The Grumpy Doc

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Keeping Things Moving: Bowel Health for Seniors

By

On May 11, 2026

In Medicine

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Introduction

Let’s talk about something that affects nearly a third of all older adults but rarely makes it into polite dinner conversation: bowel movements. Specifically, how often should you be having them, what happens when you don’t, and what can you do about it. This isn’t exactly cocktail party material, but it matters, a lot, for your comfort, your health, and your overall quality of life.

Constipation is extraordinarily common in people over 60. Some estimates put the rate of chronic constipation as high as 30% in community-dwelling older adults, and it climbs up to 50% among nursing home residents. Yet it remains under-discussed, under-treated, and frequently dismissed as just a normal part of getting older. Spoiler alert: it isn’t.

What Is a “Normal” Bowel Movement Schedule for Seniors?

Here’s a liberating fact: there is no single right answer to how often you should go. The notion that everyone should have a bowel movement every day is a myth. The accepted medical range for normal stool frequency is anywhere from three times a day to three times a week. If you’re comfortable, there’s no straining, and nothing has dramatically changed from your usual pattern, you’re probably fine.

For most seniors, having a bowel movement once a day to three times a week falls within the typical range. The key phrase here is “typical for you.” What matters clinically is consistency and comfort, not hitting some magic daily number.

A large National Health Interview Survey of over 42,000 participants found something that surprises many people: infrequent bowel movements don’t automatically increase with age the way conventional wisdom has long assumed. As the researchers noted in the Annals of Internal Medicine, a decline in bowel movement frequency is “not an invariable concomitant of aging.”

So what does change with age? The colon can slow its transit time — the speed at which food waste travels from one end to the other. Muscle tone in the abdomen and pelvic floor may decrease. Nerve sensitivity in the rectum can diminish, meaning you may not feel the urge to go as acutely as you once did. Add reduced physical activity, inadequate fluid intake, and a roster of medications, and you have a recipe for sluggishness down below.

Harvard Health recommends paying attention to any dramatic departure from what’s normal for you. If you typically go once a day and suddenly you’re going once a week without an obvious explanation like a change in diet or travel, that’s worth discussing with your doctor. Especially if it comes with fatigue, pain, unintentional weight loss, blood in the stool, or a change in consistency.

The Downside of Infrequent Bowel Movements

Constipation might seem like just an inconvenience, but when it becomes chronic or severe, the consequences can be surprisingly serious. Here’s a rundown of what can go wrong.

Fecal Impaction

The most dangerous complication of untreated chronic constipation is fecal impaction — when hardened stool becomes lodged in the colon or rectum and simply cannot pass. This is a genuine medical emergency. In the UK, fecal impaction has been identified in about 40% of hospitalized older patients. What makes it particularly tricky is that it can masquerade as diarrhea: liquid stool from above the blockage leaks around the impaction, creating what’s called overflow incontinence. If left untreated, impaction can cause intestinal obstruction, ulceration of the bowel wall, and even perforation and these can be life-threatening.

Hemorrhoids and Anal Fissures

Chronic straining on the toilet puts enormous pressure on the veins around the rectum, which can produce hemorrhoids — swollen, painful, and sometimes bleeding. Hard stools can also cause small tears called anal fissures, which are painful and can bleed with each bowel movement. These aren’t just uncomfortable; they can signal that something needs to change.

Quality of Life

Don’t underestimate how much chronic constipation chips away at daily life. Studies using validated quality-of-life instruments have consistently found that constipated older adults score lower on measures of physical functioning, mental health, general health perception, and management of bodily pain. Some studies even found improvements in mood and depression once constipation was successfully treated. This is not a trivial problem.

Confusion and Cognitive Effects

In older adults, particularly those with dementia, unresolved constipation can contribute to confusion, agitation, and behavioral changes. Clinicians who work in geriatrics are trained to consider constipation when an older patient with cognitive impairment suddenly becomes more agitated or confused. It’s one of those connections that surprises non-clinicians but is well recognized in eldercare.

A Note on Red Flags

It bears repeating, new, unexplained constipation, especially in an older adult who hasn’t had it before, deserves medical evaluation. Colon cancer, among other serious conditions, can present as a change in bowel habits. Blood in the stool, unexplained weight loss, iron-deficiency anemia, or a family history of colorectal cancer are all signals to see your doctor promptly rather than reaching for a laxative.

Non-Pharmacological Approaches

Good news: there’s a lot you can do before opening the medicine cabinet. Lifestyle measures are always considered first-line therapy, and for many people, they’re enough.

Fiber Intake

Dietary fiber is the single most important nutritional factor in maintaining regular bowel movements. Fiber adds bulk to stool and helps it move through the colon more efficiently. Whole grains, fresh fruits, vegetables, legumes, dried fruits like prunes, figs, and apricots are all solid choices. Prune juice, in particular, contains sorbitol, a natural sugar that acts as a mild laxative (but I have to admit, it’s not my favorite). Some healthcare providers recommend a simple homemade mixture of equal parts prune juice, chopped prunes, applesauce, and wheat bran, starting with one tablespoon a day and working up to four (again, not my go-to breakfast).

One caution: add fiber gradually. Ramping up too fast can cause bloating and gas, which discourages people from sticking with it. Slow and steady works better here.

Hydration

Without adequate fluid, stool dries out and becomes harder to pass. Mayo Clinic recommends 8 to 10 eight-ounce glasses of non-caffeinated fluids daily. This is especially important if you’re taking a fiber supplement, which needs water to do its job properly. Admittedly, this can be a real challenge for some people.

Physical Activity

Exercise stimulates the gut. Even light walking helps move things along, and the CDC recommends that seniors aim for about 30 minutes of cardiovascular exercise on most days, with a mix of muscle and bone-strengthening activities. The Nurses’ Health Study, which followed over 62,000 women, found that physical activity two to six times per week was associated with a 35% lower risk of constipation.

Scheduled Toileting

Taking advantage of the body’s natural gastrocolic reflex — the wave of colonic contractions triggered by eating — is a simple but effective strategy. Sitting on the toilet 15 to 30 minutes after a meal, particularly breakfast, can help train the bowel to move on a regular schedule. This is one of the most underutilized, zero-cost interventions in geriatric care.

Toilet Positioning

A simple footstool placed under the feet while on the toilet can make a meaningful difference. Raising the knees above hip level — mimicking a squatting position — straightens the angle between the rectum and the anus, making stool easier to pass. Some patients find this makes a real difference in comfort and completeness of evacuation.

Privacy and Routine

This one sounds almost too simple, but it matters: many older adults, particularly those in assisted living or with mobility limitations, feel rushed, embarrassed, or lack adequate privacy when trying to have a bowel movement. Stress and anxiety directly suppress gut motility. Ensuring that someone has enough time, privacy, and a comfortable setting is a legitimate therapeutic intervention, especially in care facility settings.

Biofeedback Therapy

For seniors whose constipation stems from difficulty coordinating the pelvic floor muscles — a condition called dyssynergic defecation — biofeedback therapy can be a game-changer. It uses electronic sensors and visual or auditory feedback to help patients learn to relax the correct muscles during a bowel movement. It’s non-invasive, has no side effects, and is particularly well-suited for people whose constipation hasn’t responded to diet and laxatives.

Pharmacological Approaches

When lifestyle changes aren’t enough and sometimes, they’re not, a range of medications are available, from gentle over-the-counter options to prescription treatments for stubborn cases. Here’s how they generally stack up, from mildest to strongest.

Fiber Supplements (Bulk-Forming Agents)

Products like psyllium (Metamucil), methylcellulose (Citrucel), and polycarbophil (FiberCon) work by absorbing water and adding bulk to stool, making it easier to pass. They’re generally safe for long-term use and are typically the first pharmaceutical step. The key is taking them with plenty of water; without adequate fluid, they can worsen constipation.

Stool Softeners

Docusate sodium (Colace) works by allowing water and fats to penetrate the stool, making it softer and easier to pass. It’s commonly used in post-surgical patients or anyone who needs to avoid straining — for example, after a heart attack or hemorrhoid surgery. It’s gentle and generally well tolerated, though evidence for its effectiveness as a standalone constipation treatment is modest.

Osmotic Laxatives

Polyethylene glycol — sold as MiraLAX — is widely considered the preferred osmotic laxative for older adults. It works by drawing water into the colon, softening the stool and stimulating movement. It’s tasteless, mixes easily into beverages, and has a favorable safety profile compared to alternatives like lactulose (which can cause bloating and gas) or magnesium-based products (which should be used cautiously in people with kidney disease). Daily use of PEG is considered safe and is quite common in geriatric practice. This is my personal option.

Milk of Magnesia (magnesium hydroxide) is another osmotic option that works well for many people, but should be used cautiously in anyone with impaired kidney function, as magnesium can accumulate and cause toxicity.

Stimulant Laxatives

Bisacodyl (Dulcolax) and senna (Senokot) work by stimulating nerve endings in the colon wall, triggering muscle contractions that push stool along. They’re effective but generally recommended for short-term use rather than daily reliance, due to concerns about dependency and potential effects on colon muscle function over time — though evidence on long-term harm is less alarming than once believed.

Suppositories and Enemas

For more immediate relief — or when oral treatments haven’t worked — glycerin or bisacodyl suppositories can sometimes trigger a bowel movement within minutes. Warm water or mineral oil enemas are typically reserved for fecal impaction. These are short-term rescue measures rather than ongoing management tools and should only be used with medical supervision.

Prescription Medications

For seniors with chronic constipation that doesn’t respond to over-the-counter options, several prescription medications have been approved. Linaclotide (Linzess) increases intestinal fluid secretion and gut motility; studies have included patients up to age 86 and demonstrated increased bowel movement frequency. Lubiprostone (Amitiza) works similarly. For patients on opioid pain medications whose constipation is directly caused by those drugs, a class of medications called peripherally acting mu-opioid antagonists — including methylnaltrexone (Relistor) and naloxegol (Movantik) — can counteract the constipating effects of opioids without reducing their pain-relieving benefits.

A Note on Medications That Cause Constipation

It’s worth pausing here to note that many medications commonly prescribed to older adults are themselves a major cause of constipation. Opioid pain medications are the biggest culprits, but the list also includes calcium channel blockers (used for blood pressure and heart conditions), certain antidepressants, antipsychotics, antihistamines, iron supplements, and some antihypertensives. If constipation is a new or worsening problem, a medication review with your doctor is one of the most productive first steps.

The Bottom Line (Sorry about the pun)

Bowel health in older adults is more nuanced than many people realize. “Normal” varies from person to person, and the goal isn’t to hit a daily number on a checklist — it’s to maintain whatever is comfortable and consistent for you, without pain or straining. When that starts to slip, you should take it seriously rather than dismissing it as just part of getting older.

