Q&A: nurse practitioners for primary care; zinc; intermittent fasting; & osteopenia
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ICYMI 👉
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Paid subscribers can submit their questions for me to answer live, right here!
In this week’s reader-submitted Q&A, we’re tackling these questions:
Is it okay to see a nurse practitioner as my primary care provider?
Are there benefits to taking zinc?
Is dizziness with intermittent fasting a cause for concern?
How should I treat my osteopenia?
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The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: NURSE PRACTITIONERS FOR PRIMARY CARE
I am Paula. Soon to be 62 years old. Retired elementary school psychologist. I'm concerned about seeing a nurse practitioner at my age. I have IBS, anxiety, migraines, spinal stenosis and severe scoliosis, mostly managed with meds and some exercise. Even when I signed up with a doctor under my PPO I had to wait much longer to see the doctor than if I saw one of the NPs in the group. I feel like they could miss stuff. Am I wrong? Am I doing myself a disservice? Thanks! I love your Q&As.
Hi Paula,
I think nurse practitioners are terrific. To me, the key isn’t so much the letters after someone’s name—MD, NP, PA—as it is how they approach patient care. What I care most about in a primary care provider are their abilities to think critically; to integrate evidence-based medicine with the unique needs of the person in front of them; and to view the patient not as a set of problems to fix, but as a whole person.
Any good provider—regardless of title—understands that care is collaborative and that a healthy patient/provider relationship is crucial. They adhere to the highest standards of care and understand the limitations of their knowledge and expertise. They know when to manage something themselves and when to loop in another member of the team. They’re not afraid to say “I don’t know,” and they don’t let ego get in the way of good care. They also aren’t afraid to have hard conversations.
So no, seeing an NP you work well with and who understands your health needs isn’t a disservice. In fact, it can be a real advantage. NPs often spend more time with patients, take a holistic view, and excel at communication. The real question is: Do you feel seen, heard, and helped? If the answer is yes, you’re likely in good hands.
QUESTION #2: ZINC BENEFITS
I have been taking zinc since beginning of COVID. Should I continue this? Any downside?
-Veronica
Dear Veronica,
Zinc is essential for immune cell function and wound healing, and some people take it to prevent or shorten the duration of colds and other viral illnesses. But if you’re eating a balanced diet with zinc-rich foods—like meat, shellfish, legumes, seeds, and whole grains—you probably don’t need a daily supplement. If you still want to take zinc occasionally during cold and flu season, that’s reasonable, but long-term daily use at high doses isn’t usually necessary for most healthy people.
The recommended daily allowance for zinc is around 8 mg for women and 11 mg for men. Many over-the-counter supplements contain much more—sometimes 30 mg or more per dose. While short-term use of higher doses (like during an illness) is generally safe, consistently taking more than 40 mg per day over time can lead to problems. High zinc intake can interfere with the absorption of other important minerals like copper and iron, potentially leading to deficiencies. It can also sometimes cause nausea or digestive upset.
In general I don’t recommend zinc supplements to my patients unless there is a specific medical reason (such as veganism or malnourishment). If you’re unsure about taking zinc, be sure to check in with your doctor!
QUESTION #3: DIZZINESS WITH INTERMITTENT FASTING
I’ve started skipping breakfast and doing 16:8 intermittent fasting because I heard it helps with focus and longevity. But I feel a little dizzy by noon. Should I push through or eat?
-Paul
Hi Paul,
Intermittent fasting, especially the 16:8 approach (fasting for 16 hours and eating during an 8-hour window), has gained popularity for its potential benefits on metabolism, focus, and even longevity. But it’s not one-size-fits-all, and feeling dizzy by noon is your body’s way of signaling that something might be off.
If you’re feeling lightheaded, shaky, or overly fatigued, it’s usually better to listen to your body than to push through. Dizziness could be a sign that your blood sugar or blood pressure is dropping too low, that you're dehydrated, or that your energy needs are not being met.
I find that many of my patients who try intermittent fasting report feeling irritable, inattentive, or “hangry”—ultimately making this type of routine difficult to adhere to. Additionally, restrictive eating behaviors are never a good idea for people with disordered eating or anxiety.
Still, some people thrive with fasting, while others may need to modify it. You might try a gentler version—like 14:10 fasting—or incorporate a small, balanced breakfast with protein and healthy fats to stabilize your energy levels. Fasting doesn't have to mean skipping meals altogether; it can simply mean being more mindful about when and what you eat.
Also consider the quality of your meals during your eating window. Are you getting enough protein, fiber, and healthy fats to keep your blood sugar stable and your energy up? If not, adjusting your food choices could help reduce that midday crash.
Ultimately, the best eating pattern is one that supports your body, brain, and lifestyle without leaving you feeling depleted. Fasting is a tool, not a rule—and it's okay if it’s not the right fit for you!
QUESTION #4: TREATING OSTEOPENIA
I was just diagnosed with osteopenia after a DEXA scan. My doctor suggested starting a bisphosphonate, but I’ve heard those medications can cause fractures in the long run. Should I be concerned about side effects, or are the benefits worth it?
-Karen
Hi Karen,
Being diagnosed with osteopenia means your bone density is lower than normal but not yet in the osteoporosis range. In general, bisphosphonate medications such as alendronate (Fosamax) or risedronate (Actonel) are reserved for osteoporosis. But the decision to take a medication like this depends on several factors, including your overall fracture risk, family history, and lifestyle.
What do bisphosphonates do? They help prevent bone loss and reduce the risk of fractures. They have been shown to be effective and are the first-line pharmacological treatment for osteoporosis, however it’s common (and understandable) to have concerns about long-term side effects. The most talked-about risks—atypical femur fractures and osteonecrosis of the jaw—are extremely rare and tend to occur in people who have been on these medications for many years, often longer than the typical five-year treatment course.
Your doctor likely recommended the medication because DEXA results alone don’t tell the whole story. Factors such as prior fractures, family history, and your FRAX score (which estimates your 10-year fracture risk) help guide treatment decisions. If your fracture risk is high, the benefits of medication likely outweigh the risks.
If you’re hesitant, you might discuss trying lifestyle changes first, including weight-bearing exercise, strength training, adequate calcium and vitamin D intake, and avoiding smoking and excessive alcohol. Some people with mild osteopenia opt for periodic DEXA scans to monitor changes before starting medication.
Ultimately, the decision should be based on your individual risk factors and comfort level. If you’re unsure, asking your doctor about your specific fracture risk and whether a “watch-and-wait” approach with lifestyle modifications could be a safe alternative for now might help guide your choice. I hope that helps!
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
Thank you so much for the information regarding zinc supplements. I will discontinue use. So comforting to know that you are out there answering everyone’s questions. You are the best.
I have had the same Primary Care nurse for over 20 years at the VA. I could discuss anything with her. Professional and easy to talk to.
Now she is retiring and am worried about what comes next with lay offs at the VA. Never worried with her there.