Friday, December 29, 2017

Health Tip: The Real Reason We Gain Weight As We Age

The Obesity Society's December newsletter listed their top 10 articles from 2017. One of them caught my attention: "The real reason you're gaining weight as you get older." This article, featuring insight from Dr. Caroline Apovian, the Director of the Nutrition and Weight Management Center at the Boston Medical Center, focused on an overlooked truth. We lose muscle as we age.

Muscle, as you may have guessed, is very metabolically active tissue. The more muscle you have, the more fuel you need. Unfortunately, muscle mass naturally declines with age, and with it, our calorie needs also decrease. There are two things you can do about this if you want to avoid weight gain: eat less as your muscles waste away (not my preferred option) or focus on gaining or maintaining muscle so you can keep eating the same amount or more.

After age 30, we naturally lose about 3-5% of our muscle mass per decade. However, we can certainly reduce the rate of muscle loss through regular progressive resistance training and increasing our protein intake. The average Senior (who does resistance training) needs to support that muscle by eating 1-1.3g of protein per kilogram of body weight per day. Let's say you weigh 150 lbs (68 kilos), that's 68-88g of protein per day. Since one large, skinless chicken breast equals about 43g, you'd need to eat at least two of them per day. Not hard to do, but takes a little bit of determination.

Obviously there are many excellent sources of protein, so I'm only using chicken breast as one example. But visually, I think it helps to imagine how much protein is necessary to maintain your muscles. As you prepare to make some New Year's resolutions, I strongly encourage you to include weight training and increased protein intake as part of your fat loss plan. At least that way, you'll have larger muscles and be able to eat more in the long run, which is what we all really want, right?

How much weight training is enough?

That's a tough question. How much muscle do you want? Do you have any injuries that might limit your ability to do certain exercises? Ideally, you should weight train at least three times a week. A beginning regimen might look like this (recommended by Harvard Health):
  • 8 to 10 exercises that target all the major muscle groups
  • sets of 12 to 15 reps, performed at an effort of about 5 to 7 on a 10-point scale
  • two or three workouts per week.
Muscles grow fastest when you challenge them with heavy weight. The right weight for you (for a given exercise) is the amount that you can do at least 8 full reps with good technique. Explosive movements (jumping, Burpees, jack pushups, etc.) are also excellent muscle-builders if injuries don't prevent you from doing them. Take athlete Kaisa Keranen, for example (check out her videos). She has extraordinary muscle mass, but does mostly body-weight activities. So whether you follow a traditional weight-lifting regime, or a more "power" focused, high-intensity style workouts, you can build great muscle and eat more calories than if you starve yourself and do low intensity cardio work outs.

Have a Happy New Year… and don't fall into the trap of starvation dieting as a resolution! Build muscle, eat protein, look younger, feel stronger! Push yourself for best results. I'll see you at the gym… or the chicken aisle of the local grocery store?


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Thursday, December 21, 2017

Health Tip: Chronic Insomnia

Poor sleep may contribute to increased risk for heart disease, diabetes, and depression, yet physicians often forget to ask their patients about their sleep habits until it becomes a crisis. Sleep specialists recommend that insomnia be treated at the same time as other medical conditions. It is common for clinicians to hope that if the other conditions are treated first, good sleep will follow. But that is rarely the case.

Chronic sleep deprivation can be exasperating, and impact everyday life. It is a vicious cycle where one feels too tired to exercise, and then lack of exercise contributes to further health deficits. The best treatment for insomnia may depend on its underlying cause, and a thorough sleep history (complete with a sleep diary or sleep lab analysis) may be necessary to confirm the source.

There is a genetic component to insomnia that is often ignored - up to 57% of patients with insomnia1 have a strong family history of it. Also, anxiety disorders and depression often co-mingle with sleep disorders. One study suggested that young people with anxiety disorders may go on to have chronic insomnia in 73% of cases. For other youth, insomnia preceded depression in 69% of cases.2 Life stressors, sleep apnea, and a sedentary lifestyle may contribute as well. So what works for chronic insomnia?

