My Health - Spring training: Moving from couch to 5K

Need a little motivation and structure to ramp up your walking routine this spring? Want to wake up your workouts? Consider trying a couch-to-5K program.

What is a couch-to-5K program?

These free or low-cost coaching plans are designed to help would-be runners train for a 5-kilometer race, which is about 3.1 miles. The programs are available online, or as apps or podcasts. They typically feature timed walking and running intervals that gradually phase out the walking over a period of about nine weeks.

Why try a couch-to-5K program?

“The purpose of a couch-to-5K program is to give you time to acclimate and start to enjoy the benefits of running and the sense of accomplishment of completing a distance safely,” says Dr. Adam Tenforde, director of the Running Medicine Program at the Harvard-affiliated Spaulding Rehabilitation Network. Running provides many cardiovascular benefits as well as an enhanced sense of well-being, he adds.

Even though these programs sound as though they’re geared for completely sedentary couch potatoes, that’s not necessarily true, he cautions. They often assume you can walk continuously for 30 minutes, which doesn’t apply to everyone.

For some people, an even easier, more gradual training regimen may be more appropriate. Also, keep in mind that you don’t have to run to do a 5K; many of these races also encourage walkers to participate as well. You’ll still reap the other rewards from committing to a race, such as being more challenged and motivated — and possibly more connected to your community. Many charitable “fun runs” benefit local schools or needy families. Some are in memory of people affected by illness or tragedy. See www.runningintheusa.com to find 5K races near you.

Before you begin

If you’re planning to walk or run your first 5K this spring, get your doctor’s approval before you start training. That’s especially important if you have heart disease or are at risk for it.

Comfortable walking or running shoes are a wise investment. Shoes that are too old or too tight in the toe box can cause or aggravate a bunion, a bony bump at the outer base of the big toe. Despite suggestions that people with flat feet or high arches need specific types of shoes, studies have found that “neutral” shoes (designed for average feet) work well for almost everyone. Walk or jog around the store when you try them on to make sure they feel good and fit properly.

You don’t need to buy special clothes: regular sweat pants or comfortable shorts and a t-shirt will suffice. Women should consider getting a supportive sports bra, however.

Slow and steady to start

• Always include a warm-up and cool-down — a few minutes of slow walking or jogging — with every exercise session.
• If you haven’t been exercising regularly, start by walking just five or 10 minutes a day, three days a week. Or, if you’re already a regular walker, add some short stints of jogging to each walking session.
• Gradually add minutes and days over the following four to six weeks.
• Once you’re up to 30 minutes a day, check how far you’re traveling. Keep increasing your distance every week until you reach 5 kilometers. Then slowly phase in more jogging and less walking over your route if you like.

For a good couch-to-5K guide, try this beginner’s program from the United Kingdom’s National Health Service.

Remember that you can always repeat a week. You’re less likely to sustain an injury if you make slow, steady progress. Pay close attention to your body and don’t push yourself too much, Dr. Tenforde advises. Former athletes who haven’t run in years may think they can pick up where they left off, but that’s not a smart move — they should also start low and go slow.

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My Health - Highly accurate test reveals recurring prostate cancer

After being treated for prostate cancer, some men will experience a rise in PSA levels suggesting that new tumors lurk somewhere in the body. Finding these tiny cancerous deposits before they grow and spread any further is crucially important. But it’s also a challenge, since the budding tumors might be too small to see with standard tools such as magnetic resonance imaging.

Now scientists in California have published results with an experimental imaging technique that detects recurring prostate cancer with the best accuracy reported yet. Importantly, some of the unveiled tumors were “still curable with targeted radiation therapy,” said Dr. Thomas Hope, a radiologist at the University of California, San Francisco School of Medicine, who led the study. “That’s what makes the research so exciting.”

How the test works

The technique used in the study is a modified form of positron emission tomography, or PET scanning. When performing a PET scan, doctors will first give an intravenous injection of a harmless radioactive tracer that travels through the bloodstream and attaches to proteins on cancer cells. The PET scanning technology detects this radiation, and thus allows specially trained experts to see where the cancer cells are located.

Two tracers have been approved so far by the FDA for use in prostate cancer diagnostics: one called choline C11 and another called fluciclovine-18-F. Dr. Hope’s team, however, used an alternative tracer called gallium-68, which has yet to win regulatory approval in the United States. Gallium-68 has the advantage of binding specifically to a protein called prostate-specific membrane antigen (PMSA), which is highly expressed on metastatic cells and shows up better on PET imaging than the current FDA-approved agents.

During the study, USCF researchers and their colleagues at the University of California, Los Angeles enrolled 635 men with rising PSA levels after prostate cancer treatment. The men were each injected with gallium-68, and then given a whole-body PET scan. Importantly, the images were interpreted by independent readers who had no other knowledge of a patient’s clinical status.

What it found

Gallium-68 PET scans produced positive results in 75% of the men, and the likelihood of a positive hit grew as their PSA levels increased. For instance, 38% of men with PSA levels of 0.5 nanograms per milliliter (ng/mL) or less were flagged by PET scanning, compared to 97% of the men with PSA levels of 5 ng/mL or higher.

The test’s positive predictive value (PPV) — meaning the probability that it would identify men with metastatic cancer correctly — ranged between 84% and 92%. According to Dr. Hope, PET scans from the pelvic lymph nodes had the highest PPVs, while scans of the lower ribs, which are prone to features that mimic cancer, had the lowest.

“As we gain more experience with gallium-68/PSMA scanning, we’ll lower the false positive rate and increase the test’s accuracy even further,” said Dr. Hope, who is now working with UCLA on efforts to win FDA approval for the tracer.

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My Health - TAVR: Aortic valve replacement without open-heart surgery

There has been a flurry of news recently about a procedure called trans-catheter aortic valve replacement (TAVR) for the treatment of the common heart condition aortic stenosis (AS). You may even know people who have had this procedure performed.

What exactly is TAVR? And what’s all the excitement about?

What is aortic stenosis?

First, it’s important to understand the condition that TAVR is designed to treat, aortic stenosis. The aortic valve is the last structure of the heart through which blood passes before entering the aorta and circulating throughout the body. The aortic valve has three flaps, called leaflets, that open and close. When working normally, the aortic valve opens to allow blood to pass from the heart into the aorta, then closes to prevent blood from flowing back into the heart.

Over time, calcium deposits can develop on the leaflets of the valve, making it more difficult for the valve to open. This puts additional strain on the heart, which can lead to symptoms such as shortness of breath, lightheadedness, or chest pain with exertion. In severe cases, AS can lead to weakening of the heart muscle. If left untreated, the condition can be fatal.

