Archive For: Wellness

Fight Fatigue

Wake-up Call: Fight Fatigue at Its Roots

Are these ordinary signs of aging? Exhausted throughout the day, joy in life slowly diminishing, active lifestyle becoming a distant memory. No, no and no. Feeling tired all the time is not a normal part of the aging process. Instead, it can point to the need for a better night’s sleep, stress or an underlying illness, or be the result of a mix of common medications. Or it may be a combination of all these things. Identifying the possible sources of your fatigue is the most important step in reenergizing your lifestyle.

Medical: Visit your physician to rule out these frequently seen causes of tiredness.

Emotional health: Low-grade depression, anxiety or chronic stress can sap energy.

Anemia: This condition occurs when your blood has too few red blood cells or those cells have too little hemoglobin, a protein that transports oxygen through the bloodstream. If untreated, anemia results in a drop in energy levels.

Heart disease: When the heart pumps blood less efficiently, it can lead to fluid in the lungs, causing shortness of breath and reducing the oxygen supply to heart and lungs.

Hypothyroidism : An underactive thyroid gland can cause fatigue – along with other symptoms, such as weight gain, weakness, dry skin, feeling cold and constipation.

Medications : Many medicines can cause fatigue, including blood pressure drugs, antidepressants, anti-anxiety drugs and antihistamines.

Lifestyle Habits

Sleep: Quality, quantity and environment matter greatly in ensuring a healthy sleep, but these factors are surprisingly misconstrued. According to NYU School of Medicine, dispelling these widely held beliefs is key:

  • Myth: “Alcohol before bed is good for sleeping.” A nightcap before bed may help you fall asleep but will dramatically reduce the quality of sleep by disrupting the REM (rapid eye movement) stage all night, and you’ll wake unrefreshed.
  • Myth: “Many adults need only five hours of sleep or less, especially as they get older.” The reality is everyone needs to get enough sleep to wake up feeling refreshed. The average is seven to eight hours nightly to allow the body to progress through four phases of restorative sleep, including deep sleep cycles of REM and delta waves sleep, which are important for generating neurons, repairing muscle and restoring the immune system.
  • Myth: “Watching TV in bed before sleep is a good way to relax.” Actually, turning off the TV and putting away electronic devices at least two hours before bedtime is recommended, as the blue light produced affects the release of melatonin, the sleep hormone, and will delay slumber.
  • Myth: “If I wake up in the middle of the night, it is best to lie in bed until I fall back asleep.” Tossing and turning for more than 20 minutes is not helpful; instead, change rooms and engage in something mindless, like folding socks. Do not watch TV or look at electronic devices, as this wakes up your brain.
  • Myth: “Snoring is a common, harmless problem.” Snoring can be a sign of sleep apnea, a disorder characterized by decreased or complete lack of airflow throughout the night. Over time, this can increase the risk of cardiovascular disease if untreated.
  • Myth: “Falling asleep anywhere, anytime is the sign of a good sleeper.” It’s just the opposite, indicating a sleep “debt” from insufficient rest or a sleep disorder such as narcolepsy or sleep apnea.

Under- or over-activity: Sedentary days and nights can cause loss of muscle mass and flexibility and make even moderately intense activities seem exhausting. However, exercising at a very high intensity can also cause fatigue.

An Infusion of Energy for Chronic Fatigue Research

Far beyond ordinary tiredness is the profound fatigue known as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), which has puzzled and frustrated medical professionals for decades. No cure or approved treatment is available to its 2.5 million sufferers, only a management of symptoms worsened by any type of physical, cognitive or emotional effort. But a sea change is underway. It began in 2015 with a new name recommendation by the Institute of Medicine (IOM): Systemic Exertion Intolerance Disease (SEID). Noting that the term chronic fatigue syndrome can trivialize the seriousness of the condition and that “ME” is inappropriate because neither muscle pain nor brain inflammation has proven to be a symptom, the IOM panel stated: “SEID captures a central characteristic of this disease – that exertion of any sort can adversely affect patients in many organ systems and in many aspects of their lives.”

Even more promising is the significant investment in research announced by the National Institutes of Health (NIH). Up to $36 million over five years has been granted to shine a brighter light on the origins and progression of chronic fatigue and ultimately to help develop diagnostic markers and effective treatments.

Did You Know?

58% of older adults sleep less than seven hours a night.

80% of people age 55 and over report unintentionally falling asleep at least once during the day within the last month.

Source: Centers for Disease Control and Prevention

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AN UPDATE ON THE MEASLES OUTBREAK IN THE US

What are the newest guidelines for measles vaccinations?

