Perhaps with this topic I should suggest people read it with a dose of caffeine to prevent the induction of sleep. Apart from exercise, it’s probably the thing that people in western cultures get too little of. Getting the right amount of sleep is important. Even though eight hours is what is usually quoted as what we need every night, the reality is some people might only need seven hours and others nine.

It’s important to sleep long enough to get into REM sleep several times. REM sleep is the period of sleep where dreams occur. It isn’t totally clear why we dream but it seems to be related to consolidating memories. It may also be beneficial to mental health.

However it is not just the total amount of hours we get, but the quality that counts as well. The quality of the sleep is important as well. If someone wakes up multiple times because they have obstructive sleep apnea (OSA) they might not wake up feeling rested. OSA also predisposes to hypertension, arrhythmias, and fatigue.  If one is fatigued enough, even things like driving can be dangerous (if you haven’ slept enough and are fatigued enough, you can be driving as if you’ve had too much to drink).

Insomnia and non refreshing sleep can have many causes.  Whether it’s OSA, restless leg syndrome, depression, or other causes, treating underlying causes can often improve sleep quality without the use of medications such as Zolpidem. Getting good sleep hygiene is important to getting and remaining asleep. Going to bed the same time every night is important, even on weekends and  vacations. Waking up the same time every day is important. If you can’t fall asleep within about 10-15 minutes of getting into bed, it’s suggested that you get up and do something else for a while, like reading.  If having good sleep hygiene doesn’t help one’s insomnia, talk with your doctor to see what else can be done, and consider referral to a sleep specialist.

I realize this blog post is a bit on the short side. I will hopefully be writing another post about going into more detail about sleep, causes of insomnia, how to sleep better, etc in the near future.

Food and Health.

This won’t be an all-inclusive blog posting. To be all inclusive would require a novel, or at least novella, length blog post. People who have read earlier blog posts will know that I’m a fan of people eating healthy and not a huge fan of “fad diets”. The best healthy diet is the one you can adhere to.

As I’ve mentioned in other posts, and can be found online, diet and other lifestyle options can affect one’s chances of developing various chronic diseases. Though in this post I’ll be limiting myself to diet, and just a few things about it as well – and save other comments and suggestions for another time.

One piece of advice I can remember getting is to make sure one’s plate (ok, the food on one’s plate) is colorful as in having a lot of different colors. Granted in some cases (carrots and spinach) the colors don’t really indicate that they’re both high in the Vitamin A precursor Beta – Carotene, but both are (and have different profiles of how much of other healthy vitamins and fiber they have). Making sure that there are differently colored foods also means you’re likely to get other benefits. Both blueberries and cherries have a lot of antioxidants in them which can affect health. Though I think that we tend to look at their antioxidant effects too much at the expense of other effects they might have, such as on sugar absorption and metabolism. Never mind that blueberries and cherries also contain some fiber. There is growing evidence that blueberries can help prevent/treat type 2 diabetes. This doesn’t mean, however, that eating them replaces medications such as metformin, acarbose, rosiglitazone, and many others. Cherries may carry a similar benefit.  Tart cherries are touted to have anti-inflammatory effects and might help reduce the need for non steroidals in some people.

The fatty acids one eats can also affect health profoundly. The N-3 (also known as omega-3) fatty acids not only help protect against heart disease, but also seem to have a role in preventing depression and helping treat it as well. Though depression as an inflammatory mediated illness has gotten some press (though at the moment I don’t have a reference for that, and who hasn’t felt miserable when (s)he has a cold or the flu), it also avoids the fact that N-3 and N-6 fatty acids also get incorporated into cell walls, including nerve cells. This incorporation also affects the fluidity of the cell walls and therefore how well receptors work as well as how easily (or hard) nerve cells release neurotransmitters.

My advice, as always, is to try to avoid getting vitamins and such through supplements for a few reasons:

  1. In some cases they can do more harm than good (especially true of fat soluble vitamins). In one study, smokers that took vitamin A supplements had higher rates of lung cancer than those that didn’t.
  2. You might not be getting all the relevant forms of particular vitamins. For example, there are different forms of vitamin K, some promote clotting, others bone health.
  3. With a varied diet, one can get enough vitamins and antioxidants without supplements. You have to eat anyhow, even if you buy pills.