Open heart surgery: Traditional treatment of aortic stenosis

Once AS is diagnosed and symptoms are present, it needs to be treated. The historical gold standard for treatment of AS has been open-heart surgery with surgical aortic valve replacement (SAVR).

Open heart surgery is a major operation in which the surgeon opens the chest to access the heart. During open-heart surgery the heart is stopped, and blood is bypassed through a heart-lung machine. With SAVR, the diseased valve is removed and a new artificial valve is sewn into place.

SAVR has had good outcomes in patients who are suitable candidates for surgery. However, SAVR does have a long recovery period that generally requires five to seven days of hospitalization after surgery, and upwards of six weeks to make a full recovery. Also, there are many patients who require aortic valve replacement but have too many other medical conditions that make them unsuitable candidates for SAVR.

TAVR: A catheter-based treatment for aortic stenosis

TAVR is performed by placing a catheter in the femoral artery, the large blood vessel in the groin. A new heart valve mounted on another catheter is threaded through the initial catheter in the blood vessel and across the diseased aortic valve. The new valve is deployed by pushing the old valve leaflets to the side. The new valve leaflets start to function immediately.

In most cases, the procedure lasts 90 minutes and is performed under sedative medications without general anesthesia. Many patients are able to be discharged the following day and are usually back to normal activity within a week.

Benefits and risks of TAVR

The initial clinical trials of TAVR, begun in 2007, evaluated TAVR in patients who were too ill to be considered for SAVR. These trials showed benefit at extending quality and length of life in patients with severe AS. Since that time, trials have been performed comparing TAVR to SAVR in patients who are considered high risk and intermediate risk for traditional SAVR. In each of these studies, TAVR was shown to be no worse or even better than SAVR. Because of the quick recovery with TAVR, it soon became the standard of care for intermediate and high surgical risk patients with AS.

The recent news about TAVR concerns clinical trials conducted on the healthiest patients; that is, patients who are considered low-risk surgical candidates. The PARTNER 3 Trial and the CoreValve Low-Risk Trial were presented at the recent American College of Cardiology Meetings in March 2019. Both trials showed significant benefits of TAVR compared to SAVR, including reduced rates of death, stroke, and repeat hospitalizations. It is expected that TAVR in low-risk patients will gain FDA approval in the near future. When this occurs, TAVR will be the standard of care or all patients with AS.

While TAVR has major benefits, there are certainly risks involved, as there are for any major heart procedure. These risks may include heart attack, stroke, bleeding, and need for emergency surgery, but these risks are low. There is also potential damage to the electrical system of the heart that may result in the need for the placement of a permanent pacemaker.

Is TAVR right for you? 

As appealing as TAVR may sound if you need your aortic valve replaced, it may not be suitable for everyone. For example, some people have heart valve anatomy that may make SAVR a better option for them.

If you need your aortic valve replaced, it is important to be evaluated by a heart team that includes your clinical cardiologist, an interventional cardiologist, and a cardiac surgeon. The heart team will evaluate you and review all of your relevant medical information. They will provide treatment options and will discuss the risks and benefits of the options with you.

Follow me on Twitter @PinakShahMD

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My Health - Mother’s Day: Tools for coping when celebration brings pain

Mother’s Day is fast approaching. As an infertility counselor, I always greet the holiday with mixed emotions. I look forward to the lilacs in full bloom, the feeling that spring is finally here, and the chance to wish some of my clients a long awaited “Happy First Mother’s Day,” knowing that they struggled for years with infertility or recurrent miscarriage.

However, I am also reminded of what a difficult day this is for many women –– not only those struggling to become moms. It’s hard for women who have lost their mothers, mothers who have lost children, women who placed children for adoption, mothers who are far from their children geographically or emotionally, and anyone grappling with family conflict. Among all the flowers and sweet Mother’s Day brunches lives a lot of pain.

The build-up to Mother’s Day

I have struggled for many years with how to help reduce the sting of Mother’s Day. It’s only one day, some may think, and surely there are ways to cope with the fuss and fanfare of that day.

If only it was so simple.

In the greeting card section of every store, on restaurant websites, and in ads in every newspaper and glossy magazine, the build-up begins at least a month before Mother’s Day. Tune in to your local public radio station for news of the day, and instead you hear the yearly “send flowers for Mother’s Day” fundraiser. Some might argue that the lead-up to Mother’s Day is actually more stressful than the day itself.

Tools for coping

So how can we cope with the discomfort, and often pain, that Mother’s Day brings? Over the years, I have seen people adopt different coping strategies for Mother’s Day. There is no magic bullet, but here are some approaches you may find helpful. Some are directed mainly to women experiencing infertility. Others may help anyone.

Avoidance. If your mother lives at a distance, a phone call and card can cover Mother’s Day responsibilities. With neither a mother nor a mother-in-law on hand to wrestle through crowds for a restaurant brunch, you can pass the day enjoying a nice hike or bike ride, or an afternoon engrossed in a good movie or book.

Strategic planning. Many people would love to avoid Mother’s Day but can’t. Mom lives nearby or is coming for a visit, and there is no option other than to celebrate with her. Consider strategic planning. Figure out what you can do on Mother’s Day that will please your mother (or mother-in-law), while sparing you the pain that comes when you are in a restaurant where the staff is wishing every woman a “Happy Mother’s Day.” Strategic planning may be cooking at home or bringing nice takeout to your mom. Or find an outing not built around Mother’s Day, perhaps theater tickets or a day-trip adventure.

Positive activities. Positioning Mother’s Day as a time for a positive activity can be win-win whether you are on your own or spending the day with your mother. You might appreciate a Mother’s Day peace walk, where you (or both of you) can join together with other women and men to combat gun violence, child abuse, or other scourges of our world. Or you might try environmental acts in celebration of Mother Earth. Positive activities sidestep the commercialism that many find so unsettling on this greeting card holiday.

One more tool

Joining in. For some, the most comfortable approach to Mother’s Day is simply to join in. Yes, they may feel sad in a church service that honors mothers or at a park where families frolic. But some women find trying to avoid or counter Mother’s Day isolating. It only adds to their pain. They may feel proud of themselves for being able to camouflage their feelings, appearing to be very much a part of the Mother’s Day celebrations. Joining in challenges them in ways that they feel they can handle. It may even offer hope for easier Mother’s Days to come.

Let me finish with a hope for comfort on Mother’s Day. This year, I hope that as you listen to the ads for flowers, pass the array of greeting cards, and perhaps cringe at a banner announcing Mother’s Day brunch, you know that you are not alone.