  • Adults with no evidence of immunity should get 1 dose of MMR. Immunity is defined as documented receipt of 1 dose, or 2 doses, 4 weeks apart if high risk, of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or birthdate before 1957.
  • High-risk people, including healthcare personnel, international travelers and students at post-high school educational institutions, should receive 2 doses.
  • Persons who previously received a dose of MMR vaccine in 1963–1967 and are unsure which type of vaccine it was, or if it was an inactivated measles vaccine, should be revaccinated with either 1 (if low-risk) or 2 (if high-risk) doses of MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered complete for their age or risk status.

Why does a birthdate prior to 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered.

Why is a second dose of MMR necessary?

Between 2% and 5% of people do not develop measles immunity after the first dose of vaccine for a variety of reasons. The second dose is to provide another chance to develop measles immunity for people who did not respond to the first dose.

Are there any situations in which more than 2 doses of MMR are recommended?

There are two circumstances when a third dose of MMR is recommended, according to ACIP.

  1. Women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. NOTE: MMR should not be administered to a pregnant woman.
  2. Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine (MMR or MMRV) to improve protection. More information is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf

Many people age 60 years and older do not have records indicating what type of measles vaccine they received as children in the early 1960s. What measles vaccine was most frequently given in that time period? That guidance would assist many older people who would prefer not to be revaccinated.

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received.

  • The killed vaccine was found to be not effective and people who received it should be revaccinated with live vaccine.
  • Persons born during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease, should receive at least 1 dose of MMR.
  • Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.

Do people who received MMR in the 1960s need to have their dose repeated?

Not necessarily.

  • People who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated.
  • People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in 1963 through 1967 and was not effective (see above).
  • Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such as persons who work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

Please explain the Advisory Committee on Immunization Practices (ACIP)’s revised definition of evidence of immunity to measles, rubella, and mumps.

In the 2013 revision of its MMR vaccine recommendations, ACIP includes laboratory confirmation of disease as evidence of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Physician diagnosis was previously not accepted as evidence of immunity for rubella. The decrease in measles and mumps cases over the last 30 years has made the validity of physician-diagnosed disease questionable. In addition, documenting history from physician records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf

What can be done for unvaccinated people who have already been exposed to measles, mumps, or rubella?

The measles vaccine, given as MMR, may be effective if given within the first 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long as 6 days after exposure. Post-exposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. However, if the exposed person does not have evidence of mumps or rubella immunity they should be vaccinated since not all exposures result in infection.

Why Today’s Health News Often Becomes Tomorrow’s Retractions

Handle with Care: Why Today’s Health News Often Becomes Tomorrow’s Retractions

We’ve all seen it played out hundreds of times, as a drug, food or habit is trumpeted as the way to lower the risk of cancer or heart disease only to be walked back the next month in another study. The reasons can be diverse, including a flawed hypothesis, bad data or misleading conclusions, but at the center is the study design itself. A longitudinal trial may yield very different findings from an observational one, while the gold standard – a randomized controlled trial (RCT) – can be extremely costly and difficult to design. The resulting patchwork of research requires professional analysis and a wait-and-see approach until confirmation is received via follow-up studies. We share some expert insights to help you view new studies with both a healthy skepticism and the realization that some of the most important medical breakthroughs of recent years have been discovered in just this way.

Did You Know?

1,400

Number of scientific papers retracted each year
Sources: Vaccine Journal August 2018, Centers for Disease Control, Harvard Health

50%

Percentage of scientific studies confirmed in follow-up studies
Source: Healthy Aging Project, University of Colorado, Boulder

Researchers agree that a randomized, controlled trial is the best way to learn about the world. In a drug study, for instance, a population is randomly divided into groups who receive the drug and those who don’t. If properly controlled and designed, any difference in outcomes between the groups can be measured and credibly attributed to the effects of the treatment. The methodology is highly valued in evidence-based medicine, proving that associations are causal, and not just by chance. The approach has powerful real-world applications, as seen in the Women’s Health Initiative (WHI), one of the nation’s largest-ever health projects.

Begun in 1993, with more than 161,000 women enrolled, the randomized, controlled clinical trial was designed to test the efficacy of long-term hormone therapy in preventing heart disease, hip fractures and other diseases in post-menopausal women over 60 years old on average. Previous observational studies had strongly suggested the preventive benefits of hormone therapy, and it was routinely recommended for women years after menopause. What happened next was stunning.