There are several times, however, where it might be worthwhile. For example:

  1. If you have had a gastric bypass, or a stomach resection for another reason, taking supplemental B12 is important so as to keep stores normal.
  2.  If you have a disease, or take a medication, that interferes with absorption of particular vitamins (Crohn’s and other diseases that affect the ileum can interfere with absorption of B12, anti ulcer mediations do the same.)

I’ve talked about diet before (The Pantry Prescription) so I won’t go into it today. I may do an updated version of  that post in the future.

Anyhow, here are some references to a few of the things I’ve mentioned today:

Coultrap, S. J., Bickford, P. C. & Browning, M. D. Blueberry-enriched diet ameliorates age-related declines in NMDA receptor-dependent LTP. Age (Dordr) 30, 263-272 (2008).

Ren, T., Zhu, J., Zhu, L. & Cheng, M. The Combination of Blueberry Juice and Probiotics Ameliorate Non-Alcoholic Steatohepatitis (NASH) by Affecting SREBP-1c/PNPLA-3 Pathway via PPAR-α. Nutrients 9, (2017).

Stull, A. J. Blueberries’ Impact on Insulin Resistance and Glucose Intolerance. Antioxidants (Basel) 5, (2016).

Lee, Y. M. et al. Dietary Anthocyanins against Obesity and Inflammation. Nutrients 9, (2017).

Mazaherioun, M. et al. Long Chain n-3 Fatty Acids Improve Depression Syndrome in Type 2 Diabetes Mellitus. Iran J Public Health 47, 575-583 (2018).

Masoumi, S. Z. et al. Effect of Citalopram in Combination with Omega-3 on Depression in Post-menopausal Women: A Triple Blind Randomized Controlled Trial. J Clin Diagn Res 10, QC01-QC05 (2016).

Grant, R. & Guest, J. Role of Omega-3 PUFAs in Neurobiological Health. Adv Neurobiol 12, 247-274 (2016).

Husted, K. S. & Bouzinova, E. V. The importance of n-6/n-3 fatty acids ratio in the major depressive disorder. Medicina (Kaunas) 52, 139-147 (2016).

Kobayashi, M. et al. Dietary n-3 Polyunsaturated Fatty Acids in Late Pregnancy and Postpartum Depressive Symptom among Japanese Women. Front Psychiatry 8, 241 (2017).

Levant, B. & Healy-Stoffel, M. N-3 (Omega-3) Fatty Acids: Effects on Brain Dopamine Systems and Potential Role in the Etiology and Treatment of Neuropsychiatric Disorders. CNS Neurol Disord Drug Targets (2018).

Pusceddu, M. M., Kelly, P., Stanton, C., Cryan, J. F. & Dinan, T. G. N-3 Polyunsaturated Fatty Acids through the Lifespan: Implication for Psychopathology. Int J Neuropsychopharmacol 19, (2016).


Let the Sunshine In.

With spring temperatures climbing higher, and with summer around the corner, I figure this is a good time to remind people about sun exposure, and using sunscreen. Too much sun exposure – or the use of tanning booths – is a risk factor for melanoma (one of the deadliest cancers) and of squamous cell carcinoma. This is especially true when one gets a sunburn. I forget where I read this statistic, but a sunburn doubles one’s risk of skin cancer (though before getting too panicky, it could mean going from a  1% chance to a 2% chance. Or 5% to 10%. I don’t want to quote exact numbers since I don’t have them handy and it probably also depends on how easily one gets a sunburn, location, skin tones, etc). This increase in risk is why I think doctors tend to encourage taking vitamin D supplements rather than suggesting sun exposure to get enough vitamin D.

However there are other reasons for getting some sunlight as one uses precautions to prevent sun burns:

  1. There might be other benefits to getting sun beyond its effects on vitamin D levels. Believe it or not it might help wiht blood pressure!! I’ll put a link at the end of this post.
  2. It might have effects on preventing other diseases as well, though it might be due to improved vitamin D levels and not some other effect light has on health.
  3. Getting outside and exercising can improve health (though any exercise, even if done indoors, such as exercising in a gym works too).