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My Health - Ease anxiety and stress: Take a (belly) breather

Quick: think of three things that make you feel anxious or stressed. Most of us have no trouble reeling off answers. And people who suffer from anxiety disorders — such as social anxiety, phobias, or generalized anxiety — may have a variety of triggers that send anxiety soaring. While belly breathing alone can’t fix deep-seated anxieties, it works well as a tool to help ease anxiety and garden-variety stress. Regularly engaging in belly breathing (or trying the mini strategy described below) can help you turn a fight-or-flight response into a relaxation response that’s beneficial to your health.

How should you breathe?

You take up to 23,000 breaths per day, so make sure you do it right.

How should you breathe? Like a sleeping child, says Dr. Katherine Rosa of the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine. “If you ever watch children sleep, they all breathe from the belly and not the chest. This relaxed state is the more normal way to breathe.”

Yet most people are chest breathers, which is how we react to stress. When we sense a threat, our fight-or-flight response automatically kicks in. We breathe at a rapid pace to suck in extra oxygen, to fuel our heart and muscles so we can flee the danger.

Of course, we don’t need our fight-or-flight to escape predators anymore. Our threats now come from the stress of emails, personal confrontations, daily news, and traffic jams.

“Your fight-or-flight response is meant to be a short-term reaction that comes and goes,” says Dr. Rosa. “But today, we are surrounded by so many stressors that we constantly stay in this state of tension. It doesn’t turn off, and we often don’t even notice it.” The result: we have become a nation of chest breathers.

Feel it in your belly

One way to change our reaction to modern stress is to learn how to belly breathe instead of chest breathe. Belly breathing stimulates the vagus nerve, which runs from the head down the neck, through the chest, and to the colon. This activates your relaxation response, reducing your heart rate and blood pressure and lowering stress levels.

If you are not familiar with belly breathing, try this exercise: sit in a chair, lean forward, and place your elbows on your knees. Then breathe naturally. “This position forces you to breathe from the belly, so you know what the sensation feels like,” says Dr. Rosa.

A mini strategy to ease anxiety and stress

A strategy to teach yourself mindful belly breathing is to practice what Dr. Rosa calls “the mini.” Here’s what you do: every time you feel stressed, simply take three slow and controlled deep belly breaths. “It’s a simple act, but this interrupts the fight-or-flight response and puts it on pause,” says Dr. Rosa. “Over time, belly breathing can buffer your resistance to your fight-or-flight response, so you are not as sensitive to stress triggers.”

To help you be more mindful about your breathing pattern, place one hand on your belly and the other on your chest. “You want the chest hand to be still and the belly hand to move out like you are blowing up a balloon,” says Dr. Rosa.

She suggests practicing belly breathing throughout the day, like once every hour or up to 10 to 15 times per day. “As it becomes more of a habit, you can automatically engage belly breathing whenever you face a stressful event.”

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My Health - Phytonutrients: Paint your plate with the colors of the rainbow

Did you know that adding color to your meals will help you live a longer, healthier life? Colorful fruits and vegetables can paint a beautiful picture of health because they contain phytonutrients, compounds that give plants their rich colors as well as their distinctive tastes and aromas. Phytonutrients also strengthen a plant’s immune system. They protect the plant from threats in their natural environment such as disease and excessive sun.

When humans eat plant foods, phytonutrients protect us from chronic diseases. Phytonutrients have potent anti-cancer and anti-heart disease effects. And epidemiological research suggests that food patterns that include fruits and vegetables are associated with a reduced risk of many chronic diseases, including cardiovascular disease, and may be protective against certain types of cancers.

The American Cancer Society recommends 2 1/2 cups per day of fruits and vegetables. The most recent US Dietary Guidelines recommends consuming even more: 2 1/2 cups of vegetables and 2 cups of fruit, based on a 2,000-calorie diet.

Getting started

To get started, try to include as many plant-based colors in your meals and snacks as possible. Each color provides various health benefits and no one color is superior to another, which is why a balance of all colors is most important. Getting the most phytonutrients also means eating the colorful skins, the richest sources of the phytonutrients, along with the paler flesh. Try to avoid peeling foods like apples, peaches and eggplant, lest you lose their most concentrated source of beneficial chemicals.

Phytonutrients in every color

Following is a rundown of fruits and vegetables sorted by color, along with the phytonutrients they contain, and which foods you’ll find them in.

Red: Rich in the carotenoid lycopene, a potent scavenger of gene-damaging free radicals that seems to protect against prostate cancer as well as heart and lung disease.
Found in: strawberries, cranberries, raspberries, tomatoes, cherries, apples, beets, watermelon, red grapes, red peppers, red onions

Orange and yellow: Provide beta cryptothanxin, which supports intracellular communication and may help prevent heart disease.
Found in: carrots, sweet potatoes, yellow peppers, oranges, bananas, pineapple, tangerines, mango, pumpkin, apricots, winter squash (butternut, acorn), peaches, cantaloupe, corn

Green: These foods are rich in cancer-blocking chemicals like sulforaphane, isocyanate, and indoles, which inhibit the action of carcinogens (cancer-causing compounds).
Found in: spinach, avocados, asparagus, artichokes, broccoli, alfalfa sprouts, kale, cabbage, Brussels sprouts, kiwi fruit, collard greens, green tea, green herbs (mint, rosemary, sage, thyme, and basil)

Blue and purple: Have powerful antioxidants called anthocyanins believed to delay cellular aging and help the heart by blocking the formation of blood clots.
Found in: blueberries, blackberries, elderberries, Concord grapes, raisins, eggplant, plums, figs, prunes, lavender, purple cabbage

White and brown: The onion family contains allicin, which has anti-tumor properties. Other foods in this group contain antioxidant flavonoids like quercetin and kaempferol.
Found in: onions, cauliflower, garlic, leeks, parsnips, daikon radish, mushrooms

Reach for the rainbow

Reaching a total of 4 1/2 cups of colorful fruits and vegetable a day is the goal for a powerful plate. Here are some ways to help make it happen:

• Servings are not that big. 1/2 cup of chopped raw vegetables or fruit makes one serving. Leafy greens take up more space, so 1 cup chopped counts as a serving. 1/2 cup of dried fruit equals one serving.
• Think in twos. Try to eat two servings in the morning, two in the afternoon, and two at night.
• Snacks count, too. Feeling hungry between meals? Munch on a piece of fruit or grab some sliced raw vegetables to go.
• When shopping, look at your cart. If you find most of your choices are the same one or two colors, swap out a few to increase the colors — and phytonutrients — in your cart.
• Dine out colorfully. Start out with a cup of vegetable soup. Choose an arugula or spinach salad and see if they can add extra vegetables. Top off your meal with fresh fruit for dessert and a soothing cup of green tea.
• Look local. Farmers markets, co-ops, buying clubs, and community supported farms are usually great sources of fresh produce. Ask a farmer for fresh ideas on how to prepare fruits and vegetables that are new to you.
• Frozen produce is okay too! It is best to eat in season, but since seasonal produce may be limited, frozen fruits and vegetables count and are just as nutritious as fresh.

