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).


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.

Random Thoughts on Women’s health

I’m dividing this post into two parts. The first is on the recommendations for screening in females. The other part is some general thoughts on women’s health in general (and are somewhat generalizable to anyone’s health, male or female). The recommendations are taken from USPSTF related sites.

If you’ve read any or all of my earlier posts, you know I’m into screening and catching diseases early, especially if there is treatment for the particular disease.

Women should get pap smears every 3-5 years with HPV testing. The frequency depends on a woman’s age, whether the pap smear is negative and the results of HPV testing. It is important that the HPV testing be done via one of the five tests that are FDA approved: the unapproved tests from what I understand are more prone to error. Ask your doctor if he or she knows whether the lab he or she uses is FDA approved.

Screening for STIs (sexually transmitted infections) is suggested. This includes syphilis and HIV in high risk individuals.

Breast cancer screening (mammography) is done every 1-2 years starting at 50 (the old recommendations were every two years starting at 40, then yearly after age 50). BRAC testing should only be done if there is a family history of breast, ovarian, peritoneal cancer.

Bone density should be done at least once after age 64. However one can consider doing bone densitometry at an earlier age.

As much time and energy that people put into screening for breast cancer, cervical cancer, etc I think there a tendency forget about screening for heart disease and colorectal cancer, things I think people tend to see as “a man’s disease”.   However in 2010, 23.5% of deaths in women were due to heart disease,  and 22.1% were due to cancer deaths (this includes all cancer deaths, not just breast cancer).  Lung cancer killed 70,000 women whereas breast cancer killed 40,000 women that same year. These are  for the most part “lifestyle diseases” in as much as most lung cancer is caused by smoking; diet, lack of exercise, obesity contribute to heart disease. These are all things that are modifiable to a  great extent.