Cognitive Behavioral Therapy (CBT) is an effective, non-pharMORE effective than most medications.3 CBT is a form of psychotherapy that focuses on solutions, encouraging patients to challenge distorted beliefs and change destructive patterns of behavior.
maceutical option for those who are willing to invest the therapy time - to set and reinforce good sleep hygiene. Studies have shown that CBT is actually

Regular Aerobic Exercise - research suggests that exercise is as effective as benzodiazepines in treating insomnia.4  Exercise reduces anxiety and depression, increases serotonin levels, and promotes immune function. It's important not to exercise right before bedtime, however. Wait at least 3 hours before you go to sleep (after exercising) for optimal effects.
Now, if you've given both of these (CBT and regular exercise) a good and sustained effort, and still need some assistance to sleep or stay asleep (i.e. you sleep <6.5 hours per night for a month or more), there are medications that may help. This is a very quick overview and I encourage you to talk to your healthcare provider before starting any of these.

Over-the-counter sleep aides:
Anti-histamines: non-selective (H1) antihistamines (such as diphenhydramine or doxylamine - aka Benadryl and Unisom) used for severe allergies have a drowsiness side-effect that can increase sleep. The problem is that people adapt fairly quickly to these drugs, rendering them less effective if used too frequently. In addition, they have long half-lives and can cause daytime drowsiness and cognitive impairments for 16 hours or more at a time.

Melatonin: our sleep/wake cycles are influenced by a gland (pineal gland) deep in our brains. This gland makes a hormone called melatonin which is available in pill form in the vitamin aisle of most grocery or pharmacy stores. Melatonin has very few side effects other than regulating sleep/wake cycles. Studies suggest that it may take 4-6 weeks of daily use before improvements are noted in regular sleep patterns.

Prescription Medications:
Benzodiazepines: (common trade names - Ativan, Xanax, Valium, Restoril). These are "sedative-hypnotic" medications that inhibit certain neurotransmitters, resulting in anti-anxiety, anti-spasmodic, and sleep-enhancing effects. Some are longer acting than others (Valium has a much longer half life than Xanax, for example) and can affect daytime cognition. They should be used sparingly, and rarely in those over age 65 because they dramatically increase their risk for falls and may be associated with an increased risk for Alzheimer's disease to boot.

Non-Benzodiazepine Hypnotics: (common trade names -Ambien, Lunesta) - these drugs work on a slightly different receptor in the brain, but are close relatives of the benzodiazepines. The exact mechanism of action of Lunesta is unknown. Sleep walking, nausea, and diarrhea are potential side effects of Ambien, headaches are the most common complaint for those using Lunesta.

Anti-depressants: (Trazodone, Paxil). Trazodone blocks Serotonin reuptake and also has some antihistamine effects, and Paxil is a Selective Serotonin Reuptake Inhibitor (SSRI). Both may improve insomnia, anxiety, or depression. Rare cases of suicidal thoughts can occur.

Anti-psychotics: (Seroquel, Risperdal, Zyprexa) These medicines are used to manage sleep disturbances caused by mania or dementia with agitation. They may be helpful in specific cases, but come with a small risk of long term movement disorders and should be used with caution.

Orexin-Blockers: (Belsomra) selectively targets and downregulates the "awake" centers of the brain. This is a newly approved drug, and less is known about its long-term side effects. Nightmares may occur.
In my view, natural methods for addressing sleep deprivation are less risky and have higher long term success rates than medications. Nevertheless, there are some cases where a short-term medication intervention may be necessary to break the cycle of chronic insomnia. I hope you find a solution for your (or your loved one's) insomnia.

Sweet dreams!

1 Rieman D et al. Lancet Neurol 2015; 14(5):547-558.
2 Johnson E O et al. J Psychiatr Res 2006; 40(8):700-708.
3 Jacobs GD et al. Arch Intern Med 2004; 164:1888-1896.

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Friday, December 15, 2017

Health Tip: Beware of Holiday Heart Syndrome

The risk of heart attacks and sudden cardiac death increase markedly (about 4%) during the winter holiday season. The more cynical among us have sometimes attributed this purely to the additional stress of close family gatherings at this time of year, but the truth is that alcohol consumption may be at its root.

"Holiday Heart" was first described by researchers (in 1978) exploring the cause of sudden heart rhythm disturbances in otherwise healthy adults. They noticed that binge alcohol consumption led to a higher risk of arrhythmias in a dose-dependent manner. The heavier the drinking, the higher the risk of irregular, and dangerous rhythms.