Remember, color in fruits and veggies is king, and the greater variety the better.

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My Health - MitraClip: Valve repair device offers new treatment option for some with severe mitral regurgitation

Mitral valve regurgitation (MR), a condition in which the mitral valve does not close properly, allowing blood to leak back into the heart’s upper chamber, is the most common disease of the heart valves. It can cause symptoms such as cough, fatigue, and trouble breathing. The risk of MR increases with age.

Until recently, there were only two methods of treatment for MR: medication and open-heart surgery. During this surgery, the surgeon accesses the heart by opening up the breastbone. He or she either repairs or replaces the mitral valve while a heart-lung machine takes over the job of the heart and lungs while the heart is stopped.

However, we now have a third option, a new device called MitraClip.

What is mitral regurgitation?

The heart receives blood from the lungs into the upper left chamber (the left atrium) and pumps blood to the body through the heart’s lower left chamber (the left ventricle). The mitral valve is located between these two chambers. The valve has two large leaflets — an anterior leaflet and a posterior leaflet — with parachute strings, called chords, that are attached to the heart muscle. When working normally, the leaflets open and close to move blood forward and prevent blood from returning to the left atrium when the heart contracts.

When these parachute chords rupture or stretch, the leaflet prolapses, so that the valve no longer closes completely. This allows blood to leak backwards, into the left atrium, when the heart contracts. This is called primary MR.

There is also a condition called secondary MR. In secondary MR, the mitral valve is pulled further apart when the heart dilates, as may happen in people with heart failure, atrial fibrillation, or other heart conditions. As a result, blood leaks from the center of the valve. This form of MR is much more common.

What is MitraClip?

MitraClip is a large clip that grasps both the anterior and posterior leaflets of the mitral valve. This creates a bridge in the middle of the valve, along with two openings. (Picture two lenses connected by the bridge on a pair of eyeglasses.) Hence, we call the clipped valve a “double orifice valve.” The double orifice valve originated with a surgical technique in which a suture was placed between the two leaflets to repair the valve.

The difference is that the MitraClip does not require having the chest opened. Rather, the small device is inserted into a vein in the groin. From there, it is threaded through the vein and advanced to the right side of the heart, and across the septum (which separates the heart’s upper chambers), from the right side to the left side of the heart. The surgeon then directs the clip to grasp the mitral valve, under ultrasound guidance. The entire procedure can be done with just a small hole in the groin. No incision in the chest is needed, nor is a heart-lung machine.

What’s new?

Until recently, MitraClip was only FDA-approved to treat primary MR in patients who were too high-risk for surgery. In this high-risk population, the risk of death was lower than expected, recovery time and the frequency of rehospitalization were reduced, and the complication rate was very low, compared to open-heart surgery. What’s more, patients only stayed in the hospital for two days after the procedure.

Then, in December 2018, a study published in the New England Journal of Medicine showed improved survival in patients with secondary MR who received MitraClip plus medical therapy, compared to medical treatment alone. This is the first therapy that has been shown to increase survival in patients with secondary MR. In March 2019, the FDA approved MitraClip for secondary MR in patients who are too high-risk for surgery. This will allow MitraClip to be used in a larger population suffering from this type of disease.

Who is a candidate for this procedure?

The Achilles heel of MitraClip is that it cannot completely eliminate the regurgitation. In another words, some leakage is likely to continue even after the clip is placed. For those with severe MR who can withstand surgery, surgical repair or replacement is still the preferred treatment.

However, those who are high-risk for surgery may be candidates for MitraClip. Valve specialists (cardiac surgeons and cardiologists) are best qualified to assess whether someone is a candidate for this procedure.

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My Health - Activity: It all counts

A study published in the British Journal of Sports Medicine found that even 10 minutes per week of light to moderate physical activity was associated with significantly lower risks of death. They also found that there is an increasing benefit, with more activity resulting in even lower risks of death, up to 1,500 minutes or more per week.

The researchers looked at self-reported lifestyle and behavioral data from the CDC’s National Health Interview Survey between 1997 and 2009, and then matched responses with diagnosis and death data from the National Death Index. They excluded participants with serious chronic diseases, incomplete responses, or less than three years of follow-up, and ended up with data from 88,140 US adults ages 40 to 85, followed for about nine years.

Participants had reported a wide range of activities which fit into light, moderate, or vigorous categories, and the researchers analyzed all of this in different ways. First, because they were mostly interested in light to moderate activity, they “translated” every minute of reported vigorous activity into two minutes of moderate activity, per accepted research protocols. Then, they divided everyone into eight groups based on reported minutes of light to moderate activity per week, ranging from completely inactive (zero minutes), to a little (between 10 and 59 minutes), and on up to over 1,500 minutes per week.

What was fascinating (and also depressing) was that the largest group by far was the completely inactive group (36,702 people, 42% of the total). As a matter of fact, over half didn’t meet the minimum recommended amount of 150 minutes of weekly activity (52,136 people, 59%), which fits with prior research. I suppose it’s heartening that a fair amount did get their 150+ minutes weekly (36,004 people, 41%).

Researchers wanted to know how little activity provided benefit

Even after adjusting for smoking, alcohol intake, and body mass index, as little as 10 minutes per week of light to moderate activity was associated with an 18% lower risk of death from any cause. The benefits of more and more exercise followed a fairly obvious dose-response curve, up to 1,500 minutes per week, which had a 46% lower risk of death from any cause (meaning the higher the “dose” of activity, the lower the risk of death). They then looked at cardiovascular (heart attack, stroke) and cancer death risk, and found very similar results.

Then they went back and looked at light to moderate vs. vigorous activity, and found that comparing them by minutes per week, there was a much greater benefit to vigorous physical activity, i.e., more bang for the buck. Those who reported 10 to 59 minutes per week of vigorous activity had a 26% lower risk of death from all causes, as compared to the light/moderate group at 19%. Again, the minutes per week of vigorous activity was associated with a clear dose-response curve, with more being better on up to 600 or more minutes per week and a 42% lower risk of death (that’s as high as they went, because only 1,973 participants reported that much). Again, when they looked at cardiovascular and cancer deaths, they had much the same result.

Why is it that all activity seems to extend our life?