However to reduce the risk of skin cancer, there are several things one can do to minimize the risk:

  • Use Sunscreen, at least SPF 15. And reapply if you’ve gone swimming, sweated a lot or if it’s been a few hours since you last applied sunscreen.
  •  Use wide brimmed hats as much as possible. Baseball caps don’t cover your necks or the back of your neck.
  • Get sun early in the day, or later in the afternoon. In other words, don’t go out to get sun when the sunlight is at it’s strongest.
  • Remember, even if you’re only in the sun for 15 minutes, you can get sun damage so sunscreen is important even if you’ll be in the sun for short periods
  • wear long sleeves and long pants if possible.


Anyhow, Here is the link, and a couple of references for those who want to dig deeper into this topic.

Could the sun be good for your heart?


Fernandes, M. R., & Barreto, W. D. R. (2017). Association between physical activity and vitamin D: A narrative literature review. Rev Assoc Med Bras (1992), 63(6), 550-556. doi:10.1590/1806-9282.63.06.550
Fleury, N., Geldenhuys, S., & Gorman, S. (2016). Sun Exposure and Its Effects on Human Health: Mechanisms through Which Sun Exposure Could Reduce the Risk of Developing Obesity and Cardiometabolic Dysfunction. Int J Environ Res Public Health, 13(10). doi:10.3390/ijerph13100999
Hoel, D. G., Berwick, M., de Gruijl, F. R., & Holick, M. F. (2016). The risks and benefits of sun exposure 2016. Dermatoendocrinol, 8(1), e1248325. doi:10.1080/19381980.2016.1248325
Langer-Gould, A., Lucas, R., Xiang, A. H., Chen, L. H., Wu, J., Gonzalez, E., . . . Barcellos, L. F. (2018). MS Sunshine Study: Sun Exposure But Not Vitamin D Is Associated with Multiple Sclerosis Risk in Blacks and Hispanics. Nutrients, 10(3). doi:10.3390/nu10030268
Rivas, M., Rojas, E., Araya, M. C., & Calaf, G. M. (2015). Ultraviolet light exposure, skin cancer risk and vitamin D production. Oncol Lett, 10(4), 2259-2264. doi:10.3892/ol.2015.3519
Santos Araújo, E. P. D., Queiroz, D. J. M., Neves, J. P. R., Lacerda, L. M., Gonçalves, M. D. C. R., & Carvalho, A. T. (2017). Prevalence of hypovitaminosis D and associated factors in adolescent students of a capital of northeastern Brazil. Nutr Hosp, 34(5), 1416-1423. doi:10.20960/nh.1097
Weller, R. B. (2016). Sunlight Has Cardiovascular Benefits Independently of Vitamin D. Blood Purif, 41(1-3), 130-134. doi:10.1159/000441266

The 100-year-old scientist who pushed the FDA to ban artificial trans fat – The Washington Post

The 100-year-old scientist who pushed the FDA to ban artificial trans fat – The Washington Post.

Though this link is on the older side, it does get me thinking. I feel like different foods or food groups are either vilified (get rid of fat!!) or put on pedestal (This superfood belongs in everyone’s pantry!! Go out and buy it now or the world will end!).  I know I’m being a bit hyperbolic when I put it like that. However I think that when talking about foods and supplements, it’s better to take a data driven view that is more even keeled. Not all fats are bad.  Trans fats definitely fit into the bad category. Fats are essential in our diet, without them there are key nutrients that we couldn’t absorb such as vitamins E, A, K, and D (though this last one we can make ourselves).

Aside from needing some fats in our diet, some fats are necessary for our diet since we can’t make them ourselves. N-3 and N-6 fatty acids are in this category.  Also known as omega-3 and omega-6 fatty acids, they’re used by the body to make prostaglandins and leukotrienes, which our body uses to help regulate many processes. The help regulate the immune system: in fact omega-3 fatty acids help reduce inflammation and omega-6 promote inflammationFatty acids make up the walls of our cells as well as the organelles inside cells.  How much of our diet fats should make up is something people can debate –  some (like Dr. Dean Ornish) advocate a low fat  – 5% of calories – diet. Others are at the other end of the spectrum. I won’t get into arguing who’s correct, though Dr. Ornish does has  data to show what he suggests helps reverse heart disease. Though to be fair, his program/views also advocates exercise, meditation, and other lifestyle changes, all of which affect heart disease and longevity so one can’t totally point to the low fat aspect and say that is the sole determinant of his success and data.  I think most would suggest 20-30% of calories come from fat. It’s important to get enough of what are called N-3 (or omega-3) fatty acids as well as N-6 (omega-6) fatty acids.