In 2002, the trial was halted three years earlier than planned as evidence mounted that the estrogen plus progestin therapy significantly raised a woman’s chances of developing cardiovascular disease, stroke and breast cancer. Millions of women stopped taking hormone therapy, and the trial has since been credited with reducing the incidence of breast cancer by 15,000-20,000 cases each year since the results were made public. Numerous follow-up studies were conducted to dig deeper into the surprising data, and while they showed that hormone therapy may still be reasonable short-term to manage menopausal symptoms in younger women, it is no longer routinely recommended years after menopause to prevent chronic disease in women.

Similarly, Vitamin E supplements, once thought to reduce risk of heart disease, were found to not have beneficial properties and actually may increase the risk of heart disease in higher doses. Consequently, the American Heart Association now advises that the best source of Vitamin E is foods, not supplements.

The biggest takeaway from both initiatives: the critical need for randomized, controlled trials to prove that associations between an intervention and a disease are causally related.

Nutrition studies have also come under increased scrutiny, especially with the recent revelation of erroneous data published by high-profile researcher Dr. Brian Wansink, founder of the Food and Brand Lab at Cornell University. Numerous papers have been retracted as the lab’s propensity for data dredging – running exhaustive analyses on data sets to cherry pick interesting and media-friendly findings – came to light. This practice, seen somewhat frequently in food and nutrition research, may be part of why contradictory headlines seem to be the norm.

As the adage goes, data can be tortured until it says what the researcher wants to hear. That’s why your physician will always be the best source for making sense of the tremendous amount of health data released each day…so please ask!


Testing by Design

The most commonly used research models include:

Randomized controlled trial (RCT): carefully planned experiments like the WHI that introduce a treatment or exposure to study its effect on real patients; includes methodologies that reduce the potential for bias and allow for comparison between intervention groups and control groups.

Observational studies: researchers observe the effect of a risk factor, diagnostic test, treatment or other intervention without trying to change who is or isn’t exposed to it. Includes cohort studies, which compare any group of people linked in some way (e.g. by birth year); and longitudinal studies in which data is gathered for the same subjects repeatedly over years or even decades. An example is the Framingham Heart Study, now in its third generation, which has provided most of our current consensus regarding the effects of diet, exercise and medications on heart disease.

Case control study: compares exposure of people with an existing health problem to a control group without the issue, seeking to identify factors or exposures associated with the illness. This is less reliable than RCTs or observational studies because causality is not proven by a statistical relationship.

Meta-analysis:  a thorough examination of numerous valid studies on a topic, which uses statistical methodology to combine and report the results of multiple studies as one large study. This is cost-effective but not as accurate as RCTs as the individual studies were not designed identically.

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A Flu-Free Winter: Your Best Shot

Take Your Best Shot for a Flu-Free Winter

Last year’s flu season was severe in most parts of the country and left many wondering why the flu vaccine hadn’t performed more effectively. However, it remains our best line of defense for averting and lessening the severity of this common but potentially deadly illness. Below we clear up some of the most common misconceptions about the flu vaccine…and continue to strongly recommend that you make sure to get your shot of prevention this fall.

Myth: I can get the flu from a flu shot.

A flu shot will not give you the flu. The viral strains in injectable influenza vaccine are inactive and biologically unable to cause illness. The one exception is the vaccine administered in nose spray form.

Myth: The vaccine didn’t work last year, so it must be losing potency.

The amount of protection provided by flu vaccines varies by influenza virus type, and how well matched vaccine viruses are to the circulating flu viruses. Last year’s results, while lower than average, still meant that the risk of getting sick from flu was reduced by a third. This year, both types of vaccines, trivalent (protection against influenza A H1N1 and H3N2 viruses and one type of influenza B virus) and quadrivalent (four component protection to protect against two types of B viruses), have been modified to better anticipate the season’s circulating flu viruses.

Myth: The flu vaccine will also prevent other viruses.

Flu vaccines do not protect against infection and illness caused by other viruses, such as rhinovirus (one cause of the common cold) and respiratory syncytial virus (RSV), despite their flu-like symptoms.

Myth: Flu vaccines are not appropriate for people over 65, who have weaker immune systems than younger people.

Although immune responses may be lower in the elderly, flu vaccine effectiveness has been similar in most flu seasons among older adults and those with chronic health conditions compared to younger, healthy adults. It’s also important to remember that people 65 and older are at increased risk of serious illness, hospitalization and death from the flu, making the flu vaccination especially important for this age group.

Myth: There are no flu vaccines just for people over 65.

There are two vaccines designed specifically to help enhance the effectiveness in adults older than 65. A high dose vaccine, containing four times the amount of antigen as the regular flu shot, and the adjuvanted flu vaccine, which creates a stronger immune response in the elderly.

Myth: The vaccine is less effective if received every year.