We know that exercise has multiple positive physical effects on weight loss and maintenance, blood sugar control, inflammation, cardiovascular and immune function, and more. Exercise has so many benefits, it’s better than any medication. It can’t be packed into a pill.

These findings underscore (again) that when it comes to exercise, every little bit counts, and a lot counts even more. The recommended minimum for heart health benefits (150 minutes of moderate intensity activity per week — like brisk walking) can be an admirable goal for some people, or a bare minimum for others, and everyone will still reap benefits.

You do not have to go to the gym

This study included a wide variety of activities. We can discover an activity that we enjoy, and do it regularly. We can also work activity into our regular day. I saw a sign hanging on a door recently, a brightly colored advertisement: “Free Exercise Equipment Inside! Open This Door for Your Free Workout Machine!” The door led to the stairwell.

And that’s the idea. Every little bit counts, so if you are blessed with the ability and the good health to move your body, do it!  Park farther away from the entrance of stores and walk extra. Grab a basket, not a cart, and work your biceps while you shop. While waiting for the train, the bus, or to board a plane, see how many steps you can log. If you’re talking on the phone, pace, or at least stand and do some leg moves. Like to watch TV? Get a used exercise bike and set it in your living room. Or grab an exercise mat and do some core work while watching your favorite TV show.

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My Health - Infertility: Extra embryos –– too much of a good thing?

For infertility patients, an IVF cycle can feel like a numbers game. How many follicles are developing well? How many oocytes are retrieved? How many will fertilize? And most important, how many embryos will be ready to transfer into the womb? Although many people say “it only takes one,” I have found that most people going through in vitro fertilization (IVF) are hoping for several.

Why do people hope for several embryos?

If it only takes one, why hope for more? For those struggling with infertility, safety in numbers may feel heartening. Some families hope to have more than one child, and welcome the chance to freeze embryos for future use. They hope to avoid the costs, both financial and emotional, of undergoing another IVF cycle. And for those who worry about aging eggs, creating embryos now enables them to use the mom’s eggs before she gets any older. Extra embryos also provide peace of mind should the cycle not result in pregnancy or end in miscarriage.

What questions arise when extra embryos exist?

In many ways, having several embryos cryopreserved is a good thing. I know one couple with five children, all from one egg donor cycle. For this couple, the bounty of embryos was a gift that kept on giving. However, for others, extra embryos can be problematic. Here are a few examples of the downside of cryopreserving embryos.

• Cryopreserved embryos can offer false hope. Reproduction is truly a mystery. I know a couple who have two sons through egg donation. They conceived their first son on their first donor cycle, a cycle that yielded 12 frozen embryos. All went so smoothly the first time around, the couple assumed that they would have another pregnancy after at most three frozen transfers. As it turned out, they went through all 12 embryos before moving on to another donor. The first cycle with their new donor brought them their second son.
• Parents may question family size. Some people embark on parenthood with a clear idea of how many children they want. Others want to take it as it comes, deciding after the birth of each child whether their family feels complete. Either way, they feel that the decision is theirs; they don’t have to have more children than they are prepared to parent.

  Ironically, this assumed ability to limit the size of one’s family is challenged when IVF yields “extra” embryos. Some feel a responsibility to the embryos to give them a chance at life after all they went through to create them. Or they may wonder if a larger family is meant to be. Some fear that not using the embryos demonstrates a lack of gratitude. After all, they would have done most anything to become parents. Can they really turn away from this ultimate gift?

What choices do people make?

What do families do when they have embryos cryopreserved that they do not intend to use? I have found that many people deal with this with avoidance. Each year they pay a storage fee and give themselves a pass to avoid the topic for another year. Some regard their embryos as a kind of fertility insurance policy. The embryos are there should they need them.

For some families, however, the decision cannot be passive. Some parents feel it is important to acknowledge that their family is complete. They prefer to actively confront the question of what to do with their extra embryos. For some this decision is fairly straightforward: they see an embryo as having a potential for life but as not yet being a life. They may decide to dispose of extra embryos and feel comfortable with their choice.

Not so for everyone. Some parents look at the child or children they have from IVF and want to give the embryos life. They may identify with birth parents in adoption, feeling a need to find parents for their embryos. Others choose to donate extra embryos to science, feeling that this raises fewer social and ethical issues, and offers them — and their embryos — the opportunity to help other infertile families through research.

When embarking on an IVF cycle, infertile individuals and couples understandably hope for several embryos. For some this proves a blessing: they are able to have a longed-for child or children. Yet many also learn that infertility is a complex experience that does not end with the birth of their children. Having cryopreserved embryos is but one way in which infertility remains with people long after their families are completed.

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My Health - Eating breakfast won’t help you lose weight, but skipping it might not either

Yet another study has dispelled the popular “you have to eat breakfast” myth, and I’m thrilled. The breakfast cereal aisle is the most nutritionally horrifying area of the supermarket, crawling with sugary carbs in all shapes and flavors, all disguised as health food.

It’s true — eating breakfast is not associated with eating less nor with weight loss, which begs the question: can skipping breakfast help with weight loss?

What does research tell us about eating breakfast?

A plethora of intermittent fasting studies suggest that extending the overnight fast is indeed associated with weight loss, but also more importantly, with improved metabolism. Overnight fasting of at least 16 hours (which really isn’t that extended) allows blood sugar and insulin levels to decrease, so that fat stores can be used for energy. This makes physiologic and logical sense: Our bodies can’t burn fat if we keep filling it with fuel. The idea that having a meal first thing in the morning revs up the metabolism isn’t based in reality.

So where did the “breakfast is good for you” myth come from? Wasn’t it based on research? Yes, but it was not the right kind of research. Observational studies produce interesting observations, and that is all. At the population level, people who regularly consume breakfast also tend to be a healthier weight. That doesn’t mean that breakfast has anything to do with it. It may be that people who regularly consume breakfast also tend to have daytime schedules (no night shifts), or higher socioeconomic status (can afford breakfast), or generally more consistent habits than those who don’t. These are all more important variables associated with healthier weight, and observational studies don’t reveal any of that.

What do the strongest studies say?

So how do you properly study the effect of eating breakfast (or not) on weight? You’d want to conduct a randomized controlled trial (RCT) evenly dividing participants into breakfast vs. no-breakfast groups, and then measure specific outcomes, like daily calorie intake and weight. RCTs are experiments where you can control for confounding variables, and thus feel more confident about drawing conclusions. (Having said that, RCTs can have other issues, and we’ll go into that.)

Researchers from Melbourne, Australia looked at a number of RCTs on breakfast and weight and/or total daily energy intake, and pooled the results. They found 13 studies in all that met their criteria: they had to define breakfast content and timing, and had to have been conducted in high-income countries (to be more comparable).