The hierarchy of treatment is straightforward: start with lifestyle — fiber, fluids, exercise, and toileting routine. If that’s not enough, move to gentle over-the-counter options like fiber supplements and MiraLAX. If those don’t work, a physician can guide more targeted approaches, including prescription medications or biofeedback therapy.

And always, always tell your doctor about changes in your bowel habits — especially if they come with blood, pain, or weight loss. Your gut has a lot to say, and it’s worth listening.

Illustration generated by author using ChatGPT.

Sources

·  PubMed / Annals of Internal Medicine — Bowel habit in relation to age and gender (National Health Interview Survey, 42,375 subjects) https://pubmed.ncbi.nlm.nih.gov/8572842/

·  Mayo Clinic Community Health — Bowel habits as you age https://communityhealth.mayoclinic.org/featured-stories/bowel-habits-aging

·  Harvard Health — Staying Regular https://www.health.harvard.edu/healthy-aging-and-longevity/staying-regular

·  National Institute on Aging (NIH) — Concerned About Constipation? https://www.nia.nih.gov/health/constipation/concerned-about-constipation

·  PubMed Central — Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management https://pmc.ncbi.nlm.nih.gov/articles/PMC7272371/

·  PubMed Central — Update on the Management of Constipation in the Elderly: New Treatment Options https://pmc.ncbi.nlm.nih.gov/articles/PMC2920196/

·  PubMed Central — Constipation in Older Adults: Stepwise Approach to Keep Things Moving https://pmc.ncbi.nlm.nih.gov/articles/PMC4325863/

·  HealthInAging.org — Caregiver Guide: Constipation Problems https://www.healthinaging.org/tools-and-tips/caregiver-guide-constipation-problems

·  American Academy of Family Physicians (AAFP) — Management of Constipation in Older Adults (2015) https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html

·  American Academy of Family Physicians (AAFP) — Treatment of Constipation in Older Adults (2005) https://www.aafp.org/pubs/afp/issues/2005/1201/p2277.html

·  Better Health While Aging — Constipation Treatment & Best Laxatives in Aging https://betterhealthwhileaging.net/how-to-prevent-and-treat-constipation-aging/

·  Medical Daily — Chronic Constipation in Seniors: Complete Guide to Causes, Risks, and Safe Treatment Options https://www.medicaldaily.com/chronic-constipation-seniors-complete-guide-causes-risks-safe-treatment-options-474499

Illustration generated by author using ChatGPT

Medical Disclaimer

The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.

If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.

Benjamin Franklin and Slavery: A Complicated Legacy

By

On May 7, 2026

In History, Politics


 
Few figures in American history are as celebrated — or as contradictory — as Benjamin Franklin. Founding Father, inventor, diplomat, and philosopher. Franklin is remembered for just about everything except the uncomfortable truth that he was also, for much of his life, a slave owner. His relationship with slavery is a study in the slow, painful moral evolution of a brilliant but flawed man — one who spent decades benefiting from the institution he would spend his final years fighting to abolish.
The Slaveowner
Franklin was a slave owner beginning around 1735, and he owned enslaved people until at least 1785 when he freed two slaves after his return from France.  Over the course of his life, there were up to seven named slaves in the Franklin household, including Peter, his wife Jemima, their son Othello, and George, John, and King.
Franklin’s complicity in slavery extended beyond personal ownership. As editor of the Pennsylvania Gazette, Franklin benefited financially from advertisements for runaway slaves and slave auctions that were paid for by slave owners and traders.  He also used his printing press to publish content that supported the slave trade and, as a British colonial agent, sought to have the British government accept Georgia’s slave code.  In short, slavery wasn’t just a private matter for Franklin — it was woven into his professional and financial life.  At the same time, he printed Quaker antislavery tracts, a sign that his professional role placed him at the intersection of both pro‑slavery commerce and early antislavery movements.
What little we know about how Franklin treated his enslaved people comes mostly from letters and financial records.  In part this is because northern slaveholders kept fewer detailed records of slave families, births, and deaths than large southern planters. His enslaved servants lived within his household and were integrated into domestic routines, a common arrangement in urban slavery that still left them legally and socially unfree.
When Franklin traveled to London in 1757, he brought two enslaved men, Peter and King, who lived and worked at 36 Craven Street. Peter remained with Franklin until their departure in 1762, but King ran away sometime in 1758 and was later found living in Suffolk, having been taken in by a Christian woman who taught him to read and write.  The fact that King fled at the first opportunity tells its own story about the nature of slavery, whatever Franklin’s personal demeanor may have been.
His Evolving Written Views
Franklin’s early writings on slavery were at best ambivalent and at worst openly racist. In his 1751 essay “Observations Concerning the Increase of Mankind,” Franklin argued that slave labor wasn’t economically efficient in part because enslaved people pilfered from their owners, writing that “almost every Slave [being] by Nature a Thief.”  His concern about slavery in this period was largely economic rather than moral — he worried that it would hurt poor white laborers and enriched a wealthy elite, not that it was a profound violation of human dignity.
By the 1760s, something began to shift. His perspective began to change following a 1759 visit arranged by his friend Samuel Johnson to one of Dr. Bray’s schools for Black children. He also met Anthony Benezet, who had started a school in Philadelphia and would later co-found the Abolition Society. By 1763, Franklin wrote that African “shortcomings” were not inherent but came from lack of education, slavery, and negative environments — and that he saw no difference in learning ability between African and white children.   
While in London in the 1760s, he supported black education projects and in 1770 anonymously published “Conversations between an Englishman, a Scotchman, and an American,” a piece that criticized both the slave trade and the broader institution. In 1782 he circulated “A Thought Concerning the Sugar Islands,” condemning the African wars that fed the trade, the horrors of the Middle Passage, and the “numbers that die under the severities of slavery,” arguing that even sugar was morally tainted by blood.
By the late 1780s, Franklin’s language had become openly abolitionist. In 1787 he signed a public antislavery appeal declaring that the Creator had made “of one flesh, all the children of men,” and in 1789–1790 he wrote essays insisting that slavery was an “atrocious debasement of human nature.” He also argued that formerly enslaved people needed education, moral instruction, and employment to make the transition from bondage to full participation in civil society.
This was a meaningful intellectual leap for the era. Franklin was moving from a view of enslaved people as economic units toward recognizing their common humanity and the role that oppression itself played in creating the inequalities he had previously attributed to nature.
Franklin the Constitutional Convention and the Three-Fifths Compromise
By the time of the 1787 Constitutional Convention in Philadelphia, Franklin. then 81 years old, was a delegate from Pennsylvania. The Three-Fifths Compromise — which counted enslaved people as three-fifths of a person for purposes of congressional representation and taxation — was one of the most contentious issues at the Convention. The compromise was formally proposed by delegate James Wilson and seconded by Charles Pinckney.
Franklin’s specific role in the Three-Fifths Compromise itself is limited. His more direct contribution to the Convention’s structural debates was to the Great Compromise about proportional representation and spending rather than the slavery count.
Notably, just weeks before the Convention began, Franklin signed a public antislavery appeal stating that “the Creator of the world” had made “of one flesh, all the children of men.”  Yet he ultimately signed a Constitution that embedded protections for slavery, including the Three-Fifths Compromise and a provision preventing Congress from banning the slave trade until 1808. Franklin’s acquiescence reflected his broader pragmatic calculation, shared by many Northern founders, that preserving the Union required compromise with the slaveholding South, even at a terrible moral cost. This is partly speculative — Franklin left few direct written statements about his reasoning on this specific tradeoff at the Convention.  
The Abolitionist
Whatever compromises Franklin made at Philadelphia, the years that followed saw him embrace abolitionism with increasing conviction and urgency. In 1787, he began serving as President of the Pennsylvania Society for Promoting the Abolition of Slavery  — the oldest abolitionist organization in the country — which had originally formed in 1775 and was reorganized and incorporated by Pennsylvania in 1789.
In 1789, Franklin wrote and published several essays supporting abolition, including a public address dated November 9th of that year in which he called slavery an “atrocious debasement of human nature.”  He called for practical support for emancipated people, including education and employment — ideas that were radical for the time and would remain largely unaddressed for generations.
His final public act was perhaps his most consequential. On February 3, 1790, Franklin signed a petition to the first Congress on behalf of the Abolition Society, asking lawmakers to “devise means for removing the Inconsistency from the Character of the American People” and to “promote mercy and justice toward this distressed Race.”  The petition was immediately denounced by pro-slavery congressmen and referred to a committee, which ultimately concluded that the Constitution prevented Congress from acting on the matter until 1808.
Franklin died in April 1790, just weeks after these debates, leaving a legacy that combined early complicity in slavery with later, forceful advocacy for abolition and Black education. As part of his will, he directed all remaining enslaved people in his household be freed upon his death, although it is unclear if he still owned slaves at the time and this may have been a symbolic declaration that he hoped others would follow.  His life illustrates both the pervasiveness of slavery in colonial America — even among its most famous reformers — and the possibility, however belated, of moral and political transformation on the issue.
 What to Make of It All
Franklin’s association with slavery resists easy conclusions. He spent roughly four and a half decades owning enslaved people, profiting from the slave trade through his newspaper, and diplomatically defending slavery when it served colonial interests. His evolution toward abolitionism was real, but it was also late — and driven partly by visits to schools for Black children and Quaker friendships rather than a spontaneous moral awakening.
At the same time, his final years represent one of the most prominent Founding Fathers publicly and passionately challenging the institution while other contemporaries remained silent or actively defended it. As historian David Waldstreicher has cautioned, Franklin’s antislavery credentials have sometimes been “remembered backwards” and exaggerated  — but that doesn’t mean the later evolution wasn’t genuine.
What Franklin’s story offers isn’t a story of redemption so much as a realistic portrait of moral growth under the weight of self-interest, social norms, and political pragmatism. He was, as one observer put it, a man who showed himself to be “thoughtful, open, teachable” — eventually. The tragedy is how long it took, how few followed his lead, and how much damage was done in the meantime.
 
Illustration generated by author using ChatGPT.