Multiple studies have shown that while immune responses to vaccination may be higher among people not previously vaccinated, those who are repeatedly vaccinated still have increased immune responses and are provided protection against the flu.

Myth: I should wait as late as possible to get immunized so it lasts throughout the season.

The CDC and Advisory Committee on Immunization Practices (ACIP) recommends that you get a flu vaccination in early fall to ensure you’re protected before flu season begins. However, as long as flu viruses are circulating, it’s not too late. Receiving a vaccination in December or January can still protect you because flu season often peaks after January and can last as late as May.

Myth: Getting sick with the flu is not all that serious.

In the U.S., 36,000 people die and more than 200,000 are hospitalized each year because of the flu. Children, the elderly and people with certain chronic conditions (heart disease, lung disease, asthma or diabetes) are at higher risk for complications such as pneumonia. For everyone, flu symptoms, including fever, headaches, cough, sore throat, nasal congestion, extreme tiredness and body aches, can disrupt work and social life for up to two weeks. The flu vaccine has proven effective in both preventing flu and in lessening the severity of symptoms if flu should occur, thereby reducing the risk of hospitalization and admission to the intensive care unit.

Did You Know?

Up to 60% – Decrease in the risk of flu during seasons when most circulating flu viruses are well matched to the flu vaccine. Put another way, in 2016-17, the vaccine prevented an estimated 5.29 million illnesses, 2.64 million medical visits and 84,700 hospitalizations associated with flu.

79% / 52% – Reduction in hospitalization for people with diabetes (79%) or chronic lung disease (52%) as a result of receiving the flu vaccine.

Sources: Vaccine Journal August 2018, Centers for Disease Control, Harvard Health

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Aging Well, Aging Healthy…a continuing series

HealthWise Spring2016 Hasson 300x295

HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We have looked at strategies to keep the aging brain healthy and to protect the aging senses. In this issue, we get under your skin to learn how to keep it supple and resilient over the years.  Wrinkles. Dry skin. Crow’s feet. Undereye circles.  Sagging. Is there a way to stave off these very natural signs of aging? The answer is yes…and no. The thickening of the stratum corneum (the outer layer of the epidermis) which causes drier and flakier skin, is inevitable, as is the thinning of the dermis (underneath the epidermis), resulting in loss of elasticity.  Genetics plays a pivotal role in determining when this starts to occur. However, there are a number of preventive steps you can take – some well-known and a few unexpected – which may help mature skin keep its youthful glow at 50, 60 and beyond.

Experts advise:

  • Cut your sun exposure in half, at a minimum. UV exposure damages elastin and causes a loss of collagen, which results in sagging, fine lines and wrinkles. Think of sunscreen as the only truly magic elixir to improve skin appearance and health, and most importantly, prevent skin cancer…and choose one with SPF 30 or above and broad-spectrum UVA/UVB protection and use daily. In addition, wear a hat and UV-protective clothing outside, and try and avoid being in the sun when UV rays are strongest, between 11 am and 1 pm.
  • Exercise. Another benefit to engaging in at least three hours of physical activity weekly is the positive impact on keeping skin younger, with the potential to reverse skin aging even for those
    who start exercising late in life. New research showed that men and women over age 65 who exercised frequently had skin composition similar to 20 to 40-year-olds, with markedly thinner,
    healthier stratum corneums and thicker dermis layers. Participants’ skin “looked like that of a much younger person, and all they had done differently was exercise.” Researchers surmised
    that myokines, substances created by working muscles, may be responsible for the results, jump starting changes in cells far from the muscles themselves. They also noted that it was
    unlikely that any pill or salve would replicate the skin benefits of a workout.
  • Take short, lukewarm showers. Long, hot showers strip your skin of its natural oils.
  • Protect in winter with a humidifier to add moisture to the home, and gloves to protect your hands from drying out.
  • Focus on the right foods and beverages.  Include omega-3 and omega-6 fatty acids in your diet, preferably from natural sources such as olive oil and fish, to help protect your skin’s
    moisture barrier. Cut back on sugars which promote inflammation and can potentially damage normal production of dermal cells. Avoid high glycemic foods such as white bread and pretzels, which may also be responsible for prematurely aging skin. Drink plenty of water, but moderate alcohol intake – red wine can dilate blood vessels and contribute to rosacea, a skin irritation.
  • Establish a smart night routine. Remove all makeup and wash your face before bed to eliminate the pollutants that break down your skin’s collagen all day. Then apply a retinoid followed
    by a moisturizer.
  • Get a good night’s sleep. During the deepest stage of sleep, your body releases growth hormones for cell repair, helping your skin rejuvenate on a daily basis.
  • Minimize dark undereye circles with an extra nighttime pillow. As the delicate skin and muscle around the eyes weaken with time, the fat under the lower-lid skin can pool beneath your eye. Sleeping on two pillows can help prevent fluid accumulation.