• Seven studies looked at the effects of breakfast on weight change, and after an average study length of seven weeks, participants who ate breakfast gained 1.2 pounds compared to those who didn’t. This was true for both normal and overweight people.
• Ten studies looked at the effects of breakfast on total daily calorie intake, and after an average study length of two weeks, participants who ate breakfast consumed 260 calories more than those who didn’t. These results help debunk the notion that skipping breakfast will cause people to binge later. While plenty of studies suggest that eating close to bedtime is associated with obesity, this has nothing to do with breakfast.

Are there flaws in these studies?

The authors do point out that the RCTs had flaws. Participants knew what experimental group they were in. The studies used various groups (college students, hospital staff, general public); featured different foods (crisped rice, wheat flakes, oatmeal); and had widely varying follow-up times. The RCT comparing a high-protein, high-fiber breakfast with nothing has yet to be conducted.

Still, in the end, the authors conclude: “While breakfast has been advocated as the most important meal of the day in the media since 1917, there is a paucity of evidence to support breakfast consumption as a strategy to achieve weight loss, including in adults with overweight or obesity.”

What’s the bottom line on eating breakfast?

Having said all this, if you love love love your breakfast, and you’re healthy, then enjoy! If you’re struggling with a metabolic medical problem, consider a breakfast of water, tea, or coffee and then have a healthy lunch. Or, at the very least, try not to eat close to bedtime. Whatever your preferred schedule, try to stretch out the time between meals, and give your body a chance to burn fat. Your metabolism will thank you!

Follow me on twitter @drmoniquetello

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My Health - The heart and science of kindness

Kindness (noun): the quality of being friendly, generous, and considerate; a kind act.
— English Oxford Living Dictionaries

Ombudspeople like myself have a unique view of the institutions they serve. Some of us fondly refer to it as the “view from the underbelly” of our organizations. The urgent calls we get aren’t to share a recent act of kindness. Visitors who arrive at our offices often do so feeling under siege from less than kindly forces. We hear repeatedly of our visitors’ desire to be treated with kindness, and of the wish that they could themselves rise above unkindness to be their best kind selves. Here, then, are some thoughts on kindness — how to give and receive it.

Kindness starts with being kind to yourself

Ever notice how much better you treat others when you’ve taken care of yourself? In a pressure-filled environment it’s easy to work through lunch, work through dinner, and respond to emails at 11 pm. But the world often rights itself when we take a moment to breathe, assess what we need, and seek it. (Sleep? A relaxed meal, anyone?)

Be kind to yourself when you misstep, which happens to everybody. Setting upon ourselves may cause collateral damage, making others the target of the anger or frustration or disappointment that we really feel about ourselves. It can feel good to direct these upsetting emotions away from ourselves and onto others, but for how long, really?

Lead with compassion, follow with kindness

Everyone has challenges, many hidden from sight. If you knew that your coworker delivering the curt response to a question or the snarky critique of a project had recently learned of a serious illness in their family, wouldn’t you cut them some slack? And better yet, might you then want to reach out with support? When we are compassionate, we are recognizing our shared human condition. Compassion can guide us to acts of kindness. Maybe we keep our mouth shut instead of calling out the misdemeanor. Or we find a private time to ask if everything is okay. Sometimes kindness is offering to get coffee, or bringing back a cookie from a lunchtime workshop just because.

We feel happier when we act in service to others

A recent study reported on how people felt after performing or observing kind acts every day for seven days. Participants were randomly assigned to carry out at least one more kind act than usual for someone close to them, an acquaintance or stranger, or themselves, or to try to actively observe kind acts. Happiness was measured before and after the seven days of kindness. The researchers found that being kind to ourselves or to anyone else — yes, even a stranger — or actively observing kindness around us boosted happiness.

Choose kindness

While we may not have control over another person, we do have control over ourselves. What does it mean to be our best selves? Isn’t being kind in the mix of choices we have each and every day? We can’t make anyone else be kind, but that doesn’t have to stop us from aspiring to be kind, no matter what.

Give to give, not to receive

The purest form of kindness may have no audience and offer no credit. Kindness to accumulate thanks is self-serving at best. Some may even say it’s an effort to control or make the recipient feel indebted. But when we are kind even if — maybe especially if — there’s no such payback, the rewards may be all the sweeter. I heard a story about someone who learned that a child from a family with very little money really wanted a bicycle. This fairy godparent bought a super nice bike and asked the shopkeeper to write a highly discounted receipt for an amount the family could afford. The family reimbursed the fairy godparent for the receipt price without knowing it cost far more. Now that’s kindness!

We become kinder with practice

So, practice. Aesop, the ancient Greek storyteller, once said, “No act of kindness, no matter how small, is ever wasted.” If random acts of kindness don’t come easily to you, try this challenge: do one small, kind thing each day for someone. Then pay attention to the impact on you. Does it become easier the more you do it? Do you start to notice and act on more opportunities to be kind in your world? Do you start to feel lighter? Kinder?

Kindness begets kindness

Just as a bully of a boss can foster a culture of bullying and fear down the hierarchical line, so can kindness from one help to foster kindness in others. We often take our cues from leaders, coworkers, labmates, and others we live with many hours a day. Why not be the kind person from whom others take their cues? The one who helps people turn to one another in small and big ways that illustrate a spirit of generosity?

Kindness is lasting

When I was a terribly insecure and shy misfit of a college freshman, I was going through the cafeteria line by myself one fall day. When I got to the checkout, the woman at the cash register said, “You have such a pretty face.” Now, over 40 years later, I still remember that unexpected moment of kindness from a stranger. Who do you remember most? And how do you want to be remembered?

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My Health - How to handle stress at work

If you’re currently working, you probably know what it feels like to be stressed on the job. A must-do project arrives without warning. Three emails stack up for each one you delete. Phones ring, meetings are scheduled, a coworker drops the ball on a shared assignment.

How does your body react to work stress?

Imagine for a moment that your boss has emailed you about an unfinished assignment (a stressor). Your body and mind instantly respond, activating a physical reaction called the fight-or-flight response. Your heart beats faster, your breath quickens, and your muscles tense. At the same time you might say to yourself, “I’m going to get fired if I don’t finish this.” Then to manage your anxiety and negative self-talk, you work late into the night to complete the task.

Over the course of our evolutionary history, humans developed this coordinated fear response to protect against dangers in our environment. For example, a faster heart rate and tense muscles would help us escape from predators. In the modern era, fear continues to serve an important function. After all, the fight-or-flight response can provide the necessary energy to pull an all-nighter and keep your job.

