Monday, June 23, 2014

Live Long & Prosper Newsletter #5

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP. 

Nutrition
1.   Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis.
   Based on 16 studies, people who eat > 1 egg/day have a 42% greater risk of getting diabetes, relative to those who eat less than 1 egg per week.
August 28, 2013

2.   Effect of the vegetarian diet on non-communicable diseases.
   The science overall is very favorable for vegetarian vs omnivorous diets. E.g. "RRs for all cancers were 0.82 (0.73-0.93) in pescetarian and 0.88 (0.81-0.96) in vegetarians". However "vegetarian diets may lead to an inadequate intake of several important nutrients, particularly Fe, Zn, vitamin B12 and n-3 PUFA, which are associated with some disadvantages and health risks" So perhaps don't be strict and perhaps take a supplementary multivitamin containing just a little zinc, iron, B12 and omega-3s.
August 29, 2013
Exercise
1.   A non-exercise testing method for estimating cardiorespiratory fitness: associations with all-cause and cardiovascular mortality in a pooled analysis of eight population-based cohorts.
   Ho hum another big study shows people who are physically fit live longer.
August 25, 2013

2.   The role of physical activity in cancer prevention, treatment, recovery, and survivorship.
   With all these studies the question is: is this association causal or not? For this review, they found " all-cause mortality in cancer survivors decreases with increasing amounts of exercise". Does the exercise reduce your risk of cancer recurrence? Or are people who are not likely to get cancer recurrence for other reasons, happen to walk more? We don't know but I figure better to put yourself in the lower risk category if you can!
August 29, 2013
Lifestyle
1.   Multicenter, Randomized Controlled Trial of Yoga for Sleep Quality Among Cancer Survivors.
   Cancer survivors have a high incidence of sleep problems. Yoga helps these problems.
August 15, 2013

2.   Smoking status, physical health-related quality of life, and mortality in middle-aged and older women.
   Women who smoke have lower quality of life and higher mortality. The more you smoke, the bigger the effect.
August 15, 2013
Prevention
1.   Mediterranean Diet and Cardiovascular Disease: Historical Perspective and Latest Evidence
   "Contrary to the pharmacological approach of cardiovascular prevention, the adoption of the Mediterranean diet has been associated with a significant reduction in new cancers and overall mortality". If you have high cholesterol, it might be just as important to switch to a Mediterranean-style diet as it is to take medications to lower your cholesterol.
October 8, 2013

2.   The joint association of physical activity, blood-pressure control, and pharmacologic treatment of hypertension for all-cause mortality risk.
   "Physical activity may be as or even more important than pharmacotherapy for reducing the risk of mortality in adults with hypertension. However, the risk of mortality remained higher for physically active adults with treated and controlled hypertension than did the risk of mortality for physically active normotensive populations. Prevention of hypertension is therefore imperative for reducing the all-cause risk of premature mortality in adults. " We have been telling patients to think of physical activity as the most important medication you can take. Take it every day.
October 23, 2013
Safety
1.   Light physical activity is a better determinant of lower adiposity during the menopausal transition.
   Starting menopause? Lighter-intensity physical activity was best to prevent fat gain.
August 22, 2013

2.   Diet and food allergy development during infancy: Birth cohort study findings using prospective food diary data.
   More helpful tools for nagging your daughter-in-law: "An infant diet consisting of high levels of fruits, vegetables, and home-prepared foods is associated with less food allergy by the age of 2 years."
August 22, 2013

3.   [Cognitive behavioral therapy for chronic insomnia].
   Have insomnia? Consider seeing a therapist. Cognitive Behavioral Therapy improved insomnia in 80% tested.
August 22, 2013

Tuesday, April 22, 2014

Return Old Prescription Drugs April 26


Have old prescription drugs that expired?  Or ones that you don't take anymore?  Saturday, April 26th is the day to safely discard these medications.  See link for more information and to find a site near you:

Sunday, April 6, 2014

Live Long and Prosper Newsletter #4

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP. 