If you want to explore other remedies, consider peels that exfoliate, and fractional resurfacing, a laser process that increases collagen production.

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Stressed Out? A Guide to Signs, Symptoms

Hasson HW 2017 Spring FINAL 293x300

“I think that you will all agree that we are living in most interesting times. I never remember myself a time in which our history was so full, in which day by day brought us new objects of interest, and, let me say also, new objects for anxiety.”

Was the above heard: 1. At a recent town hall meeting in Florida? 2. On the 2016 campaign trail? 3. During an 1898 address by a British statesman?

It may surprise you to learn that number 3 is the correct answer, and provides a welcome bit of perspective on the stress felt by every generation. While current times are considered stressful by a majority of adults, we also have better ways to identify, manage and prevent it than before.

Did You Know?

60-80%  Percentage of visits to primary care physicians for stress-related conditions.  Sources: APA, Mayo Clinic, Benson Henry Institute

Causes of stress

While stressors of American adults have remained fairly stable over the years, some are specific to the decade. As the American Psychological Association’s “2017 Stress in America” survey shows, the political climate and technology-centric world has caused an uptick in stress:

One nation, over stressed. 57% of Americans report the political climate is a significant source of stress; 66% say the same about the nation’s future. Stress about acts of terrorism was high at 59%, while worries over personal safety rose to 34%, the highest since the question was first asked in 2008.

Money, money, money. Other top causes of stress include money (61%), work (58%) and the economy (50%).

Media overload. Although nearly all adults own at least one electronic device, and more than 86% check emails, text or social media accounts daily, those who do so constantly report higher stress levels.

How to cope: For decades, stress-related issues have been recognized as the leading cause of visits to a primary care physician. Stress-relieving techniques continue to evolve:

Eat, pray, love. Exercise and going online are frequently used to manage stress. Women, how- ever, also reported spending time with friends or family, reading, engaging in prayer or eating as their primary methods of relieving stress.

Unplug. Interestingly, while 65% of Americans agree that periodically disconnecting is important for mental health, only 21% actually report doing so. Some techniques that work include no cell phones at the dinner table or while with friends, periodic digital detoxes, watching less tv, and turning off notifications for social media apps.

Trigger your relaxation response. Based on Dr. Herbert Benson’s 1974 discovery of an opposite state to the fight-or-flight response, the relaxation response puts the body in a state of deep rest. Techniques include mindful meditation, repetitive prayer, focused breathing, progressive muscle relaxation, tai chi and yoga. Studies have shown significant short-term impact on stress symptoms, as well as profound long-term improvements. Immediate reductions in blood pressure, heart and breathing rate helps manage periods of acute stress. If practiced regularly, the relaxation response can also help decrease inflammation and stress hormone levels and improve insulin activity and gastrointestinal issues.

Types of stress

Acute stress, the most common form, is experienced by virtually everyone at some point. Arising from the pressures of current conditions, and anticipated ones in the near future, acute stress can be exciting, even motivating, but too much is simply exhausting.

Symptoms: Emotional distress, such as anger, irritability, anxiety or depression; muscular problems including tension headache, back or jaw pain; stomach and bowel problems; temporary elevation in blood pressure; rapid heartbeat; sweaty palms, heart palpitations; dizziness; shortness of breath.

Solutions: This stress is short-term and highly manageable. Techniques to slow your breathing and focus your attention, as well as walking outdoors or participating in sports, can all help dispel it.

Episodic acute stress is a fact of life for those people who are always rushed, late and dealing with a plethora of self-inflicted demands and pressures. This category includes “Type A” personalities – aggressive, impatient, short-tempered. Another type of person who feels episodic acute stress is the worrier – those with a pessimistic world view and a tendency to catastrophize every situation; likely to also feel anxious and depressed.

Symptoms: Persistent tension headaches, insomnia, migraines, hypertension, chest pain and heart disease.

Solutions: Lifestyle changes, such as daily physical exercise, meditation and mindful prayer, as well as expanding social support, can help. Additionally, consider consulting with a psychologist or other mental health professional, who can offer a range of treatment, from pharmaceutical to biofeedback. For example, insomnia, a considerable source of stress in adults, can be remedied with cognitive behavioral therapy, CBT-I, a structured program to help replace negative or obsessive thoughts that keep you up at night with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

Chronic stress wears people down on a daily basis, often for years. Whether the cause is a dysfunctional family situation a bad career fit, people suffering from chronic stress often can’t see a way out.