Sources:
                Benjamin Franklin House – Franklin and Slavery
https://benjaminfranklinhouse.org/education/benjamin-franklin-and-slavery/
 
                Benjamin Franklin House – The Philadelphia Household 1735–1790
https://benjaminfranklinhouse.org/franklin-and-slavery-the-philadelphia-household-1735-1790/
 
                Online Library of Liberty – Benjamin Franklin and Slavery, Part One
https://oll.libertyfund.org/publications/reading-room/2023-07-05-ealy-franklin-slavery-part-one
 
                Benjamin Franklin Historical Society – Slavery and the Abolition Society
http://www.benjamin-franklin-history.org/slavery-abolition-society/
 
                National Archives – Benjamin Franklin’s Anti-Slavery Petitions to Congress
https://www.archives.gov/legislative/features/franklin
 
                Penn & Slavery Project – Benjamin Franklin
https://pennandslaveryproject.archives.upenn.edu/2025/07/09/benjamin-franklin/
 
                Commonplace: The Journal of Early American Life – Benjamin Franklin, Slavery, and the Founders
https://commonplace.online/article/benjamin-franklin-slavery/
 
                U.S. History – Ben Franklin and the Vexing Question of Race in America
https://www.ushistory.org/franklin/essays/franklin_race.htm
 
                Wikipedia – Benjamin Franklin
https://en.wikipedia.org/wiki/Benjamin_Franklin
 
                Wikipedia – Three-Fifths Compromise
https://en.wikipedia.org/wiki/Three-fifths_Compromise
 
                Britannica – Three-Fifths Compromise
https://www.britannica.com/topic/three-fifths-compromise
 
                U.S. Senate – Equal State Representation and the Great Compromise
https://www.senate.gov/about/origins-foundations/senate-and-constitution/equal-state-representation.htm
 
                Wikipedia – Connecticut Compromise
https://en.wikipedia.org/wiki/Connecticut_Compromise
 
                Teaching American History – The Constitutional Convention: The Three-Fifths Clause
https://teachingamericanhistory.org/document/the-constitutional-convention-the-three-fifths-clause/​​​​​​​​​​​​​​​​
 

Cold Plunging: Real Physiology, Real Risks, and a Whole Lot of Hype

By

On May 4, 2026

In Medicine

Cold plunge tubs are popping up everywhere — gyms, spas, suburban backyards, and increasingly in high-end wellness retreats. Influencers post videos of themselves lowering into icy water with overly dramatic grimaces. Podcasters talk enthusiastically about dopamine surges and mental clarity. Biohackers track immersion times with the seriousness of laboratory researchers.

I have always been skeptical of what I call “fad medicine,” but cold plunging has become so widespread that it warrants a closer, more careful look. The question most people want answered is a simple one: is any of this real, is it at least minimally beneficial,  or is it just expensive discomfort dressed up in scientific language?

The most honest answer is that it is a mix of all three. Some of the claims are grounded in solid physiology. Some are intriguing but still preliminary. And some have clearly outpaced the available evidence.

Cold-water immersion, often abbreviated as CWI, does have some legitimate scientific literature behind it. That said, the body of research is smaller, more recent, and less definitive than popular wellness culture would suggest. What follows is an attempt to separate what is known from what is plausible, what remains largely speculative, and what may be downright dangerous.

Long before cold plunging became a modern wellness trend, it existed as a long-standing human practice. References to cold water therapy appear in Egyptian medical texts dating back several thousand years. The Greek physician Hippocrates recommended cold water for pain relief and fatigue. Even Thomas Jefferson was said to have soaked his feet in cold water every morning for decades, believing it contributed to his health. The practice itself is not new but the attempt to study it systematically is.

For much of modern medical history, research on cold exposure focused primarily on its dangers—hypothermia, cardiac stress, and survival in extreme environments. Only in recent years has attention shifted toward possible benefits, driven largely by the explosion of public interest and researchers have acknowledged that the science is still catching up.

When it comes to physical effects, the strongest evidence relates to muscle recovery. Cold-water immersion has been shown to reduce soreness following intense exercise. The mechanism is relatively well understood. Exposure to cold causes blood vessels to constrict, which limits swelling and reduces inflammatory signaling. When normal circulation returns, metabolic byproducts are cleared more efficiently from muscle tissue. This is why athletes have relied on ice baths for decades.

However, this benefit comes with an important caveat. The same processes that reduce inflammation may also interfere with the body’s ability to adapt to strength training. Some studies suggest that regular cold exposure immediately after resistance exercise can blunt the molecular signals responsible for muscle growth. In practical terms, what helps you feel better in the short term may limit gains over the long term. For endurance athletes, this effect appears less pronounced, but for individuals focused on building strength and muscle mass, it is a meaningful consideration.

Cold exposure also has immediate and dramatic effects on the cardiovascular system. Immersion in cold water triggers what is often referred to as the “cold shock” response. Heart rate increases rapidly, blood pressure rises, and blood vessels in the skin constrict sharply, redirecting blood toward the body’s core. This is a powerful physiological stressor. Interestingly, once the body begins to recover, there is often a shift toward increased parasympathetic activity — the branch of the nervous system associated with rest and recovery. This shift is sometimes reflected in improved heart rate variability, a marker that correlates with cardiovascular resilience.

Observational studies of habitual cold-water swimmers suggest improvements in certain cardiovascular risk markers, including lipid profiles and oxidative stress. At the same time, it is important to recognize that even in well-adapted individuals, cold immersion still increases cardiac workload. The potential benefits and risks are not separate; they occur simultaneously. Whether long-term adaptation outweighs repeated short-term stress is still an open question.

Another frequently discussed area involves metabolism, particularly the activation of brown adipose tissue, or “brown fat.” Unlike white fat, which stores energy, brown fat burns energy to generate heat. Cold exposure stimulates this process, and some studies suggest it may improve insulin sensitivity and metabolic efficiency. A 2024 review published in GeroScience highlighted the possibility that cold exposure could reduce cardiometabolic risk. However, most of these studies are small and conducted under controlled conditions that may not reflect real-world behavior. While the findings are promising, they are not yet strong enough to support broad clinical recommendations.

More recently, researchers have begun exploring cellular-level effects. A 2025 study from the University of Ottawa found that repeated cold exposure influenced processes such as autophagy and apoptosis, which are involved in cellular repair and turnover. These mechanisms are often associated with aging and longevity. While the findings are intriguing, they were observed in a limited population and over a short time frame. At this stage, they represent an interesting possibility rather than a definitive conclusion.

The mental and emotional effects of cold plunging are perhaps the most widely discussed and the least clearly understood. Cold exposure triggers a surge in neurotransmitters, particularly norepinephrine and dopamine. These chemicals are associated with alertness, focus, and the experience of reward. Many individuals report feeling energized, clear-headed, and even euphoric after a cold plunge.

The key question, however, is whether these short-term effects translate into lasting improvements in mental health. Current evidence suggests that while immediate mood elevation is real, long-term benefits are less certain. Systematic reviews have found that the evidence for sustained reductions in anxiety or depression is inconclusive. It is also worth noting that some of the perceived benefit may reflect a placebo effect, which, while real, complicates interpretation.

There is somewhat stronger evidence supporting short-term stress reduction. Cold exposure acts as a controlled stressor, forcing the body to adapt. This concept, known as hormesis, suggests that small, manageable stressors can enhance resilience over time. Some studies have found that cold-water immersion is associated with reduced stress levels, improved sleep, and enhanced subjective well-being for several hours following exposure. However, these effects appear to be time-limited, and it is not yet clear whether they accumulate in a meaningful way over longer periods.

Claims regarding immune function are among the most popular and the least substantiated. A frequently cited study reported that individuals who took cold showers experienced fewer sick days. However, cold showers are not the same as full immersion, and reduced absenteeism is not a direct measure of immune performance. Studies examining cold-water immersion have produced inconsistent results. Some show changes in immune markers, while others do not. Most focus on laboratory measurements rather than actual illness outcomes. At present, the evidence for immune enhancement remains inconclusive.

For older adults, the picture becomes more complex. Aging affects the body’s ability to regulate temperature. The capacity to generate heat declines, sensitivity to cold may be reduced, and chronic conditions or medications can further impair thermoregulation. What might be an invigorating experience for a younger individual can pose a genuine risk for someone in their later decades.

This does not mean cold exposure is entirely off the table, but it does mean the approach must be modified. Milder temperatures, shorter durations, and greater caution are essential.  The margin for error is smaller, and symptoms such as dizziness, confusion, or irregular heartbeat may be delayed. The risk-benefit balance shifts noticeably with age.

There are also groups for whom cold plunging is best avoided altogether. Individuals with cardiovascular disease, particularly those with arrhythmias or a history of heart attack, face increased risk due to the sudden cardiovascular stress. People with peripheral vascular disease or Raynaud’s phenomenon may experience harmful levels of vasoconstriction. Those with diabetes and neuropathy may have impaired sensation and circulation, increasing the risk of injury. Individuals with respiratory conditions such as severe asthma may be vulnerable to cold-induced bronchospasm. Additional caution applies to those with rare conditions such as cold urticaria or cryoglobulinemia, as well as anyone recovering from recent surgery.

It is important to acknowledge what the evidence does not support. Claims that cold plunging significantly slows aging are not backed by clinical data. The idea that it produces long-term immune enhancement remains unproven. Even the metabolic benefits, while biologically plausible, appear modest and context-dependent.

Another challenge is the lack of standardization in the research itself. Studies vary widely in water temperature, duration of exposure, frequency, and participant characteristics. This makes it difficult to compare results or draw firm conclusions. In many cases, researchers are effectively studying different interventions under the same label.

The bottom line is that cold plunging is neither a miracle cure nor pure nonsense. It produces real physiological effects, some of which are beneficial, particularly in the context of athletic recovery. For healthy individuals, it may offer short-term improvements in mood, stress, and perceived well-being. At the same time, its long-term benefits remain uncertain, and its risks are not trivial for certain populations.

For those who are curious and in good health, a gradual and cautious approach may be reasonable. Starting with cool water and progressing slowly allows the body to adapt while minimizing risk. A visit with a physician is still advised before starting any new regimen.

 For individuals with underlying medical conditions, particularly cardiovascular disease, the prudent course is to consult a physician before attempting any cold water immersion.

Cold plunging clearly does something. The challenge is that we are still in the early stages of understanding exactly what that “something” is, how durable it may be, and for whom it is most appropriate. In medicine, that places it in a familiar category—an intervention that is interesting, potentially useful, possibly harmful in some cases, but not yet fully defined.

Illustration generated by author using ChatGPT.

Sources

1. Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis — PLOS One (2025)

2. Cold-water plunging health benefits — Mayo Clinic Health System (2024)

3. Cold plunges: Healthy or harmful for your heart? — Harvard Health (2025)

4. The untapped potential of cold water therapy for healthy aging — PMC / GeroScience (2024)

5. Health effects of voluntary exposure to cold water — PMC / Int J Circumpolar Health (2022)

6. Cold plunges actually change your cells — ScienceDaily / University of Ottawa (2025)

7. The health benefits (and risks) of cold plunges — Advisory Board (2025)

8. What are the health benefits of a cold plunge? Scientists vet the claims — NPR (2023)

9. The benefits of cold-water immersion therapy — UF Health Jacksonville (2024)

10. Cold and longevity: Can cold exposure counteract aging? — ScienceDirect (2025)

11. Ice bath for seniors: Safety and age-appropriate cold therapy — PlungeChill (2025)

12. What seniors should know before trying a cold plunge — SilverSneakers (2025)

13. Ice baths over 50, according to a geriatrician — Parade (2023)

14. Ice baths and saunas: Are the latest health trends bad for your lungs? — American Lung Association

15. Sauna and cold plunge for seniors 60+: Safe protocols guide 2026 — Calore Health

16. Cold plunge benefits, risks, and who should avoid — Dr. Axe (2024)

Medical Disclaimer

The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.