Alcohol is known to be toxic to heart muscle, as it affects the pH and electrolytes involved in conduction of electrical impulses through the organ. It is suspected that marijuana may also affect heart rhythms the way alcohol does (there have been a few cases reported). The most common alcohol-induced rhythm disorder is atrial fibrillation. In fact, some studies suggest that about 60% of new cases of atrial fibrillation (in patients under the age of 65) may be linked to excessive alcohol consumption.

Why should you care about atrial fibrillation?

Atrial fibrillation occurs when the upper heart chambers cease contracting effectively, and simply shake rather than pump. This results in a slowdown of blood flow in the upper part of the heart. Slow-moving blood tends to clot, and these clots can travel through blood vessels until they lodge in a narrow section of artery, usually in the brain, resulting in a stroke. To reduce this risk, physicians often prescribe "blood thinners" such as Coumadin (Warfarin) to those with known history of atrial fibrillation.

However, if you're a young(er) person without any history of heart disease and are just having a little extra alcohol at various parties over the holiday season, you may not realize that you're at risk for holiday heart. If you feel palpitations, chest pain or pressure, or sudden onset of stroke-like symptoms, please proceed immediately to the nearest emergency department. For every minute that oxygen is not reaching heart or brain tissue (due to blocked blood flow), long term damage can result.

Can you recognize stroke symptoms?

The American Stroke Association (ASA) has an easy mnemonic for assessing someone for stroke. It's called F-A-S-T:

F = face drooping
A = arm weakness
S = speech difficulties
T = time to call 9-1-1

 Beyond F.A.S.T. - Other Symptoms You Should Know (from ASA)
  • Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
  • Sudden CONFUSION, trouble speaking or understanding speech
  • Sudden TROUBLE SEEING in one or both eyes
  • Sudden TROUBLE WALKING, dizziness, loss of balance or coordination
  • Sudden SEVERE HEADACHE with no known cause
  • So enjoy your holiday festivities, but be prepared to get yourself (or friends/family) medical attention right away if you think they're having holiday heart syndrome, or a resultant stroke. Of course, going easy on the alcohol would also be a good preventive measure to consider!
Happy & Healthy Holidays!


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Friday, December 8, 2017

Health Tip: The 2017 Flu Vaccine Might Not Be Very Effective This Year

I recently wrote a health tip about the importance of getting the flu vaccine each fall season [insert link please] because it is our only real defense against the virus. We are getting closer to a master vaccine for these wiley viruses (meaning one day we will be able to get a flu vaccine to last a lifetime), but until then, we have to get a new injection each fall/winter season. This is because the virus is so changeable - we have to teach our immune systems to recognize each new strain. Some years we guess correctly regarding which strain will dominate the local human population, and provide accurate vaccine protection. And some years, like this one, we guess incorrectly.

In 2017, it looks as if the predominant flu strain is H3N2. And the vaccines we're using in the US this season were tried in Australia during their flu season. Unfortunately they were estimated to be only 10% effective there!

What this means is that we all should take extra precautions to avoid transmission of the virus, because the vaccine is unlikely to provide much protection. Our main weapons are therefore (according to the CDC - Centers For Disease Control and Prevention):
  1. Avoiding close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
  2. Staying home when you are sick. If possible, stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others.
  3. Covering your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
  4. Washing your hands. Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.
  5. Avoiding touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
  6. Disinfecting contaminated surfaces. Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill.
  7. Keep your immune system strong. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
If you do get the flu, are there medicines to make it go away faster?
Yes, there are are three FDA-approved, anti-viral medications that can reduce the severity of the flu and reduce it's duration by a day or two.
  • oseltamivir (available as a generic version or under the trade name Tamiflu®),
  • zanamivir (trade name Relenza®), and
  • peramivir (trade name Rapivab®).
If you are in a "high risk group" for flu complications, you should see your doctor about anti-viral medications (they are only available by prescription). But hurry, these medications only help if you take them within 48 hours of symptom onset.
Who is at high risk for flu complications?
  • Children younger than 2 and adults over 65
  • Pregnant women
  • Nursing home residents
  • Native Americans
  • Those with medical conditions that put them at higher risk for flu complications (including heart disease, lung disease, asthma, and a long list of others.)
This may be an especially dangerous flu season, my friends. So take steps to protect yourself and your loved ones, especially those at higher risk for flu complications.

Chasing Seasonal Influenza - The Need for a Universal Influenza Vaccine - NEJM

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