a high-quality, well-fitting mask will reduce your risk of contracting COVID-19 and spreading it to long COVID patients and others. At indoor gatherings, improving ventilation by opening doors and windows, using high-efficiency particulate air (HEPA) filters, and building your own Corsi-Rosenthal box can also reduce the spread of the COVID-19 virus.
Long COVID patients may also benefit from emotional and financial support as they manage symptoms, navigate barriers to treatment, and go through the months-long process of applying for and receiving disability benefits.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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‘Disease X’: What it is (and isn’t)
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What you need to know
- In January 2024, the World Economic Forum hosted an event called Preparing for Disease X to discuss strategies to improve international pandemic response.
- Disease X is a term used in epidemiology to refer to potential disease threats. It is not a real disease or a global conspiracy.
- Preparation to prevent and respond to future pandemics is a necessary part of global health to keep us all safer.
During the World Economic Forum’s 54th annual meeting in Davos, Switzerland, global health experts discussed ways to strengthen health care systems in preparation for future pandemics. Conspiracy theories quickly began circulating posts about the event and the fictional disease at its center, so-called Disease X.
What is Disease X?
In 2018, the World Health Organization added Disease X to its list of Blueprint Priority Diseases that are public health risks. But, unlike the other diseases on the list, Disease X doesn’t exist. The term represents a hypothetical human disease capable of causing a pandemic. Although experts don’t know what the next Disease X will be, they can make educated guesses about where and how it may emerge—and how we can prepare for it.
Why are we hearing about Disease X now?
COVID-19 has been the deadliest infectious disease outbreak of the 21st century. It’s also an example of a Disease X: a previously unknown pathogen that spreads rapidly around the world, claiming millions of lives.
When the WEF hosted a panel of experts to discuss Disease X, it was the first exposure that many people had to a concept that global health experts have been discussing since 2018.
Even before the routine pandemic preparedness event took place, online conspiracy theorists began circulating false claims that those discussing and preparing for Disease X had sinister motives, underscoring how widespread distrust of global health entities has become in the wake of the COVID-19 pandemic.
Why does Disease X matter?
Epidemiologists use concepts like Disease X to plan for future outbreaks and avoid the mistakes of past outbreaks. The COVID-19 pandemic and the recent non-endemic outbreak of mpox highlight the importance of global coordination to efficiently prevent and respond to disease outbreaks.
Pandemics are inevitable, but the scale of their destruction doesn’t have to be. Major disease outbreaks are likely to become more frequent due to the impacts of climate change. Preparing for a pandemic now helps ensure that the world is better equipped to handle the next one.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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PFAS Exposure & Cancer: The Numbers Are High
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PFAS & Cancer Risk: The Numbers Are High
Image Credits Mount Sinai This is Dr. Maaike van Gerwen. Is that an MD or a PhD, you wonder? It’s both.
She’s also Director of Research in the Department of Otolaryngology at Mount Sinai Hospital in New York, Scientific Director of the Program of Personalized Management of Thyroid Disease, and Member of the Institute for Translational Epidemiology and the Transdisciplinary Center on Early Environmental Exposures.
What does she want us to know?
She’d love for us to know about her latest research published literally today, about the risks associated with PFAS, such as the kind widely found in non-stick cookware:
Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer risk
Dr. van Gerwen and her team tested this several ways, and the very short and simple version of the findings is that per doubling of exposure, there was a 56% increased rate of thyroid cancer diagnosis.
(The rate of exposure was not just guessed based on self-reports; it was measured directly from PFAS levels in the blood of participants)
- PFAS exposure can come from many sources, not just non-stick cookware, but that’s a “biggie” since it transfers directly into food that we consume.
- Same goes for widely-available microwaveable plastic food containers.
- Relatively less dangerous exposures include waterproofed clothing.
To keep it simple and look at the non-stick pans and microwavable plastic containers, doubling exposure might mean using such things every day vs every second day.
Practical take-away: PFAS may be impossible to avoid completely, but even just cutting down on the use of such products is already reducing your cancer risk.
Isn’t it too late, by this point in life? Aren’t they “forever chemicals”?
They’re not truly “forever”, but they do have long half-lives, yes.
See: Can we take the “forever” out of forever chemicals?
The half-lives of PFOS and PFOA in water are 41 years and 92 years, respectively.
In the body, however, because our body is constantly trying to repair itself and eliminate toxins, it’s more like 3–7 years.
That might seem like a long time, and perhaps it is, but the time will pass anyway, so might as well get started now, rather than in 3–7 years time!
Read more: National Academies Report Calls for Testing People With High Exposure to “Forever Chemicals”
What should we use instead?
In place of non-stick cookware, cast iron is fantastic. It’s not everyone’s preference, though, so you might also like to know that ceramic cookware is a fine option that’s functionally non-stick but without needing a non-stick coating. Check for PFAS-free status; they should advertise this.
In place of plastic microwaveable containers, Pyrex (or equivalent) glass dishes (you can get them with lids) are a top-tier option. Ceramic containers (without metallic bits!) are also safely microwaveable.
See also:
Here’s a List of Products with PFAS (& How to Avoid Them)
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You can now order all kinds of medical tests online. Our research shows this is (mostly) a bad idea
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Elena.Katkova/Shutterstock Many of us have done countless rapid antigen tests (RATs) over the course of the pandemic. Testing ourselves at home has become second nature.
But there’s also a growing worldwide market in medical tests sold online directly to the public. These are “direct-to-consumer” tests, and you can access them without seeing a doctor.
While this might sound convenient, the benefits to most consumers are questionable, as we discovered in a recent study.
What are direct-to-consumer tests?