Symptoms: Anxiety, insomnia, muscle pain, high blood pressure, weakened immune system; can contribute to the development of heart disease, depression and obesity.

Solutions: The most effective strategy is to seek help from professionals who can help you develop and implement lifestyle and behavior changes, recommend therapy, and prescribe medication when needed.

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The Connected Patient: Keeping Up with Apps

apps-

The ubiquitous smart phone has boosted its useful- ness tenfold in the past decade with a mushrooming library of health and wellness apps. Some aim to help you monitor your condition day-to-day, understand and stay on track with medications, or diagnose your symptoms, while others prepare you for an unforeseen emergency, allow you to share information electronically with your physician or receive education and encouragement between doctor’s appointments. With almost 200,000 apps already on the market, the real challenge is identifying the treasures that are credible, accurate and can guide you toward a healthier lifestyle. Some notable apps are listed below; all are available for iPhone (in iTunes store) and Android (Google Play).

Condition-specific information

Diabetes Tracker and One Drop offer comprehensive logging of glucose, food, medication and activity; GluCoMo works as an electronic diary to store data for blood sugar levels, weight, insulin intake, pulse rate, blood pressure and other information.

AsthmaSense and AsthmaMD provide tools to manage the disease with a digital record of triggers, medications and testing.

The National Comprehensive Cancer Network Patient Guides for Cancer covers 25 different types of cancer, with medical illustrations, information on screening, treatment and follow-up, and questions for patients to ask their physician.

A healthier lifestyle

MyFitnessPal Calorie Counter & Diet Tracker remains one of the best diet trackers, allowing you to log meals and weight data for an at-a-glance view of your intake on the dashboard.

Nike+ Running and Garmin Connect lets you log distance, time and intensity of jogs and runs; Endomondo enables logging and sharing of information from walks, hikes and cycles; Trails, known as the ‘ultimate walker’s app,’ provides topographical tracking of your strolls; and 7 Minute Workout provides exercise timers, instructional videos and a personalized exercise plan.

Buddhify and Omvana offer guided meditation tracks, ranging from three minutes to an hour.

Deep Sleep with Andrew Johnson features step- by-step instructions to guide yourself into meditation and a restful sleep and Sleep Cycle provides easy- to-read graphs to help you make sense of your sleep patterns and wakes you when you will feel the least groggy.

Medication tracking

Drugs.com is an easy way to look up drug informa- tion, identify pills, check interactions with different drugs and foods and set up your own personal medication records. A symptom checker powered by Harvard Health Publications is included with the app. CareZone will curate a list of medications, dosages, and schedules directly from your photo library, enable you to share symptoms with your doctor, store insurance information and schedule reminders for upcoming appointments.

GoodRx shows current pricing for your prescrip- tions at nearby pharmacies.

Round Health and Medisafe make it easier to follow a medication regimen with reminders on timing and dosage for each prescription, customized to your schedule.

Healthcare news

For information you can trust, check out Medscape MedPulse, a robust news aggregator for the world of medicine and UptoDate’s patient information section, featuring evidence-based, peer-reviewed information on hundreds of medical topics.

First aid

Download First Aid by American Red Cross to receive simple step-by-step instructions to guide you through everyday first aid scenarios, from asthma attacks to broken bones; there’s a Pet First Aid app as well; and Resuscitate! CPR AED & Choking, developed by doctors and educators at the University of Washington, features short videos on how to perform CPR, operate commonly available Automated External Defibrillators (AEDs) and aid a choking victim.

New parents

BabyBump helps parents-to-be keep track of the stages of pregnancy, doctor’s appointments, and share their news on social networks when baby arrives; Sprout offers 3D images of baby’s growth by the week and advice on essential items needed for the newborn.

KidsDoc from the American Academy of Pediat- rics offers expert advice to help parents make smart decisions on level of care needed for their child’s illness or injury.

Please remember: an app, no matter how sophisticated or technologically advanced, cannot replace a phone call or visit to your personal physician.

Sources: Digitaltrends.com, Harvard Health, imedicalapps.com

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Gut Instincts: Can More Bacteria Mean Better Health?

bacteria

Healthy bacteria may seem like a contradiction in terms, but years of research and real world experience point toward an unexpectedly promising finding: the microorganisms continually forming in your intestine may confer health benefits that we are only just beginning to understand.