Nutrition
1.   Relationship of sedentary behavior and physical activity to incident cardiovascular disease: results from the Women's Health Initiative.
   Women who sit over 10 hours per day have 18% higher risk of cardiovascular disease relative to those who sit less than 5 hours.
August 15, 2013

2.   Morbidity prior to a diagnosis of sleep-disordered breathing: a controlled national study.
   Sleep apnea is thought to make us sick in many ways. This study found that people with sleep apnea had more health problems, from head to toe, for 3 years prior to their diagnosis. Is this because undiagnosed sleep apnea was eating away at their health for years before anyone knew? Or whatever causes sleep apnea (especially overweight) is also causing other problems. Unclear from this study.
August 16, 2013


Exercise
1.   Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention.
   If you have coronary artery disease, you should go for cardiac rehabilitation and exercise training program. You will probably live longer.
August 14, 2013

2.   Healthy lifestyle behaviors and decreased risk of mortality in a large prospective study of U.S. women and men.
   Very large 13 years study, following over 2 million person years of Americans' lives. Findings are compelling. Achieving any of these key health goals reduces your mortality significantly. * abdominal leanness (waist under 34 inches in women or 40 inches in men) * nonsmoking * regular exercise (60 minutes vigorous/week or 150 minutes moderate) * Mediterranean diet People who achieved all 4, had a whopping 73% of reduction of their mortality relative to those who achieved none.
August 15, 2013

Lifestyle
1.   Consequences of Nocturia.
   Get up to pee at night? We have a word for you people: nocturic. It is a significant source of sleep problems and other health problems. Frequent nighttime awakenings in general can be a sign of SLEEP APNEA, a common, underdiagnosed problem that very much affects quality and quantity of life.
August 12, 2013

2.   Vegetarian dietary patterns and mortality in adventist health study 2.
   73,000 7th Day Adventists followed for 5 years: Pescatarians had the lowest mortality rate. "The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo-vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians"
August 12, 2013

Prevention
1.   Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)
   This big Greek study observed 22,000 people for 11 years and found that a Mediterranean diet (low starch and sugar and meat and dairy, high legumes, vegetables, olive oil, fish) reduced diabetes by a whopping 12%.
October 31, 2013

2.   Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women’s health initiative
   Women who took a multivitamin with mineral for about 7 years experienced a 24% reduction in their risk of death from breast cancer during that period, after controlling for confounding variables. This is the first study I have seen in along while attesting to the merits of multivitamin. Just because a multivitamin reduced deaths from breast cancer in 1 observational study, does not mean it will make you live longer.
October 8, 2013

Monday, March 17, 2014

Welcome Ashley!


We are pleased to announce that we are joined by a new colleague!  Ashley Kontra, PA-C, will assist in delivering our core mission of excellence in primary care. In addition, she has taken a leadership position with our Progressive Weight Loss Program.

Ashley Kontra is a graduate of Pennsylvania College of Technology’s Physician Assistant Program. During her studies she served as class historian and graduated cum laude. Before studying to become a physician assistant, Ashley attended Lock Haven University where she earned her undergraduate degree in Health Sciences. Her special interests within primary care include dermatology, weight loss, and helping those with special needs. Ashley is a current resident of Philadelphia, PA and grew up in Lancaster, PA. While not at the office, she enjoys exploring Philly, photography, and the arts. Her goal is to make every healthcare visit a positive and comfortable experience that motivates her patients to strive for wellness.

Saturday, March 15, 2014

Live Long and Prosper Newsletter #3

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP.

Nutrition
1.   Relationship between 25-hydroxyvitamin D and all-cause and cardiovascular disease mortality.
   Being deficient in vitamin D puts you in a category that has almost double the risk of death relative to normal levels. However, supplementation with vitamin D has not shown greater longevity. We know that low vitamin D levels come with the usual suspects (obesity, sedentary behavior).
August 12, 2013

2.   Towards measurement of the Healthy Ageing Phenotype in lifestyle-based intervention studies.
   Interesting discussion. E.g. If you have these conditions in mid-life: overweight, pre-diabetes, elevated blood pressure, then it puts you at greater risk for cognitive decline later in life. Waist line of 52 inches in men or 45 inches in women doubles your risk of mortality.
August 14, 2013


Exercise
1.   Cardiovascular fitness and mortality after contemporary cardiac rehabilitation.
   People who have coronary heart disease live longer if they get on a cardiac rehab exercise program. The greater the level of fitness they are able to achieve and the more they work out, the longer they live.
August 12, 2013

2.   Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries.
   Dean Ornish style low lat diet plus lifestyle changes resulted in better outcomes and a little lower costs for patients with coronary heart disease.
August 12, 2013



Lifestyle
1.   Lifestyle interventions in patients with coronary heart disease: a systematic review.
   The aggregate research done to date suggests when doctors do "multifactorial lifestyle interventions" (i.e., trying to get patients to eat and exercise better), their patients' risk of dying from heart disease is reduced by 18%.
August 12, 2013

2.   Non-nutritive sweeteners: Review and update.
   There is insufficient evidence to conclude that artificial sweeteners are safe.
August 12, 2013