If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.

“86” — A Little Number With a Big History

By

On May 2, 2026

In Commentary

Fifty some years ago when I was in the Marines, we used the term “86” to refer to something that should be ignored or discarded—in the colorful vernacular of the Corps, “shit canned”. That’s trashed to you civilians.  The Marines have never been known as a peaceable lot and we had many colorful euphemisms for doing grievous bodily harm, but “86” was never among them.

So why is “86” suddenly everywhere in the news? Blame James Comey. The former FBI Director posted a beach photo on Instagram showing seashells arranged to spell out “86 47” — and the internet promptly exploded. Republicans argued it was a death threat against the 47th president. Comey said it simply meant he wanted Trump removed from office. That dispute has brought a piece of century-old American slang back into the spotlight, so it’s worth taking a look at what the term means and where it came from.

The Short Answer

Eighty-six is slang meaning “to throw out,” “to get rid of,” or “to refuse service to.” It most likely comes from 1930s soda-counter slang meaning that an item was sold out. This was part of a broader diner code that included: 13 “the boss is around,” 81 “glass of water,” and 95 “customer left without paying”.  Over the decades it evolved from a kitchen noun into a verb with broader reach, and today it shows up everywhere from restaurant kitchens to Twitter and now worldwide headlines.

The Longer Answer

Here’s the honest answer: nobody knows for certain. Its etymology is unknown, but it seems to have been coined in the 1920s or 1930s. There are many theories about its origin — one article enumerates 18 possibilities, and another suggests there are “about 86 theories about 86.”

While the leading contender is the mundane diner option, there are several other more or less plausible and frequently more colorful options.

The most linguistically grounded explanation is that “86” is simply rhyming slang. The most common theory is that it is rhyming slang for “nix.” That’s the same “nix” meaning to reject or say no.

One of the more colorful stories involves a Prohibition-era speakeasy. Chumley’s, a bar with multiple entrances including one at 86 Bedford Street in New York. The story goes that the bar was supposedly warned by police before raids. Customers were told to “86 it” — meaning leave through the Bedford Street exit while cops came through the other door. It’s a great story, and if it’s not true it should be.

How It Evolved

First appearing in the early 1930s as a noun, it did not take long for the word to broaden its use beyond the realm of the soda counter. In the 1950s the word underwent some functional shift and began to be used as a verb — initially meaning “to refuse to serve a customer,” and later taking on the slightly extended meaning of “to get rid of; to throw out.”

It was quickly adopted and members of the military services who love slang, shortcuts, and inside terminology.  It may just be a coincidence that Article 86 of the U.S. Uniform Code of Military Justice concerns Absence Without Leave, or AWOL.

By the 1970s it had moved well beyond the restaurant world. In the 1972 film The Candidate, a media adviser says to Robert Redford’s character, “OK, now, for starters, we got to cut your hair and eighty-six the sideburns.”

Where It Stands Today

These days, people use “86” when they cancel plans, dump something, or boot someone from a chat. Social media picked it up — Twitter and TikTok users will “86 a trend” or “86 a person” in a heartbeat.

In professional kitchens and bars, it remains “everyday lingo” — one hospitality industry veteran called it “probably the most overused word in hospitality.”

The Comey controversy also resurrected an older, arcane, and darker shade of the term. According to Cassell’s Dictionary of Slang, “to 86” can alternatively mean “to kill, to murder; to execute judicially.” That said, Merriam-Webster notes this use is infrequent, and they do not include this sense due to its relative recency and sparseness of use.

The bottom line is that “86” is one of those wonderfully slippery pieces of American slang that started in a noisy kitchen, picked up mythology along the way, and is now flexible enough to mean anything from “we’re out of the salmon” to a loaded political statement — depending entirely on who’s using it and who’s listening.

Or, perhaps this entire tempest is just the response of one thin skinned man to his pathologic fear of seashells.

Gluten and Your Gut: Celiac Disease, Sensitivity, and the Gluten-Free Craze.

By

On April 30, 2026

In Medicine, Science

Walk down the aisles at any grocery store today and you’ll find bread, crackers, cereals, and pastas proudly stamped “Gluten-Free” — as if gluten were some kind of dietary villain lurking in your morning toast. For the roughly 1% of Americans with celiac disease, avoiding gluten isn’t a lifestyle choice; it’s a medical necessity. But for the much larger slice of the population without any gluten-related disorder, the science tells a more complicated story.

What Is Celiac Disease, and What Causes It?

Celiac disease is an autoimmune disorder — meaning the immune system turns on the body itself. The trigger is gluten, a protein found in wheat, barley, and rye. Gluten fragments interact with an enzyme called tissue transglutaminase in the gut. The immune system mistakes this complex for a threat and attacks it, but in the process, it damages the body’s own intestinal tissue. This is what makes celiac disease an autoimmune condition, rather than a simple food allergy. The immune system mounts an attack, generating antibodies that damage the villi, the tiny finger-like projections lining the small intestine that are responsible for absorbing nutrients. Over time, that damage leads to malabsorption and a cascade of health problems.

The disease has a strong hereditary component — about 7.5% of close relatives of people with celiac disease also have it. Researchers have identified two specific genetic variants, HLA-DQ2 and HLA-DQ8, that are present in virtually all celiac patients. But here’s the catch: about 40% of the general population carry one of these genes, yet most of them never develop celiac disease. That means genes load the gun, but something else pulls the trigger. Environmental factors — gastrointestinal infections, timing of gluten introduction in infancy, and other autoimmune conditions like type 1 diabetes and thyroid disease, surgery, even pregnancy — all appear to play a role. Researchers continue to study why some genetically susceptible individuals develop the disease while others do not.

Symptoms and Diagnosis: A Tricky Puzzle

If you’re picturing someone doubled over with stomach pain after eating a sandwich, that’s one version of celiac disease — but far from the only one. The disease presents in more than 200 documented ways. Classic gut symptoms include abdominal pain, bloating, diarrhea, and foul-smelling stools. But celiac disease can also show up as iron-deficiency anemia, bone loss, infertility, nerve damage, depression, liver enzyme abnormalities, and even a distinctive itchy skin rash called dermatitis herpetiformis. Children may experience stunted growth and delayed puberty. Some people, especially seniors, may have no obvious symptoms at all.

This symptom diversity is part of why diagnosis is so often delayed. Researchers estimate that somewhere between 60–70% of Americans with celiac disease remain undiagnosed.

The path to diagnosis typically starts with a blood test measuring tissue transglutaminase IgA antibodies — a marker the immune system produces in response to gluten. If that test is positive, a gastroenterologist performs an upper endoscopy and takes small tissue samples from the small intestine to look for the telltale villous damage under a microscope. Both tests need to be done while the patient is still eating gluten; going gluten-free first can produce falsely normal results and delay or prevent an accurate diagnosis.

Treatment: One Answer, Lifelong Commitment

There are no medications, no injections, no surgical fixes for celiac disease. The only effective treatment is a strict, lifelong gluten-free diet. And “strict” really does mean strict — even trace amounts of gluten can damage the intestinal lining, sometimes without producing obvious symptoms. Gluten hides in surprising places: commercial soups, sauces, ice cream, hot dogs, medications, dietary supplements, and even some communion wafers. Working with a registered dietitian is strongly recommended.

The good news is that the intestinal lining is remarkably resilient. Once gluten is eliminated, symptoms typically improve within one to two weeks, and mucosal healing generally follows over one to two years. Nutritional deficiencies — commonly iron, folate, calcium, and B vitamins — are addressed with supplements during recovery. A small subset of patients develop “refractory celiac disease,” where the intestine doesn’t heal despite strict dietary adherence; these cases may require corticosteroids and carry a less favorable prognosis.

Prognosis: Life After Diagnosis

Most people with celiac disease who strictly follow a gluten-free diet do very well over the long term. Intestinal architecture normalizes, antibody levels drop, and many of the downstream complications — anemia, bone loss, neurological symptoms — improve or resolve. The earlier the diagnosis is made and the gluten-free diet is initiated, the better the outcome.

One significant concern on the long-term horizon is cancer risk. People with longstanding, untreated celiac disease face a roughly 6–8% elevated risk of lymphoma of the small intestine. There is also a modestly increased risk of other gastrointestinal cancers. The reassuring part: patients who achieve normal intestinal histology on a gluten-free diet appear to have the same lymphoma risk as the general population. Adherence to the diet is, quite literally, protective.

Non-Celiac Gluten Sensitivity: The Gray Zone

Between full-blown celiac disease and perfectly healthy gluten tolerance lies a murkier territory: non-celiac gluten sensitivity (NCGS). People with NCGS experience symptoms similar to celiac disease — bloating, abdominal pain, fatigue, headaches, brain fog — after eating gluten, but their blood tests for celiac antibodies are negative and intestinal biopsies show no structural damage. The condition is real and increasingly recognized, but its biology remains incompletely understood.

Non‑celiac gluten sensitivity does not have a single definitive test. Instead, it is a diagnosis of exclusion. Once all other causes have been excluded, NCGS is what’s left.

Milder Forms of Gluten Intolerance

Not everyone with gluten‑related complaints fits neatly into the categories above. Some people never undergo formal testing but notice a pattern: when they eat bread, pasta, or pastries, they just don’t feel good. When they cut back on those foods, they feel lighter and more energetic.

These milder forms of gluten intolerance can be tricky to interpret. The symptoms overlap with irritable bowel syndrome, lactose intolerance, stress‑related gut issues, and reactions to FODMAPs (fermentable carbohydrates) found in wheat and many other foods. In some cases, it may not be gluten itself causing problems but the overall carbohydrate profile of a highly processed, wheat‑heavy diet. Some scientists suggest renaming the condition “non-celiac wheat sensitivity” to better capture this complexity. Still, for the individual, what matters most is whether changing their diet in a structured way leads to sustained relief.

Wheat allergy is a classic IgE‑mediated food allergy to wheat proteins that can cause hives, wheezing, or even anaphylaxis, and needs to be distinguished from celiac disease and NCGS.  It is treated like other food allergies and is best managed by an allergist. 

The Gluten-Free Craze: Helpful Trend or Expensive Fad?