But what happens if you encounter stressful experiences at work every day? Over time, chronic work stress can lead to a psychological syndrome known as burnout. Warning signs of burnout are overwhelming exhaustion, cynicism, and a sense of inefficacy. Certain work-related stressors are closely linked with burnout. Examples are having too much work or too little independence, inadequate pay, lack of community between coworkers, unfairness or disrespect, and a mismatch between workplace and personal values.

How can work stress affect well-being?

Long-term exposure to work-related stressors like these can affect mental health. Research links burnout with symptoms of anxiety and depression. In some cases, this sets the stage for serious mental health problems. Indeed, one study shows younger people who routinely face heavy workloads and extreme time pressure on the job are more likely to experience major depressive disorder and generalized anxiety disorder.

High levels of stress at work –– and outside of it –– can affect physical health, too. Repeated activation of the fight-or-flight response can disrupt bodily systems and increase susceptibility to disease. For example, repeated release of the stress hormone cortisol can disturb the immune system, and raise the likelihood of developing autoimmune disorders, cardiovascular disease, and Alzheimer’s disease. Chronic stress can also affect health by interfering with healthy behaviors, such as exercise, balanced eating, and sleep.

Work stress can also harm companies or organizations. Burnout reduces job productivity and boosts absenteeism and job turnover, and also leads to conflict between coworkers, causing stress to spread within a workplace.

How can you cope with work stress?

All of us can benefit by learning skills to manage fear and anxiety on the job. Several skills taught in cognitive behavioral therapy may help, including these:

• Relaxation strategies. Relaxation helps counter the physiological effects of the fight-or-flight response. For example, progressive muscle relaxation helps reduce muscle tension associated with anxiety. To practice this skill, sit comfortably with your eyes closed. Working from your legs upward, systematically tense and relax each major muscle groups. Hold the tension for 10 seconds; release tension for 20 seconds. Each time you release muscle tension, think “relax” to yourself. This skill and many other relaxation strategies can help reduce symptoms of anxiety.
• Problem-solving. Problem-solving is an active coping strategy that involves teaching people to take specific steps when approaching a roadblock or challenge. These steps include defining the problem, brainstorming potential solutions, ranking the solutions, developing an action plan, and testing the chosen solution.
• Mindfulness. Mindfulness is the ability to pay attention to the present moment with curiosity, openness, and acceptance. Stress can be exacerbated when we spend time ruminating about the past, worrying about the future, or engaging in self-criticism. Mindfulness helps to train the brain to break these harmful habits. You can cultivate mindfulness skills through formal practice (like guided meditation) and informal exercises (like mindful walking), or try mindfulness apps or classes. Mindfulness-based therapies are effective for reducing symptoms of depression and anxiety.
• Reappraising negative thoughts. Chronic stress and worry can lead people to develop a mental filter in which they automatically interpret situations through a negative lens. A person might jump to negative conclusions with little or no evidence (“my boss thinks I’m incompetent”) and doubt their ability to cope with stressors (“I’ll be devastated if I don’t get the promotion”). To reappraise negative thoughts, treat them as hypotheses instead of facts and consider other possibilities. Regularly practicing this skill can help people reduce negative emotions in response to stressors.

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My Health - What to do with that foam roller at the gym?

The foam roller is possibly the least intimidating piece of equipment in the gym. It’s light. It’s no-tech. And like most things in the gym, you’ve heard something about its benefits, seen a few people using it, and wonder if you should be doing the same.

What is myofascial release?

Foam rolling is a myofascial release technique. The fascia is a sheet of fibrous connective tissue made of collagen that surrounds muscles. It holds muscles in place and helps them glide through their range of motion, says Carina O’Neill, DO, medical director of Spaulding Outpatient Center–Braintree. Think of the relationship like an orange cut in half, she suggests: the edible sections are the muscle, the surrounding white part is the fascia.

Whether you use massage, chiropractic care, or foam rolling, when you press on one tissue, you unavoidably press on the other. There are spots where only fascia is being worked, such as the bottom of the foot and the iliotibial band that runs along the outside of your upper leg, but mostly it’s a combination.

Why is myofascial release performed?

Muscles and fascia can become tight from overuse, repetition, body mechanics, and weakness. In response, the body may protect itself by limiting your range of motion. That protection can be a benefit, except when it doesn’t allow the body to heal itself or move freely.

“Muscles tighten up for a reason, but sometimes they don’t get the memo that they can loosen up because there’s no tissue damage,” Dr. O’Neill says. “Muscles can be stupid.”

How can a foam roller help?

Myofascial release techniques manipulate tissue in order to return it to the proper position and looseness. For example, with massage a therapist would feel the muscle, sensing changes in texture and tenderness, and use pressure to stretch and soften up the tissue, Dr. O’Neill says. The challenge is that sometimes myofascial pain and the source of it are not in the same place. Pain running down the legs could be from tightness in the glutes. Headaches can be from tightness in the trapezius muscles.

The limited research about foam rolling comes from short-term studies of specific sports or even specific muscles. Most studies are small and some involve performing intense activities, such as box jumps, or foam rolling for an extended period of time. Within this context, there is evidence that foam rolling helps with delayed onset muscle soreness (DOMS), recovery, muscle fatigue, and range of motion. Another possible use for a foam roller, Dr. O’Neill says, is during a warm-up for exercise to enhance flexibility.

How should I use a foam roller?

Consider foam rolling a tool to try — an option if you find it helps with your warm-up or eases muscle stiffness, rather than a mandatory segment of your exercise routine. Target big muscle groups — the glutes, legs, back — and slowly roll over an area. Once you hit the “hurt so good spot,” as O’Neill calls it, use your body weight to roll back and forth, moving only about two to six inches. The area could be tender at first, so start with five to 10 seconds to make it more pliant. As you become more accustomed to foam rolling, you can work up to 15 to 30 seconds.

Any exercise-related activity comes with caveats. If pain causes you to clench or grimace, stop rolling. Post-exercise soreness (DOMS) is normal and should resolve within two to four days. Lingering pain reflects a bigger problem and you should call your health care provider for advice. Finally, even if rolling initially feels good, start slowly and don’t overdo it. If you roll too vigorously or for too long, you can cause tissue damage. “Too much of anything is a bad thing,” Dr. O’Neil says.

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My Health - 5 reasons we need to help kids live “heads up” instead of “heads down”

I was recently at an accepted-students day at a local university with my daughter, and the president of the university spoke of how youth these days live a “heads down” life. We need them to be more “heads up,” he said.

He is right.