People trash carbohydrates a lot as well. My view of this is that refined sugar should be used sparingly. If one puts sugar in his/her coffee and only occasionally has something else that is sugary (donuts anyone? Ice Cream?), the world won’t end. If having something that is sweet helps keep someone eating healthy but not feel like they’re denying  themselves, then it’s ok.

The big danger is to lump all carbohydrates together. Yes, having some refined sugar is ok, and simpler sugars are ok in moderation: if you’re getting them by eating an apple or an orange, that’s ok. But when we talk about fiber, we’re actually talking about complex sugars which our bodies can’t digest or breakdown. These are actually healthy sugars! If I haven’t done so already, I’ll probably talk more about the specifics in a future blog.

My whole point of this particular blog is to use the above link to have people think about what they hear or read about nutrition, especially if what they hear is lumping all of a particular food/food group together for good or bad!

What’s the Secret to Longevity? Lessons from “Blue Zones” Worldwide – MPR

What’s the Secret to Longevity? Lessons from “Blue Zones” Worldwide – MPR.

I found this article interesting, although  it’s a few years old. I don’t know how the life span compares to communities surrounding the ones listed. The things each community does or has do sound a lot like the health advice given to patients to stay healthy and each community has things in common with each other.

The things that likely make a “blue zone” a blue zone are as follows:

1) They maintain a healthy plant based diet. With the exception of Seventh Day Adventists who don’t eat meat at all, meat is only eaten either in moderation or very rarely. In Okinawa people grow their own food, which also means they’re outside walking, bending, exercising, etc.

2) Exercise is done. It can be physical work, it can be walking. Current recommendations are for 2.5 hours of exercise a week (this works out to roughly 20-30 minutes daily).

3) People are part of  the community. Some have made the claim that regular church going helps you live longer. Given that there’s no empiric evidence for a higher power, it’s more likely the social contacts, the sense of belonging or being part of something greater than oneself that help maintain emotional health. I won’t ponder more about this at the moment. At this point I’m planning a post talking more about this because it deserves a post of it’s own (or two).

Of note, I haven’t been too active blogging here the past couple of years and am planning on becoming more active in doing so. I am considering adding another blog where I talk about self care things people can do to helps stay healthy and keep this blog to talk more about medicine itself, and  talk about specific illnesses. Let me know which (an additional blog about staying healthy/self care issues + this one or an “all in one” blog) you think would work better.

10 Biggest Nutrition Myths—Ever

>10 Biggest Nutrition Myths—Ever

I am a big fan of having people eat a healthy diet. The best of all possible worlds, doctors would know more about diet and have the time to talk with/educate their patients about this. Additionally everyone would have access to a nutritionist/Registered dietitian and access to healthy foods.  Lastly, people would not buy into fad diets or believe all of the mis information out there. Here is a list of some things to keep in mind.

Better Sleep May Be Incredibly Important to Alzheimer’s Risk

Better Sleep May Be Incredibly Important to Alzheimer’s Risk.

Sleep disturbances are common. Sometimes patients have come in with sleep problems that are clearly related to temporal issues (such as stressors like a death in the family, work stress, etc).

It is the people that come in with chronic issues which I think are challenging. Some patients have come on while on medications chronically to help with sleep. One concern is that they end up being too dependent on medications to sleep. When seeing things like this, it makes me wonder if patients on sleep medications chronically are altering their sleep architecture enough that it still puts them at risk for things.

Some sleep issues, such as obstructive sleep apnea, do put one at risk for things like high blood pressure, irregular heart rhythms, etc. luckily for that things like weight loss, CPAP machines, etc can help without the use of medications. This article does make the case for getting good sleep regularly!