Here’s where things get interesting — and a little frustrating for nutritional scientists. Surveys suggest that roughly 30% of American adults are actively trying to reduce or eliminate gluten from their diets. A 2013 poll found that 65% of Americans believed gluten-free foods were simply healthier, and 27% thought going gluten-free would help them lose weight. These numbers vastly outpace the actual prevalence of celiac disease and gluten sensitivity combined.

What does the science actually say? For people without celiac disease, NCGS, or a wheat allergy, there’s no compelling evidence that a gluten-free diet improves health, reduces inflammation, boosts athletic performance, or prevents disease. A large 2017 study of over 100,000 participants without celiac disease found no association between long-term gluten consumption and heart disease risk — and in fact suggested that gluten-avoiders who cut back on whole grains might be inadvertently increasing their cardiovascular risk through lower dietary fiber and an increase in refined starches, sugars and fats in gluten substitutes.

There’s also a nutritional downside worth considering. Gluten-free processed foods — the breads, pastas, crackers, and cookies filling grocery shelves — are often lower in fiber, iron, zinc, B vitamins, and folate than their conventional counterparts. They tend to be higher in sugar and fat to compensate for gluten’s structural role. And they’re almost always more expensive.  

On the other hand, for some people, adopting a gluten‑free pattern coincides with broader healthy changes—more fruits, vegetables, and home‑cooked meals—so perceived benefits may come from overall diet quality rather than gluten removal itself.

The bottom line from Harvard Medical School is clear: if you feel well and have no digestive symptoms, there’s no evidence that a gluten-free diet will help, and some modest evidence it might hurt.

That said, if you’re experiencing real, persistent gut symptoms and haven’t been evaluated, the right move isn’t to quietly go gluten-free and see if you feel better — it’s to see a doctor and get tested first. Eliminating gluten before testing can produce falsely negative results and close the diagnostic door on a condition that, left untreated, carries genuine long-term risks.

The Takeaway

Celiac disease is a serious autoimmune condition affecting about 1% of the population, with the majority still undiagnosed. It requires strict, permanent gluten avoidance and careful medical follow-up. Non-celiac gluten sensitivity occupies a legitimate but scientifically murkier space, affecting a real but incompletely defined group of people for whom reducing gluten makes practical sense. For everyone else — the majority of gluten-free shoppers — the science doesn’t support the hype. Gluten itself isn’t the villain; it’s just a protein. The real story is in the individual biology of those who can’t tolerate it.

Illustration generated by author using ChatGPT.

Sources:

·  WebMD — Celiac Disease: Symptoms, Causes, and Treatment https://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease

·  Merck Manual (Consumer Version) — Celiac Disease https://www.merckmanuals.com/home/digestive-disorders/malabsorption/celiac-disease

·  Merck Manual (Professional Edition) — Celiac Disease https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/celiac-disease

·  American Academy of Family Physicians (AAFP) — Diagnosis and Management of Celiac Disease: Guidelines From the American College of Gastroenterology (2024) https://www.aafp.org/pubs/afp/issues/2024/0100/practice-guidelines-celiac-disease.html

·  Houston Methodist — Celiac Disease: Symptoms, Treatment and What To Know (2024) https://www.houstonmethodist.org/blog/articles/2024/jun/celiac-disease-symptoms-treatment-and-what-to-know/

·  PMC / Nutrients Journal — The Gluten-Free Diet for Celiac Disease and Beyond https://pmc.ncbi.nlm.nih.gov/articles/PMC8625243/

·  PMC / Diabetes Spectrum — The Gluten-Free Diet: Fad or Necessity? https://pmc.ncbi.nlm.nih.gov/articles/PMC5439366/

·  Harvard T.H. Chan School of Public Health — Gluten: A Benefit or Harm to the Body? https://nutritionsource.hsph.harvard.edu/gluten/

·Harvard Health — Ditch the Gluten, Improve Your Health? https://www.health.harvard.edu/staying-healthy/ditch-the-gluten-improve-your-health

Medical Disclaimer

The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.

If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.

From Minstrel Stage to State Law: The History of Jim Crow

By

On April 27, 2026

In History

Source: Library of Congress via Wikimedia Commons, public domain

Few phrases in American history carry as much weight as Jim Crow. It is shorthand for a century of systematic racial oppression — separate schools, separate water fountains, disenfranchisement and even terror. But the term itself has an origin that is both surprising and telling: it began not in a courthouse or a legislature, but on a minstrel stage in the 1820s, as the punchline of a song-and-dance act performed by a white man in blackface.

Jump Jim Crow: The Birth of a Slur

The story starts with Thomas Dartmouth “Daddy” Rice, a struggling white actor from the Lower East Side of Manhattan who would go on to become one of the most famous entertainers of his era. Around 1828, Rice developed a stage character he called Jim Crow — a singing, dancing, shuffling caricature of a Black man, performed in blackface makeup made from burnt cork and wearing ragged clothes. The precise inspiration for the character is disputed and has, as historians put it, been lost to legend. Rice claimed to have based it on a disabled enslaved stableman he observed singing and dancing to amuse himself, though the time, place, and truth of this claim have never been verified.

What is not disputed is the impact. Rice’s “Jump Jim Crow” routine was a sensation. By 1832 he had turned the character into his signature act, touring from Louisville to Cincinnati to Philadelphia to New York, playing to sold-out houses. He eventually took the show to London and Dublin, where audiences were equally enthralled. Rice became known as “Jim Crow Rice,” the self-proclaimed “Father of American Minstrelsy.”

The character Rice created was deliberately degrading — a dim-witted, lazy, buffoonish caricature built to confirm the worst racial stereotypes white audiences held about Black Americans and to reinforce a racial hierarchy that portrayed Black people as naturally suited to servitude and exclusion from the rights of citizenship. He and his imitators spread these images across the country. By 1838, the term “Jim Crow” had crossed from the stage into everyday speech as a collective racial slur for Black people. The minstrel show had given American racism a catchy name.

It is worth pausing on the cultural mechanics of what minstrelsy did. It was not just entertainment — it was propaganda. Rice and his many imitators, including the wildly popular Christy Minstrels (for whom Stephen Foster wrote songs), systematically presented Black Americans as subhuman, unworthy of social participation, and fundamentally inferior and ridiculous figures. These depictions played to a stereotype that reinforced racial prejudice among white audiences and softened their moral resistance to segregation and violence long before those policies were ever written into law.

Reconstruction and Its Violent Undoing

The Civil War ended in 1865 with the abolition of slavery, and the Reconstruction era that followed was a genuine, if incomplete, experiment in racial equality. The 13th, 14th, and 15th Amendments abolished slavery, granted citizenship, and extended voting rights to Black men. For a brief window, Black Americans served in state legislatures and held federal office across the South.

That window slammed shut in 1877, when President Rutherford B. Hayes withdrew the last federal troops from the South as part of a political compromise. Southern white Democrats — calling themselves “Redeemers” — systematically retook their state legislatures using violence, voter fraud, and paramilitary terror groups like the Ku Klux Klan, the White League, and the Red Shirts. Republican officeholders were run out of town or worse. Black voters were lynched as a warning to others.

Once back in power, Southern legislatures began passing the laws that would become known as Jim Crow — a name borrowed directly from Rice’s minstrel slur. The term had traveled from the stage to common speech and then into the legal codebook and reflected the same racist assumptions embodied in the minstrel character: that Black Americans were inherently inferior and should occupy a subordinate social and legal position.

Beginning with Florida in 1887, states required railroads to maintain separate cars for Black and white passengers. Similar laws quickly spread segregation to schools, restaurants, hospitals, theaters, cemeteries, parks, waiting rooms, and virtually every other point of public contact between the races. Many facilities were marked with signs reading “White” and “Colored” to emphasize the exclusion of Black citizens.  The laws varied by state but shared a common goal—racial separation and political exclusion.

Plessy v. Ferguson: The Supreme Court Blesses Segregation

In 1892, a group of Black and mixed-race citizens in New Orleans organized a deliberate legal challenge to Louisiana’s Separate Car Act. They recruited Homer Plessy — a man who was seven-eighths white but legally classified as Black under Louisiana law — to board a whites-only train car and refuse to move. He was arrested on cue, and his case wound its way through the court system to the United States Supreme Court.

In Plessy v. Ferguson (1896), the Court ruled 7-1 that racial segregation was constitutional as long as the separate facilities were nominally equal. The lone dissenter, Justice John Harlan, stated that the constitution should be color blind and warned prophetically that the decision would prove as pernicious as the Dred Scott ruling. He was right. The “separate but equal” doctrine became the legal foundation for a total apartheid system across the South — and, in many respects, well beyond it.

In practice, of course, the facilities were never equal. Black schools were chronically underfunded, with inferior buildings, used textbooks, and far lower teacher salaries. Black hospitals, where they existed at all, were understaffed and under-equipped. “Separate but equal” was a legal fiction that everyone understood as a polite cover for second-class citizenship.

Between 1890 and 1910, ten of the eleven former Confederate states rewrote constitutions or passed amendments to systematically disenfranchise Black voters through poll taxes, literacy tests administered by white registrars, grandfather clauses, and outright violent intimidation. African Americans who had briefly held political power during Reconstruction effectively disappeared from public life.

The Long Arm of Jim Crow: Life Under the System

For the better part of a century, Jim Crow was not merely a set of legal rules — it was a total social order enforced by custom, economic pressure, and the ever-present threat of violence. A Black man who looked a white man in the eye too long, or failed to step off the sidewalk, or was accused of anything at all, could find himself facing a lynch mob. Between Reconstruction and World War II, thousands of Black Americans — men, women and even children — were lynched, often publicly and festively, with onlookers smiling while posing for pictures with the victim. Law enforcement often did nothing and at times even actively participated.

The Great Migration — the mass movement of Black Americans from the South to Northern and Midwestern cities beginning around 1910 — was driven in large part by Jim Crow. Millions fled to Chicago, Detroit, New York, and Los Angeles in search of something approaching equal treatment. What they often found instead was a northern variant: informal segregation through redlining (systematic denial of mortgages in Black neighborhoods), discriminatory hiring, and residential segregation enforced by real estate covenants and social pressure.

The Legal Dismantling: Brown, the Civil Rights Act, and the Voting Rights Act

The legal edifice of Jim Crow began to crack in 1954, when the Supreme Court issued its unanimous decision in Brown v. Board of Education. Directly overturning Plessy, the Court held that segregated schools were inherently unequal and unconstitutional. The ruling did not end segregation — Southern states resisted fiercely, and desegregation proceeded at a glacial pace well into the 1970s — but Brown pulled the legal rug out from under “separate but equal.”