Let’s start with what they’re not. We’re not talking about patients who are diagnosed with a condition, and use tests to monitor themselves (for example, finger-prick testing to monitor blood sugar levels for people with diabetes).
We’re also not talking about home testing kits used for population screening, such as RATs for COVID, or the “poo tests” sent to people aged 50 and over for bowel cancer screening.
Direct-to-consumer tests are products marketed to anyone who is willing to pay, without going through their GP. They can include hormone profiling tests, tests for thyroid disease and food sensitivity tests, among many others.
Some direct-to-consumer tests allow you to complete the test at home, while self-collected lab tests give you the equipment to collect a sample, which you then send to a lab. You can now also buy pathology requests for a lab directly from a company without seeing a doctor.
We’ve all become accustomed to RATs during the pandemic.
Ground Picture/ShutterstockWhat we did in our study
We searched (via Google) for direct-to-consumer products advertised for sale online in Australia between June and December 2021. We then assessed whether each test was likely to provide benefits to those who use them based on scientific literature published about the tests, and any recommendations either for or against their use from professional medical organisations.
We identified 103 types of tests and 484 individual products ranging in price from A$12.99 to A$1,947.
We concluded only 11% of these tests were likely to benefit most consumers. These included tests for STIs, where social stigma can sometimes discourage people from testing at a clinic.
A further 31% could possibly benefit a person, if they were at higher risk. For example, if a person had symptoms of thyroid disease, a test may benefit them. But the Royal Australian College of General Practitioners does not recommend testing for thyroid disease in people without symptoms because evidence showing benefits of identifying and treating people with early thyroid disease is lacking.
Some 42% were commercial “health checks” such as hormone and nutritional status tests. Although these are legitimate tests – they may be ordered by a doctor in certain circumstances, or be used in research – they have limited usefulness for consumers.
A test of your hormone or vitamin levels at a particular time can’t do much to help you improve your health, especially because test results change depending on the time of day, month or season you test.
Most worryingly, 17% of the tests were outright “quackery” that wouldn’t be recommended by any mainstream health practitioner. For example, hair analysis for assessing food allergies is unproven and can lead to misdiagnosis and ineffective treatments.
More than half of the tests we looked at didn’t state they offered a pre- or post-test consultation.
Ordering medical tests online probably isn’t a good idea.
fizkes/ShutterstockProducts available may change outside the time frame of our study, and direct-to-consumer tests not promoted or directly purchasable online, such as those offered in pharmacies or by commercial health clinics, were not included.
But in Australia, ours is the first and only study we know of mapping the scale and variety of direct-to-consumer tests sold online.
Research from other countries has similarly found a lack of evidence to support the majority of direct-to-consumer tests.
4 questions to ask before you buy a test online
Many direct-to-consumer tests offer limited benefits, and could even lead to harms. Here are four questions you should ask yourself if you’re considering buying a medical test online.
1. If I do this test, could I end up with extra medical appointments or treatments I don’t need?
Doing a test yourself might seem harmless (it’s just information, after all), but unnecessary tests often find issues that would never have caused you problems.
For example, someone taking a diabetes test may find moderately high blood sugar levels see them labelled as “pre-diabetic”. However, this diagnosis has been controversial, regarded by many as making patients out of healthy people, a large number of whom won’t go on to develop diabetes.
2. Would my GP recommend this test?
If you have worrying symptoms or risk factors, your GP can recommend the best tests for you. Tests your GP orders are more likely to be covered by Medicare, so will cost you a lot less than a direct-to-consumer test.
3. Is this a good quality test?
A good quality home self-testing kit should indicate high sensitivity (the proportion of true cases that will be accurately detected) and high specificity (the proportion of people who don’t have the disease who will be accurately ruled out). These figures should ideally be in the high 90s, and clearly printed on the product packaging.
For tests analysed in a lab, check if the lab is accredited by the National Association of Testing Authorities. Avoid tests sent to overseas labs, where Australian regulators can’t control the quality, or the protection of your sample or personal health information.
4. Do I really need this test?
There are lots of reasons to want information from a test, like peace of mind, or just curiosity. But unless you have clear symptoms and risk factors, you’re probably testing yourself unnecessarily and wasting your money.
Direct-to-consumer tests might seem like a good idea, but in most cases, you’d be better off letting sleeping dogs lie if you feel well, or going to your GP if you have concerns.
Patti Shih, Senior Lecturer, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong; Fiona Stanaway, Associate Professor in Clinical Epidemiology, University of Sydney; Katy Bell, Associate Professor in Clinical Epidemiology, Sydney School of Public Health, University of Sydney, and Stacy Carter, Professor and Director, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Inhaled Eucalyptus’s Immunomodulatory and Antimicrobial Effects
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝At the first hint of a cough or a cold, I resort to steam inhalation. Some people add herbs or aromatic oils to the boiling water. What do you recommend?❞
First of all, please do be careful:
Western science’s view is predominantly “this is popular and/but evidence for its usefulness is lacking”:
But! Traditional Chinese Medicine indicates shuanghuanglian, yuxingcao and qingkailing, which the China Food and Drug Administration has also approved:
Chinese Medicine in Inhalation Therapy: A Review of Clinical Application and Formulation Development
Indian scientists are also looking at modern scientific applications of certain Ayurvedic herbs:
Promising phytochemicals of traditional Indian herbal steam inhalation therapy to combat COVID-19
In terms of what is likely more available to you, there are several reasons to choose eucalyptus over popular alternatives:
Immune-modifying and antimicrobial effects of Eucalyptus oil and simple inhalation devices
For the sake of being methodical, here’s an example product on Amazon, though we’re sure you’d have no trouble finding this in your local pharmacy if you prefer.
Take care!
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