Prevention
1.   Comparison between the effects of continuous and intermittent aerobic exercise on weight loss and body fat percentage in overweight and obese women: a randomized controlled trial.
   2 interesting findings in this small study: (1) that exercise added weight loss to those eating a calorie-restricted diet, and (2) splitting up exercise into three daily ~13 minute bouts caused 3X the weight loss at 12 weeks, than doing 40 minutes of exercise all at once. This suggests that we might be best served to "exercise as you are, whenever you can" rather than the monolithic trip to the gym.
September 22, 2013

Tuesday, February 25, 2014

Live Long and Prosper Newsletter #2

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP.
Nutrition
1.   Effects of dark chocolate in a population of Normal Weight Obese women: a pilot study.
15 women with normal weight but excess body fat ate 100gm dark chocolate (70% cacao) for just 7 days, and surprisingly had improvement in waist circumference and cholesterol levels.

2.   Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial.
Eating nuts (mostly walnuts and almonds) reduced mortality by 39%. This confirms other trials attesting to the life-extending properties of nuts (in moderation). I have often wondered how much of a favor we are doing our children by aggressively branding them lifelong nut-allergics.

3.   IOM report: Evidence fails to support guidelines for dietary salt reduction.
Institute of Medicine does not find dietary salt to be a risk.

4.   Subclinical hypothyroidism and survival: the effects of heart failure and race.
Having an underactive thyroid increases your risk of death if you are black or if you have congestive heart failure.

5.   Joint associations of alcohol consumption and physical activity with all-cause and cardiovascular mortality.
Being sedentary seems to be a bigger risk of death, than being a heavy drinker (>35 per week for men or >21 per week for women).

Exercise
1.   Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
"CONCLUSIONS: An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes." This large study was stopped early because they failed to reduce heart attacks, strokes, and the like. What was the intervention? Low calorie diet and exercise. Why did they fail, when so many other studies have shown a positive benefit? We could argue that by focusing on calorie counting they did not stress enough the importance of switching to entirely different classes of foods. Look for example at the recent large prospective trial on the Mediterranean Diet, which did just that. This trial had to be halted early because it showed so much benefit (in reducing these same cardiovascular events) than this trial. That is instead of advising 'Eat only half a sandwich for lunch', we should instead advise 'Eat a large salad with nuts and other whole foods at lunch and stop eating sandwiches and other highly refined western foods'.

2.   Scientific overview of hormone treatment used for rejuvenation.
Want to rejuvenate? Hormones don't seem to work much. Vitamin D or sunlight might help, and perhaps testosterone in men who are deficient. From the scientific literature, your best bets are exercise, sunlight, a plant-based diet, protein. And let's see what materializes with resveratrol.

3.   Vehicle submersion: a review of the problem, associated risks, and survival information.
Take homes: If you drive your car into a lake, get out first and call 911 later. Don't forget to unbuckle the little ones.

4.   Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people.
Elderly folks undergoing major elective surgery (like a joint replacement) had almost 50% reduction in risk of perioperative death, and a shorter hospital stay, than those who are not fit.

5.   Statin and exercise prescription.
In veterans with elevated blood lipids or cholesterol, the combination of a statin (like pravastatin or simvastatin) plus physical exercise achieved the greatest reduction in mortality (70% reduction over 10 years). Either a statin or exercise alone also reduced mortality, but not as much as the combination.



Lifestyle
1.   Physical activity and mortality in a prospective cohort of middle-aged and elderly men -- a time perspective.
More in favor of physical activity: "physically active lifestyle is associated with a substantial improvement in survival time, up to 2.5 years over 13 years of follow-up"

2.   Mortality in depressed and non-depressed primary care Swedish patients: a 12-year follow-up cohort study.
This 12 year study found depressed Swedes were 3.3 times as likely to die during the 12 years then non-depressed Swedes.

3.   [Psychosis, cardiovascular risk and associated mortality: Are we on the right track?]
Beware antipsychotic medicines. They are often prescribed off-label, and there is considerable evidence that they make you die younger.

4.   Adverse childhood experiences and premature all-cause mortality.
The more adverse childhood experiences you have, the greater the shorter the lifespan on average. Maybe the helicopter moms have a point. The Longevity Project similarly found childhood divorce had an impact on the child's lifespan.

5.   Leisure time physical activity and mortality.
Physical activity or many kinds correlated with lower death rate. "We found lower mortality with participation in sports (for women, mortality rate ratio = 0.75, 95% confidence interval = 0.69-0.81; for men, 0.78, 0.73-0.84), cycling (for women, 0.77, 0.71-0.84; for men, 0.90, 0.84-0.96), or gardening (for women, 0.84, 0.78-0.91; for men, 0.73, 0.68-0.79) and in men participating in do-it-yourself activity (0.77, 0.71-0.84)"

Prevention
1.   Durability of effect of massage therapy on blood pressure.
Swedish massage 10-15 min, 3 times a week for 10 sessions experienced lowered blood pressure. Those receiving massage continued to have blood pressures lower by 11/5 points, 72 hours after the massage.