The civil rights movement of the late 1950s and early 1960s — marked by sit-ins, freedom rides, the Birmingham campaign, the March on Washington, and countless acts of individual courage in the face of brutal repression — built the political pressure that forced legislative action. The Civil Rights Act of 1964 prohibited discrimination in public accommodations and employment. The Voting Rights Act of 1965 dismantled the machinery of Black disenfranchisement in the South, sending federal examiners into states with histories of discrimination to ensure that Black citizens could actually register and vote. By 1965 the majority of the formal Jim Crow laws had been overturned.

The Vestiges: Jim Crow’s Long Shadow

Ending Jim Crow legally is not the same as ending its consequences — or, as some argue, its functional successors. Legal scholar Michelle Alexander, in her landmark 2010 book The New Jim Crow, argues that mass incarceration has emerged as a new system of racialized social control. Black Americans are incarcerated at roughly five times the rate of white Americans. A felony conviction — often stemming from drug offenses prosecuted far more aggressively in Black communities despite similar rates of drug use across races — carries a cascade of legal disabilities: loss of voting rights in most states, exclusion from public housing and many jobs, and ineligibility for certain federal benefits. Nearly 30% of Black men carry felony records.

The racial wealth gap stands as perhaps the most stubborn vestige of a century of legal exclusion. The median Black family holds roughly one-tenth the wealth of the median white family — a gap driven not by individual choices but by generations of legally enforced exclusion from homeownership, inheritance, and wealth-building opportunities. Redlining — the systematic denial of mortgages in Black neighborhoods by federally-backed banks — was official federal policy from the 1930s through the 1960s and left neighborhood segregation patterns that persist visibly today.

Voting rights remain contested territory. The Supreme Court’s 2013 ruling in Shelby County v. Holder gutted the preclearance requirement of the Voting Rights Act, which had required states with histories of discrimination to get federal approval before changing election laws. Since then, a wave of new restrictions — voter ID laws, aggressive voter roll purges, reduced polling locations, and aggressive felony disenfranchisement — has fallen disproportionately on Black, Latino, and Indigenous voters. As of April 2024, 19 states require photo identification to vote, a requirement critics note functions as a modern poll tax for those who lack access to the required documents.

Residential segregation, too, endures. American neighborhoods and, by extension, their schools remain largely segregated by race — a product not of individual choice but of policies like redlining, racially restrictive housing covenants, and “white flight” that were actively promoted by governments at every level. These patterns mean that school quality, which is largely tied to local property tax revenues, continues to diverge sharply by race.

Conclusion

The arc of Jim Crow runs from the absurd to the tragic: from a white comedian in burnt-cork makeup doing a shuffling dance routine, to a legal apparatus that stripped millions of Americans of their dignity, their rights, and their lives for a century. The name itself tells you what the architects of segregation thought of their project — it was always a contemptuous slap in the face of Black Americans.

While the formal system was legally dismantled between 1954 and 1965 — which is rightly understood as a profound achievement — the legal end of Jim Crow is not the same as justice, and it is not the same as equality. The wealth gap, the incarceration gap, the voting access gap, and the education gap all bear the fingerprints of a system that successfully kept Black Americans subordinate for generations.

Understanding Jim Crow fully requires tracing it from its shameful origins in a minstrel song, through its deadly flowering as a legal regime, to its present-day aftereffects. The name may have disappeared from the law books, but the consequences have not and some critics of the current administration see the dismantling of DEI as an indirect form of Jim Crow revival or neo-segregation. They believe that race-neutral language is being used to reproduce racial inequality without openly naming race.  This is sometimes described this as “Jim Crow 2.0” or “colorblind Jim Crow” and should be no more acceptable than its more blatant ancestor.

Sources

1. Wikipedia — Thomas D. Rice: https://en.wikipedia.org/wiki/Thomas_D._Rice

2. Wikipedia — Jim Crow (Character): https://en.wikipedia.org/wiki/Jim_Crow_(character)

3. Wikipedia — Jump Jim Crow: https://en.wikipedia.org/wiki/Jump_Jim_Crow

4. Jim Crow Museum, Ferris State University — Who Was Jim Crow?: https://jimcrowmuseum.ferris.edu/who/index.htm

5. Jim Crow Museum, Ferris State University — The Origins of Jim Crow: https://jimcrowmuseum.ferris.edu/origins.htm

6. Britannica — What Is the Origin of the Term “Jim Crow”?: https://www.britannica.com/story/what-is-the-origin-of-the-term-jim-crow

7. Britannica — Jim Crow Law: https://www.britannica.com/event/Jim-Crow-law

8. National Archives — Plessy v. Ferguson (1896): https://www.archives.gov/milestone-documents/plessy-v-ferguson

9. Wikipedia — Plessy v. Ferguson: https://en.wikipedia.org/wiki/Plessy_v._Ferguson

10. Wikipedia — Jim Crow Laws: https://en.wikipedia.org/wiki/Jim_Crow_laws

11. PBS — Jim Crow & Plessy v. Ferguson: https://www.pbs.org/tpt/slavery-by-another-name/themes/jim-crow/

12. Howard University School of Law — Reconstruction and Jim Crow Eras: https://library.law.howard.edu/civilrightshistory/blackrights/jimcrow

13. American Battlefield Trust — The Jim Crow Era: https://www.battlefields.org/learn/articles/jim-crow-era

14. Michelle Alexander — The New Jim Crow (Introduction Excerpt): https://newjimcrow.com/about/excerpt-from-the-introduction

15. Economic Policy Institute — Voter Suppression Rooted in Racism: https://www.epi.org/publication/rooted-racism-voter-suppression/

16. American Academy of Arts and Sciences — Somewhere Between Jim Crow and Post-Racialism: https://www.amacad.org/publication/daedalus/somewhere-between-jim-crow-post-racialism

17. Yale Macmillan — History of Minstrel Shows and Jim Crow: https://macmillan.yale.edu/glc/history-minstrel-shows-and-jim-crow

Announcing a New Feature

By

On April 23, 2026

In Commentary, Uncategorized

As part of my ongoing efforts to make sure that The Grumpy Doc is no more than 20 years out of date, I’ve added a search function to the site.  If you look to your right, you will see it cleverly labeled as SEARCH.  Just enter any keyword and search away.

The One True Gospel of Wellness

By

On April 23, 2026

In Commentary, Medicine

Why Every Guru Thinks They’ve Found the Only Path to Health

There’s a peculiar affliction that seems to strike fitness influencers, biohackers, homeopathic healers, and wellness gurus with near-universal consistency — the unshakeable conviction that they, and only they, have cracked the code on human health. Whether it’s cold plunges at 4 a.m., microdosing mushrooms, coffee enemas, or whatever supplement stack is trending this week, every one of these prophets arrives at the same conclusion: their method is the path, the others are at best misguided, and mainstream medicine is a corrupt temple worth burning down.

Psychologists have a name for part of what’s happening here. It’s called the Dunning-Kruger effect — the tendency for people with limited knowledge in a domain to overestimate their own competence. But that’s only part of the story. Many of these figures are genuinely smart, sometimes even credentialed. What really drives the zealotry is something closer to what researchers call “belief perseverance” — the tendency to hold tightly to a conclusion even when contradicting evidence rolls in. Once someone has built an identity, a brand, and an income stream around a single idea, the psychological and financial cost of admitting nuance becomes enormous.

Take the biohacking community as a prime example. Some influencers — like the self-proclaimed “father of biohacking” — have built empires on the premise that optimizing the body is a matter of finding the right levers and pulling them correctly. They have championed everything from Bulletproof Coffee to infrared saunas to testosterone replacement, positioning each as a revelation that conventional medicine is too slow or too corrupted to acknowledge. The problem isn’t that all of these interventions lack merit — some have legitimate science behind them. The problem is the rhetorical framework: the idea that skeptics aren’t just wrong, they’re complicit. That’s not science; that’s a revival meeting.

Homeopathy sits at a different extreme but runs on the same engine. Developed in the late 18th century by Samuel Hahnemann, homeopathy is based on the idea that substances that cause symptoms in healthy people can cure those symptoms in the sick — and that extreme dilution actually strengthens a remedy’s potency. The scientific consensus is unambiguous: systematic reviews and meta-analyses have repeatedly found homeopathic remedies perform no better than placebo. And yet its advocates don’t merely disagree with this consensus — they dismiss the entire evidentiary framework, arguing that conventional research methods simply can’t measure what homeopathy does. It’s an airtight position: no evidence can ever count against it.

The fitness world runs its own version of this dogmatism on a perpetual loop. CrossFit devotees insist that anything other than functional high-intensity training is a waste of time. Carnivore diet advocates declare that vegetables are quietly poisoning you with antinutrients. Yoga instructors sometimes slide into the claim that breath control and mindfulness can substitute for actual medical care. Each subculture has its orthodoxy, its apostles, and its convenient explanations for why people who don’t follow the program are sick, lazy, or deceived. The irony is that many of these systems contain genuinely useful elements. Resistance training really does build muscle and bone density. Mindfulness really does reduce cortisol. Dietary quality really does matter enormously. But the insistence on one method to the exclusion of all others transforms useful practices into something closer to religious doctrine.

What’s lost in all the noise is the most important truth in medicine: human bodies are wildly heterogeneous. What works beautifully for one person may be ineffective or even harmful for another. This isn’t a flaw in the science — it is the science. Precision medicine, one of the most promising frontiers in modern healthcare, is built entirely on this recognition. The dream of a single universal protocol for human health isn’t just unrealized — it’s probably unrealizable. Yet that’s precisely what every wellness guru is selling.

There’s also a social dimension worth naming. The wellness industry is, in the most literal sense, an industry. It generated an estimated $5.6 trillion globally in 2022, according to the Global Wellness Institute, and that number continues to climb. When someone’s livelihood depends on their particular system being not just good but uniquely correct, objectivity becomes a luxury they can’t easily afford. Dismissing alternatives isn’t just tribalism — it’s good business.

None of this is to say that skepticism toward mainstream medicine is always misplaced. Conventional healthcare has real blind spots — in chronic disease management, in nutrition research, in the treatment of pain, and in its historical tendency to dismiss patient experience. The gurus often fill genuine gaps that the system has left open. But filling a gap is different from claiming you have the only map to the entire territory. The honest answer in health and fitness, as in most complex domains, is that we know a good deal, we don’t know quite enough, and anyone who tells you they’ve figured it all out probably hasn’t.

The next time someone tells you they’ve discovered the only way — whether it’s a supplement protocol, a spiritual practice, or a morning routine — it might be worth asking the simplest question in science: compared to what? If the answer is a dismissive wave at everything else, you probably have your answer.

Illustration generated by author using ChatGPT.