Here is what we know: each of us has an individual set of microbes, collectively known as the microbiome, from the moment we are born, starting with our mother’s bacteria and then continuing to gather new microbes throughout our life as a result of environmental influences. Among these are probiotics, needed and beneficial bacteria which support the bacteria that live within us. Their numbers can become challenged by factors that include antibiotics, poor diet or travel. Scientific investigators are finding their impact on overall health can be significant. The chemicals they emit may interfere with the way food is digested, medicine is deployed, and even how a disease progresses, according to experts.

Research in the last decade on manipulating the microbes within has been varied and extensive, involving antibiotics, probiotics and prebiotics (dietary fibers that promote the growth and met- abolic activity of beneficial bacteria, including probiotics). The results of numerous studies suggest that certain types of probiotics may play a potential role in reducing gastrointestinal illnesses, including inflammatory bowel diseases, antibiotic-related and infectious diarrhea and irritable bowel syndrome. Additionally, the benefits of probiotics may extend into enhancing immune function. The idea that probiotics can improve the ability to fight off colds, promote a healthy urinary tract, reduce the risk of eczema, allergies and possibly Parkinson’s disease, in preliminary studies, has gained traction with nutritionists and gastrointestinal physicians alike.

As with all touted healthcare advancements, however, a note of caution should be sounded.

According to the American Gastroenterological Association (AGA) Institute, adding probiotics to your diet, especially in the form of a supplement, should only be done in consultation with your physician. Some probiotics may not be appropriate for seniors, others may interfere with or interact with medication. Not all strains are the same, and while a specific kind of Lactobacillus may help prevent an illness, that doesn’t necessarily mean that another kind of Lactobacillus would have the same effect or that Bifidobacterium probiotics would work. The same advice applies to adding prebiotic supple- ments to your diet. Although a great deal of research has been done, much remains to be learned. The encouraging news: gaining a comprehensive picture of the microbiome is a matter of intense interest to the medical community, and will be further advanced in 2017 by programs such as the government-funded $121 million National Microbiome initiative.

The best approach now? To promote intestinal health, make sure your diet includes foods that are good sources of fiber, probiotics and probiotics:

  • Fiber: Fruits, vegetables, whole grains, legumes and nuts
  • Prebiotics: Oats, flaxseed, onions, garlic, chicory root, Jerusalem artichokes, bananas and greens
  • Probiotics: Yogurt, buttermilk, kefir, soft cheeses, sauerkraut, and other fermented foods like kombucha

Did you know?

100 trillion
Number of bacterial cells in the human digestive tract
Source: International Scientific Association for Probiotics and Prebiotics

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Try a New Approach to Food in the New Year: Stop Dieting and Focus on Mindful Eating

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The dieting-overeating-weight regain cycle is almost inevitable, not because people fail diets but because diets fail people. It is important to understand that rebound overeating happens to almost everybody, and should not be viewed as an individual weakness or fault. The main reason diets do not work over the long term is they create deprivation and promote a loss of the internal signals for hunger and fullness that are necessary for normal eating. In fact, dieting sets in motion physiological and psychological factors that actually trigger overeating.

How does mindful eating address the dieter’s dilemma?

Mindful eating begins when you ask: Do you know when you are hungry? Do you eat when you are hungry? Do you eat what you are hungry for? Do you stop when you are full? If you answered “yes,” you’re in tune with your body’s natural hunger signals. If you replied “no,” you may be out of touch with your true hunger needs.

How do you teach people to change their eating habits of a lifetime and adopt mindful eating?

It begins with learning how to identify your physical hunger. If you experience symptoms such as headaches, weakness, shakiness, irritability and lightheadedness, you may have waited too long to eat, and unfortunately, are now at high risk for overeating. Instead, look for an empty or gnawing feeling. The Hunger Scale above is a tool to help you evaluate your internal state. Ideally, you would stay in the range of ‘hungry’ to ‘full’ so you don’t become ravenous or stuffed. As you consistently ask yourself, “Am I hungry?” you will become better able to recognize your body’s needs.

The next step is deciding what to eat when you are physically hungry. When people eliminate categories of food in pursuit of weight loss, they frequently experience deprivation that ultimately leads to overeating the very foods they tried to avoid. Instead, think of what will truly satisfy you and supports your body as you make the match. Also take into consideration what will best support your body’s needs. For instance, those with high cholesterol might choose sorbet instead of ice cream if they are craving a cold, sweet snack. Consider not just taste, but feel – do you crave hot, cold, crunchy, smooth, salty, sweet, spicy, etc? If you eat what you are hungry for when you are hungry, you will find a moment when your stomach feels satisfied.

Is this process effective for most people?

Absolutely. The key is to be consistent and keep accumulating attuned eating experiences day in and day out.

 Will I lose weight by becoming a mindful eater?