Monday, January 6, 2014

Live Long and Prosper Newsletter #1

This newsletter was compiled from the latest research on health and longevity, by David Donohue, MD, FACP. 

Nutrition
1.   Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn Study.
   Here's a plug for low fat dairy. Dutch people who ate high fat dairy had higher rates of death due to heart disease. Dairy intake itself (high or low fat) did not correlate with CVD or death in this study.
August 16, 2013

2.   Economic Costs and Benefits of Healthy Eating
   " We estimate the benefits of healthy eating in the United States to be $114.5 billion per year (in 2012 dollars) in medical savings, increased productivity, and the value of prolonged life"
August 31, 2013
Exercise
1.   Prevention of falls in the elderly--a review.
   These things have been shown in randomized trials, to reduce falls in the elderly: (1) regular, varied exercise program (like Tai-chi) (2) antislip shoe devices when icy (3) reduction of the total number of medicines especially sedatives (4) correct vitamin D deficiency which is common in this group (5) correct other conditions like cataracts, pacemakers where indicated
August 15, 2013

2.   Exercise and longevity.
   A 2008 meta-analysis showed that across 33 studies done to date, achieving greater fitness correlates with lower mortality. How much? About 33% if you adjust for other (related) variables like high blood pressure, cholesterol, and diabetes. If you do not adjust then the benefit is higher. Confused? Exercise ~30-60 minutes per day and you might add an extra hour per day onto your lifespan. So make sure it is something you love doing. Tennis anyone?
August 22, 2013
Lifestyle
1.   Does neuroticism make you old? Prospective associations between neuroticism and leukocyte telomere length.
   Neurotic people have shorter telomeres. Shorter telomeres correlate with older age and sooner death.
August 12, 2013

2.   Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study.
   Already have these 4 aspects of healthy lifestyle? * Sufficient physical activity (≥3.5 h/week cycling or sports), * a healthy diet (Mediterranean Diet Score ≥5), * (moderate) alcohol consumption (≥1 beverage/month), * non-smoking If you also get sufficient sleep duration (≥7 hours) then you are in a category with a further 65% reduction in cardiovascular disease.
August 12, 2013
Prevention
1.   Association between red and processed meat intake and mortality among colorectal cancer survivors.
   Among people diagnosed with colon cancer, those who ate the most red meat had 29% higher death rate from colon cancer than those who ate the least.
October 2, 2013

2.   Dietary Approaches to Prevent Hypertension
   "Dietary strategies for the prevention of hypertension include reducing sodium intake, limiting alcohol consumption, increasing potassium intake, and adopting an overall dietary pattern such as the DASH (Dietary Approaches to Stop Hypertension) diet or a Mediterranean diet."
October 2, 2013
Safety
1.   Increasing awareness of hypoglycaemia in patients with Type 2 diabetes treated with oral agents.
   If you have diabetes and take certain medicines (like insulin, glyburide) then you are at risk for hypoglycemia (low blood sugar). Hypoglycemia can kill, so take precautions! Check sugars regularly, explain hypoglycemia to your loved ones, be aware of the signs (sweating, elevated heart rate, confusion, anxiety, fatigue). If you can, look into switching to diabetic medicines that do not cause hypoglycemia.
August 22, 2013

2.   Temporal associations between spouse criticism/hostility and pain among patients with chronic pain: A within-couple daily diary study.
   Criticism of hostility from your spouse can make your chronic pain worse. We can speculate that spousal support is a form of pain reliever.
August 22, 2013

3.   Analyzing and modeling risk exposure of pedestrian children to involvement in car crashes.
   Who is most at risk to get hit by a car? "Most vulnerable are boys from a low socio-economic group who live in areas of high density and mixed land use near a major road and who tend to walk to and from school and additional activities after school."
August 22, 2013

Medication
1.   Sarcopenia as a risk factor for falls in elderly individuals: Results from the ilSIRENTE study
   As we get older, we lose muscle mass. Elderly folks who lose muscle mass have increased risk of falls. What can we do to increase muscle? Resistance training, exercise, dietary protein (especially at breakfast and lunch), and Vitamin D.
August 16, 2013

2.   A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes.
   Many diabetics are depressed. If you are, seeing a mental health therapist can help both your depression and your control of diabetes.
October 30, 2013

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