Sources

Global Wellness Institute — Global Wellness Economy Monitor: https://globalwellnessinstitute.org/industry-research/

Ernst E. — Homeopathy: The Undiluted Facts (Springer, 2016): https://link.springer.com/book/10.1007/978-3-319-43592-3

Dunning D. — The Dunning-Kruger Effect, Advances in Experimental Social Psychology: https://www.sciencedirect.com/science/article/pii/S0065260111440024

National Institutes of Health — Precision Medicine Initiative: https://www.nih.gov/research-training/allofus-research-program

Medical Disclaimer

The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.

Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.

If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.

The Curious Art of Pointing: Late 18th-Century Portraiture and the Language of Gestures

By

On April 20, 2026

In Art

I spend a lot of time studying the period of American history from the late 18th century to the early 19th century, particularly the events and the people surrounding the American Revolution. One of the things I like to do is study portraits of the main characters to try to get a sense of what they may have been like.  When you examine portraits from that period, you’ll notice something peculiar: people are constantly pointing at things. I couldn’t help but wonder: “What’s that all about? “

 English aristocrats extend their fingers toward their estates, American founding fathers gesture toward constitutional documents, and wealthy merchants direct our attention to symbols of their success. This wasn’t accidental theatrical posing—it was a sophisticated visual language where hand gestures functioned as a kind of shorthand, acting as indicators of the subject’s station, qualities and character.

The pointing gesture had become such a convention by the late 18th century that it almost seemed compulsory. But unlike today’s selfie poses, these carefully orchestrated hand positions required subjects to hold them for hours while painters worked. So why would anyone endure such discomfort just to point at seemingly empty space or distant objects?

Where They Were Pointing—And Why It Mattered

The objects of these pointing gestures reveal what late 18th-century society considered worth advertising. In Gainsborough’s painting of Mr. and Mrs. Robert Andrews, the landscape performs a much more important role than mere background—it depicts the Andrews’ estate and is intended to represent their wealth and status. Mr. Andrews doesn’t just stand near his property; he actively directs the viewer’s attention to it, essentially saying “Look at what I own.”

This was particularly important in England, where portraits became public records of status and position during the 18th century, and images of opulently attired figures were a means to affirm the authority of important individuals. Property ownership defined social standing in ways modern Americans might find difficult to fully appreciate. Your land wasn’t just where you lived—it was your identity, your political power, and your legacy rolled into one.

Sometimes the gesture proved unintentionally ironic.  In his 1768 portrait, General Thomas Gage points to imagined military success—an outcome history would later deny him.

American portraiture developed its own flavor of pointing symbolism, though it borrowed heavily from English conventions. After the Revolution, the United States looked for a new identity and history, a capacity for visual communication aimed at all citizens. American subjects often pointed toward documents, books, or symbols of their professional achievements rather than ancestral estates they didn’t possess. A lawyer might gesture toward law books, a scientist toward instruments, a founding father toward constitutional documents. The gesture said, “This is what I’ve accomplished” rather than “This is what I inherited.”

The Multiple Meanings of a Pointed Finger

The act of pointing served several simultaneous purposes in these portraits, which made it remarkably efficient for painters and patrons working within the constraints of canvas and paint. First, it created visual movement and prevented the deadly sin of portrait painting: making your subject look like a corpse propped up in fancy clothes. Long fingers were a sign of elegance and beauty, which signified culture, and hence intelligence, wealth and benevolence in the convention of these pictures.

Second, the gesture connected the subject to their accomplishments and possessions without requiring them all to fit within the frame. A merchant pointing toward a distant ship implied maritime trade; a landowner gesturing toward rolling fields suggested vast holdings beyond what any canvas could contain. The pointed finger became a visual ellipsis, suggesting “and more besides.”

Third, pointing engaged viewers in a way static poses couldn’t. When Thomas Gainsborough’s subjects point at their estates, or when artist Angelica Kauffman depicts herself with art personified pointing the way forward, they’re creating a relationship with anyone looking at the painting. The gesture says, “Let me show you something,” turning passive viewing into a guided tour.

The Curious Case of Pointing at Nothing

Here’s where things get genuinely weird: many portrait subjects from this period appear to be pointing at absolutely nothing of consequence. There’s an abundance of important people pointing at nothing, which most likely has meaning, but it’s impossible to know what. King James II appears in multiple portraits pointing off-canvas at no identifiable object. English courtesans and French aristocrats extend elegant fingers toward empty space. What gives?

Several theories attempt to explain this phenomenon. Some art historians argue these portraits once formed diptychs or larger compositions where the pointing made sense in context. Others suggest the gesture had become so conventionalized that it persisted even without specific referents—it simply meant “I am important enough to be painted pointing at things.” Perhaps the ambiguity was intentional. It invited the viewer to imagine: the future, moral principles, destiny, or duty. This wasn’t symbolism in the modern sense—it was rhetorical suggestion.

Still others propose that the elegant display of hands was itself the point. During the Renaissance and into the 18th century, hands were as important a focus of attention as the face was, because they were the only other visible area of the body, and representation of the position of the hands became a decorative element that was almost as important as the face. Showing refined, aristocratic hands in graceful poses demonstrated genteel breeding regardless of where they pointed.

The Anglo-American Divergence

American portraits, by contrast, celebrated individual achievement in a republic supposedly free from hereditary privilege. In the New World, portraits were created by the people, the ordinary settlers and citizens of the developing countries, and portraits began to make a move from a false pretense to almost exact likeness in the 1730s. John Singleton Copley’s American subjects pointed toward symbols of their professions, their intellectual pursuits, or occasionally toward landscapes that represented American natural abundance rather than private ownership.

This difference wasn’t just aesthetic—it reflected fundamentally different answers to the question “What makes someone worth painting?” In England, the answer remained largely “birth and property.” In America, it was increasingly “accomplishment and character,” even if wealthy Americans proved just as eager to commission portraits displaying their property as any English lord.

The Practical and the Symbolic

There were also wonderfully mundane reasons for the pointing convention. With the invention of photography, the pose continued but may have had an additional purpose in preventing blurring by maintaining the sitter’s hand in a single place. Even in painted portraits, giving subjects something to “do” with their hands solved the age-old problem of what to do with idle limbs during hours of sitting still. The pointing gesture was energetic enough to look dynamic but simple enough to hold for extended periods.

Artists also recognized that pointing could subtly advertise their own skills. German artist Albrecht Dürer’s earliest self-portrait, drawn when he was only thirteen, depicts him pointing with his finger, suggesting that even at that age he knew that a pointing finger was an important symbol. The gesture reminded viewers that what they saw was created by an artist’s hand, a commentary woven into the composition itself.

Those pointing fingers weren’t quirks or affectations. They were a shared visual grammar that told viewers how to understand power, intellect, and legitimacy in an Enlightenment world that cared deeply about appearing rational, purposeful, and morally grounded.

Once you see it, you can’t unsee it—and you’ll start noticing how modern leaders use subtler versions of the same visual cues today.

Image Sources

Gilbert Stuart – George Washington – Google Art Project.jpg Copy, via Wikimedia Commons,  public domain

John Singleton Copley – General Thomas Gage – Google Art Project.jpg Copy, via Wikimedia Commons, public domain

Angelica Kauffmann –  Self Portrait of the Artist Hesitating between the Arts of Music and Painting; National Trust, Nostell Priory, via Wikimedia Commons, public domain

Sir Peter Lely – James II and Anne Hyde, Copy, National Trust, via Wikimedia Commons, public domain

John Trumbull – Alexander Hamilton, full-length portrait, standing, facing left, left hand on hip, right arm extended outward, books and papers beside him LCCN89706847.jpg Copy, via Wikimedia Commons, public domain

Text Sources

·  Baetjer, Katharine. “Portrait Painting in England, 1600–1800.” Metropolitan Museum of Art. https://www.metmuseum.org/toah/hd/bpor/hd_bpor.htm

·  Gustlin, Katherine and Gustlin, Mark. “Portraits (18th Century).” A World Perspective of Art Appreciation. Humanities LibreTexts. https://human.libretexts.org/Courses/Evergreen_Valley_College/A_World_Perspective_of_Art_Appreciation_(Gustlin_and_Gustlin)/10:_The_New_World_Grows_(1700_CE__1800_CE)/10.2:_Portraits_(18th_Century)

·  Lazzeri, D., Nicoli, F., Zhang, Y.X. “Secret hand gestures in paintings.” Acta Biomedica 2019; Vol. 90, N. 4: 526-532. https://www.researchgate.net/publication/338457261_Secret_hand_gestures_in_paintings

·  “Pointing and Touch.” Every Painter Paints Himself. https://www.everypainterpaintshimself.com/theme/pointing_and_touch

·  “Pointing in portraits.” History Forum. https://historum.com/t/pointing-in-portraits.83092/

·  “Portrait painting.” Wikipedia. https://en.wikipedia.org/wiki/Portrait_painting

·  “Portraits in the Landscape.” Photo-graph. https://photo-graph.org/2013/01/09/portraits-in-the-landscape/

The Accidental Footnote: Heel Spurs, the Vietnam Draft, and American Inequality

By

On April 17, 2026

In Commentary, History, Medicine, Politics

If you’ve ever winced taking your first steps out of bed in the morning, you may have already made an involuntary acquaintance with heel spurs — or more precisely, with the condition that often travels with them. The term itself sounds alarming, and for a brief but colorful stretch of American political history, it became something far more charged than a footnote to podiatry. But before we get to the politics, it’s worth understanding what a heel spur actually is, because the medical reality is both more mundane and more complicated than the caricature.


What Exactly Is a Heel Spur?
A heel spur is a small bony outgrowth — technically called a calcaneal spur — that extends from the underside of the heel bone (the calcaneus). It forms at the spot where the plantar fascia — the thick ligament running the length of your foot from heel to toe — attaches to the heel bone. The spur is not, despite what the name implies, a sharp spike. It is typically smooth and rounded, though it can still cause irritation if it presses into surrounding soft tissue.


The image depicts a comparison between a healthy foot and one with a prominent foot ulcer, highlighting the condition's visible effects. AI-generated content may be incorrect.
 
Heel spurs affect about 10% of the population, making them one of the more common foot conditions around, though most people who have one don’t know it. The spur develops gradually — usually over months or even years — as the body deposits calcium in response to chronic stress at that heel attachment point. Think of it less as damage and more as your skeleton’s attempt at reinforcement.

What Causes Them?
The underlying driver is repetitive mechanical stress on the foot. Heel spurs are particularly associated with strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated small tears in the membrane covering the heel bone. Athletes who do a lot of running and jumping are especially prone.

But you don’t need to be an elite runner to develop one. Walking gait problems — particularly overpronation, where the foot rolls inward — place uneven stress on the heel with each step. Worn-out or poorly fitted shoes, which fail to absorb shock or support the arch, compound the problem. Obesity increases the mechanical load on the heel. Occupations that require prolonged standing or walking on hard surfaces put the plantar fascia under constant tension. And as people age, tendons and ligaments lose their elasticity, making the tissues more vulnerable to micro-tears and the subsequent bony repair response.