If weight loss occurs, it will be a side effect. However, I urge people to not use weight as a measure of success or failure. Health is so much more than just numbers on the scale, and a positive relationship with food along with a focus on physical activity, good sleep habits and regular medical care are much more important.

Did You Know?

33 – 66 Percentage of dieters that regain more weight than they lost on their diets

 What is ‘mindful’ or ‘attuned’ eating?

Attuned eating teaches people to reconnect with their natural, inner signals that guide them as to when, what and how much to eat…literally bringing harmony into their relationship with food and allowing them to experience the real joy of eating. Mindfulness means bringing awareness to the experience without judgment or distraction. It is a transformative process that takes some time before people are able to honor their natural cues for hunger and satiety.

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Sleep: A Prescription for Better Health

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In today’s time-pressed world, a full night’s sleep has become akin to a luxury, but beware: it is a vital necessity. Lack of sleep affects your health, from stress to heart disease to overall well-being. Even an occasional all-nighter impedes our ability to concentrate, analyze information, and significantly, to drive, making sleepiness at the wheel the cause of over 100,000 car accidents each year.

Call it a by-product of our increasingly hectic lifestyle: we now sleep two hours less nightly than our ancestors, and in just the last decade, another 38 minutes has been shaved off. Despite the fact that at least seven to nine hours of sleep is recommended for the average individual under 65, and for over 65, an average seven to eight hours, 40 percent of adults report sleeping less than six hours nightly. Additionally, between 50 and 70 million adults suffer from some sort of sleep disorder, with one in three saying they had trouble falling or staying asleep, according to the National Sleep Foundation.

To sleep, perchance to dream…

To understand why these numbers concern the medical community, consider how critical sleep is to human functioning. Many essential physiological activities that aid digestion, cell and tissue repair and growth, muscle growth, protein synthesis and release of growth hormone occur mostly, or sometimes only, during sleep. Sleep also regulates the hormones epinephrine, dopamine and serotonin, which are closely linked to mood and behavior.

The rejuvenating power of sleep is most evident during REM (rapid eye movement). This deepest, last, and most important phase accounts for 25 to 30 percent of the sleep cycle, when dreaming occurs. At this point, the learning region of the brain is stimulated, new neuronal connections are formed and proteins associated with aging and neural degeneration are eliminated. For example, one expert theory states the production of adenosine in brain cells remains high during wakefulness, but promotes the “drive to sleep.” Once the body has a chance to clear adenosine from the system during sleep, we wake feeling rested and more alert.

What happens when the body is regularly deprived of life-sustaining sleep? It’s enough to keep you more awake at night, with research pointing to the potential for: more frequent colds; irritability; lower quality of life; elevated blood pressure which can increase the risk of kidney disease; decreased insulin sensitivity and glucose tolerance (diabetes); impaired pancreatic cell responsiveness; calcification of coronary arteries (heart disease and stroke); mood disorders (anxiety and depression); and obesity (lower levels of appetitecontrolling hormone, leptin, and higher levels of ghrelin, which tends to make people ravenous). The immune system is particularly affected, as production of proteins needed by the body to fight infections and inflammations decreases.

Sleep easy

Reassuringly, an extra 15 to 30 minutes of sleep each night can make a significant difference in overall health and quality of life. Sleep specialists offer these tips:

  • Disconnect. Sixty percent of Americans bring electronic devices along for the night. “We can’t resist the stimulation,” says Sleepless in America director John Hoffman. “It’s exceeding anything that we were designed to experience…its keeping us up beyond what we’re designed for.” Turn off phones, tablets and TV one hour before sleep time.
  • Avoid alcohol before bedtime. Trickier than caffeine, alcohol typically makes it easier to fall asleep but the sleep is of poorer quality. Most people will fall asleep sooner, but spend less time in REM sleep and consequently wake up feeling less refreshed.
  • Adjust your bedroom environment by decreasing light, noise and temperature so that you are comfortable for the night.
  • Avoid discussing emotional issues or exercising right before bed, both of which can cause the body to secrete the stress hormone cortisol, associated with alertness.
  • Try mindful meditation. Focusing on breathing and remaining in the present moment was found to improve sleep quality in older adults with moderate sleep disturbance, according to JAMA Internal Medicine.
  • Reset your body clock. Frequent travelers and seniors are at particular risk for sleeping problems, including advanced sleep phase syndrome, which causes earlier than normal sleepiness and too-early wake up the next morning. Using specialized light boxes before bed or taking melatonin, the “sleep hormone,” have proven effective in readjusting circadian rhythms.

Still can’t get a good night’s sleep? Please call my office.

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