Heel spurs are also closely connected to a condition most people have heard of: plantar fasciitis. The two are related a but not identical. Plantar fasciitis is inflammation of the plantar fascia itself, usually from overuse. A heel spur can develop as a downstream consequence of that inflammation — the body lays down extra bone in response to the ongoing stress at the fascia’s attachment point.

Symptoms — or the Lack Thereof
Here’s the part that surprises most people: the majority of heel spurs cause no symptoms at all, and many are discovered incidentally on X-rays taken for other reasons. Only about 5% of heel spurs are estimated to be symptomatic.

When a heel spur does produce symptoms, the experience is heavily intertwined with plantar fasciitis. The classic description is a sharp, stabbing pain on the bottom of the foot first thing in the morning, or after any prolonged rest. Many people compare it to stepping on a tack. Paradoxically, this pain often eases somewhat after walking around for a few minutes, only to return after extended time on the feet or after another rest. It’s that “worse in the morning” quality that tends to be the giveaway.

Other symptoms, when present, can include localized swelling, warmth, and tenderness along the front of the heel, as well as increased sensitivity on the underside of the foot. It’s worth noting that the pain associated with a heel spur is not generally thought to come from the bony spur itself, but from the irritation it causes in the surrounding soft tissue — tendons, ligaments, and bursae.

How Is It Diagnosed?
Diagnosis typically begins with a physical exam. Your doctor or podiatrist will ask about when the pain started, what activities preceded it, and what makes it better or worse. They’ll examine your foot for tenderness at specific points, assess your range of motion, and check foot alignment and press on key areas to locate the source of pain.

Imaging confirms the picture. An X-ray can clearly show the bony spur and is the most commonly used test. That said, the size of the spur on an X-ray doesn’t necessarily correspond to how much pain a patient is experiencing — a small spur can be quite painful while a large one may cause no trouble at all. In more complex cases, an MRI may be ordered to assess the soft tissues more closely and evaluate whether plantar fasciitis or another condition is also in play.

Treatment Options
The reassuring news is that the vast majority of cases resolve without surgery. More than 90% of patients improve with nonsurgical treatment. The catch is that conservative management requires patience — improvement typically takes weeks, and more stubborn cases can take months.

The cornerstone of treatment is rest and reducing the activities that provoke pain. This doesn’t necessarily mean completely stopping exercise; low-impact alternatives like swimming, cycling, or rowing allow you to stay active while giving the heel a break from impact. Icing the bottom of the foot after activity helps manage inflammation. Over-the-counter anti-inflammatory medications like ibuprofen or naproxen can provide relief, though they’re intended for short-term use.

Footwear matters enormously. Supportive shoes with good arch support, cushioning, and a slight heel rise reduce the strain on the plantar fascia. Custom orthotics with molded insoles designed to redistribute pressure across the foot are often recommended, particularly for people with gait abnormalities or flat feet. Physical therapy can be part of the treatment plan, focusing on stretching the calf muscles and plantar fascia, strengthening the foot’s intrinsic muscles, and correcting biomechanical issues.

For cases that don’t respond to these initial measures, the next tier of treatment includes corticosteroid injections to reduce inflammation at the spur site, and extracorporeal shockwave therapy — a non-invasive procedure that uses sound waves to stimulate healing in chronically inflamed tissue. Surgery is reserved for the minority of cases where conservative treatment fails after nine to twelve months. Possible complications include nerve pain, infection, scarring, and — with plantar fascia release — the risk of foot instability or stress fracture. Most orthopedic surgeons regard surgery as a last resort.

Are Heel Spurs Debilitating?
For most people, the honest answer is: no.  Heel spurs are a common condition with a favorable prognosis, especially with early diagnosis and appropriate management. Many people live with heel spurs for years without ever knowing it, and even those who develop pain typically find substantial relief with conservative treatment within four to eight weeks.
That said, the pain at its worst — particularly in conjunction with plantar fasciitis — can be genuinely disruptive to daily life. Athletes may find their training significantly limited. People who spend long hours on their feet at work may struggle with sustained discomfort. And a small percentage of patients do end up with prolonged, treatment-resistant pain that affects mobility. So, the more accurate framing might be: heel spurs have the potential to be significantly uncomfortable and functionally limiting during flare-ups, but with proper treatment most people recover well and return to normal activity.

Heel Spurs and the Vietnam-Era Draft
Which brings us to an improbable chapter in heel spur history. During the Vietnam War era, heel spurs became — for at least one famous case — a ticket out of military service. Understanding how that worked requires a brief detour into the draft system of the 1960s and 1970s, and what it meant to receive a medical deferment.
According to the National Archives, of the roughly 27 million American men eligible for military service between 1964 and 1973, about 15 million were granted deferments — mostly for education, and some for mental or physical problems — while only 2,215,000 were actually drafted into service—another eight million volunteered. Some of those who later served had previously had deferments. The system was sprawling, complex, and — as was widely acknowledged even at the time — deeply unequal.
Roughly 60% of draft-eligible American men took some sort of action to avoid military conscription. There were many routes: college deferments, fatherhood, conscientious objector status (170,000 men received those alone), National Guard enlistment, and medical exemptions. Medical deferments covered a wide range of conditions — from serious chronic illness to conditions that, in a different context, most people would consider minor. Flat feet, poor eyesight, asthma, and yes, bone spurs all appeared on the list of potentially disqualifying ailments.
The system was known to favor men with access to money, education, and well-connected physicians. American forces in Vietnam were 55% working-class and 25% poor — reflecting those who didn’t have the means to navigate the deferment labyrinth. A working-class kid from rural West Virginia was far more likely to end up in the Mekong Delta than the son of a New York real estate developer.

The Most Famous Heel Spur in American History
Which leads, inevitably, to Donald Trump. As confirmed by Selective Service records obtained and reported by multiple news outlets, Trump received five Vietnam-era draft deferments — four for college attendance at Fordham and the Wharton School, and a fifth in 1968, recorded as a medical deferment for bone spurs in his heels. The medical classification left him disqualified for military service.

The circumstances surrounding the diagnosis have been contested ever since. Reporting by the New York Times included accounts from the daughters of a Queens podiatrist named Larry Braunstein, who alleged that their father had provided or vouched for the diagnosis as a professional favor to Trump’s father, Fred Trump — a landlord to whom Braunstein reportedly owed a debt of gratitude. Trump’s former lawyer Michael Cohen also testified that Trump had admitted to fabricating the injury. Trump himself has maintained that the diagnosis was legitimate, stating that a doctor “gave me a letter — a very strong letter — on the heels.” The underlying medical records that would resolve the dispute are, conveniently, not publicly available; most individual Selective Service medical records from that era were subsequently destroyed.

It’s worth noting that Trump’s pattern — using legal channels, including a medical deferment of questionable validity, to avoid Vietnam service — was not unique to him. Historians have pointed out that numerous prominent figures on both sides of the political aisle received deferments of various kinds, including Joe Biden (asthma), Dick Cheney (student deferments), Bill Clinton (navigated the ROTC system), and George W. Bush (National Guard). The heel spur episode became politically charged in part because of Trump’s later hawkish rhetoric and his outspokenness in questioning the military service of others — most notably Senator John McCain, who spent years as a prisoner of war in North Vietnam.

How Many People Got Heel Spur Deferments?
This is where the historical record hits a hard wall. No reliable statistics exist specifically for heel spur deferments. The Selective Service tracked broad categories — student deferments, hardship deferments, conscientious objector status, medical disqualifications — but it did not publish a breakdown by specific diagnosis, and most individual medical records from that era no longer exist.

What we can say is that bone spurs were a recognized medical disqualifier under Selective Service regulations, that medical deferments broadly were a commonly used — and commonly abused — avenue for avoiding service, and that the process was heavily influenced by access to sympathetic physicians. A man with means, connections, and a cooperative podiatrist had options that a man without those resources did not.

The honest answer, then, is that we don’t know how many men received deferments citing heel spurs specifically, and we almost certainly never will. The data either wasn’t tracked at that level of granularity or was long since destroyed. What we do know is that the condition became, for a time, a lens through which Americans examined something much larger: who serves, who doesn’t, and whether the systems meant to govern those decisions are applied fairly.

For most people, a heel spur is a manageable, if annoying, footnote in the story of their health. For at least one person, it became a footnote in the history of American politics.
 
Personal Note: I have heel spurs; I wish I’d known about them in 1967.
 
Images generated by author using AI.

Medical Sources
Cleveland Clinic — Heel Spurs overview
https://my.clevelandclinic.org/health/diseases/21965-heel-spurs
WebMD — Heel Spur Causes, Symptoms, Treatments, and Surgery
https://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments
Hackensack Meridian Health — Bone Spurs in the Heel: Symptoms and Recovery
https://www.hackensackmeridianhealth.org/en/healthier-you/2024/01/02/bone-spurs-in-the-heel-symptoms-and-recovery
OrthoArkansas — Heel Spurs
https://www.orthoarkansas.com/heel-spurs-orthoarkansas/
EmergeOrtho — Heel Bone Spurs: Causes, Symptoms, Treatment
https://emergeortho.com/news/heel-bone-spurs/
American Academy of Orthopaedic Surgeons — Plantar Fasciitis and Bone Spurs
https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs/
Vietnam Draft & Military Service Sources
History.com — 7 Ways Americans Avoided the Draft During the Vietnam War
https://www.history.com/articles/vietnam-war-draft-avoiding
Wikipedia — Draft Evasion in the Vietnam War
https://en.wikipedia.org/wiki/Draft_evasion_in_the_Vietnam_War
Wikipedia — Conscription in the United States
https://en.wikipedia.org/wiki/Conscription_in_the_United_States
Students of History — The Draft and the Vietnam War
https://www.studentsofhistory.com/vietnam-war-draft
University of Michigan — The Military Draft During the Vietnam War
https://michiganintheworld.history.lsa.umich.edu/antivietnamwar/exhibits/show/exhibit/draft_protests/the-military-draft-during-the-
Vietnam Veterans of America Chapter 310 — Vietnam War Statistics
https://www.vva310.org/vietnam-war-statistics
Vietnam Veterans of Foreign Wars — Fact vs. Fiction: The Vietnam Veteran
https://www.vvof.org/factsvnv.htm
New York City Vietnam Veterans Plaza — Interesting Facts About Vietnam
https://www.vietnamveteransplaza.com/interesting-facts-about-vietnam/
 
 
Medical Disclaimer
The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.
Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.
If you are experiencing a medical emergency, call 911 or your local emergency number immediately.
The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.
 

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