He is quite literally right that our youth are “heads down.” Our children and teens, like the rest of us, have their faces in their phones more often than not. We’ve grown used to it. Everywhere we go, kids are looking down at their phones and other devices. This could have real implications not just now, but for their future — because looking down all the time has some real downsides.

There are five important ways living “heads down” is bad for our youth.

1.  Safety. This is the obvious one. Anyone who does any driving anywhere has seen someone lost in their phone walk out into traffic — or worse, drive with their attention on their phone. We look down as we walk along a hallway or sidewalk and collide into others doing the same, or into doors, or poles, or other hazards. The university my daughter and I were visiting is an urban one, adding a whole other layer of danger: being aware of one’s surroundings is hard when you are looking at your device.

2.  Health. Our devices tend to make us more sedentary. Too often, our kids are happy to curl up with their phones, their tablets, their computers, or their video games instead of being active. Kids should be active for an hour a day to be healthy, and devices get in the way of that. Since using devices is generally an indoor thing, kids also lose out on being outdoors, in the sunshine, which impacts health. Devices also get in the way of sleep. More and more, especially with teens, cell phones keep kids awake — and wake them up during the night. All of these factors could have both short- and long-term effects on health.

3.  Anxiety. There is growing concern that social media fuels anxiety in our youth. Too often, youth feel measured by how many people click on or “like” their posts. They can feel like their lives pale in comparison to the lives of peers that look so successful and happy on social media. In so many ways, social media can make youth worry and feel inadequate.

4.  Social connections. Not only do kids not notice people around them when they are on their devices, it’s becoming more common for kids to be on their phones even in social situations — rather than talking or otherwise interacting. Kids are at risk of losing the important social skills of making conversation and building relationships, and losing these skills could have lifelong implications.

5.  Losing connection with the physical world. It’s not just about avoiding bumping into people or not learning how to make small talk. There is a bigger problem when people experience the world through devices. They miss out on experiencing the natural world and on all the hands-on experiences and skills the physical world provides.

There is much that devices can offer in terms of connection and information, so many ways they can make our lives streamlined and more efficient. But we owe it to our children to be sure that they live their lives in a “heads-up” way: fully engaged with everyone and everything around them.

Follow me on Twitter @drClaire

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My Health - Is obesity a reason to avoid joint replacement surgery?

“Come back when you’ve lost 40 pounds.” That’s something obese patients have heard often when being evaluated for a hip or knee replacement for severe arthritis. And sometimes the recommendation is to lose even more — 50, 75, or even 100 pounds… as if that’s an easy or realistic prospect.

As you might expect, patients hearing this often feel disappointed and disheartened. After all, most have already tried hard to lose weight with limited success. Their arthritis pain impairs their ability to exercise, and decreasing activity has contributed to their weight gain. So being told to lose significant weight before they can be considered for joint surgery sounds a lot like being told it’s just not going to happen.

Why should obesity preclude joint surgery?

While the surgeon’s recommendations may be disappointing, the rationale seems sound: people carrying a lot of excess weight have long been considered at higher risk for complications, and less likely to experience the profound pain relief expected from this major operation. Indeed, several studies describe higher rates of infections and dislocations and lower rates of good results after hip or knee replacement among the obese, especially the severely obese.

Importantly, many of these studies are more than a decade old, and newer studies are beginning to paint a different picture. A recent study on the risks and benefits of joint replacement among the obese sheds new — and positive — light on an issue that affects many thousands of people.

A new study suggests that being obese should not preclude joint replacement

Researchers analyzed the results of more than 5,000 people having hip or knee replacement surgery, comparing pain and function before and six months after surgery. Here’s what they found:

• Those who were the most obese (about 25% of those in the study) had more pain and poorer function prior to surgery than those who were leaner.
• The amount of functional gain in obese individuals six months after joint replacement was significant, and similar to that experienced by those who were not obese.
• Pain relief was greater among the most obese than other weight groups. After surgery, pain levels were similar in all weight groups.

The authors conclude that “obesity in itself should not be a deterrent to undergoing total joint replacement to relieve symptoms.” However, the potential for more complications must be considered as well, something this study did not formally examine.

Given the high and rising rates of obesity and arthritis in this country, the results of this study will likely apply to many people. And they suggest that surgeons should change expectations about what surgery has to offer obese individuals with severe arthritis.

The bottom line

While avoiding obesity in the first place is still preferable, there is increasing evidence that the benefits of joint replacement surgery are not limited to those who are lean. If this new research is confirmed by others, we may see fewer obese people turned down for joint replacement surgery in the future.

Follow me on Twitter @RobShmerling

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My Health - Brain-gut connection explains why integrative treatments can help relieve digestive ailments

During the 20th century, medicine became very good at compartmentalizing different systems of the body in order to understand them better. However, today we are increasingly realizing that different systems of the body are interconnected and cannot be completely understood in isolation. The brain-gut connection is one very important example of this phenomenon.

Anatomy of the brain-gut connection

What exactly is the connection between brain and gut? The brain sends signals to the digestive, or gastrointestinal (GI), tract via the sympathetic (“fight or flight”) nervous system and the parasympathetic (“rest and digest”) nervous system. The balance of signals from these two inputs can affect the speed at which food moves through the digestive system, absorption of nutrients, secretion of digestive juices, and level of inflammation in the digestive system.

The digestive system also has its own nervous system, the enteric nervous system, consisting of approximately 100 million nerve cells in and around the GI tract. The enteric nervous system receives inputs from the sympathetic and parasympathetic nervous systems but can also function independently of them.

The enteric nervous system is also intimately interconnected with millions of immune cells. These cells survey the digestive system and convey information, such as whether the stomach is bloated or whether there is infection in the GI tract or insufficient blood flow, back to the brain. Thus, the brain and GI system communicate with one another in both directions.

Effects of stress and negative emotions on the gut

Because of this strong brain-gut connection, stress and a variety of negative emotions such as anxiety, sadness, depression, fear, and anger can all affect the GI system. These triggers can speed up or slow down the movements of the GI tract and the contents within it; make the digestive system overly sensitive to bloating and other pain signals; make it easier for bacteria to cross the gut lining and activate the immune system; increase inflammation in the gut; and change the gut microbiota (the types of bacteria that reside in the gut). That’s why stress and strong emotions can contribute to or worsen a variety of GI conditions such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and food allergies and sensitivities.

The negative changes in the GI system can then feed back on the brain, creating a vicious cycle. For example, new research is demonstrating that increased gut inflammation and changes in the gut microbiome can have profound effects throughout the body and contribute to fatigue, cardiovascular disease, and depression.

Mind-body approaches to GI ailments

Given this strong mind-body/brain-gut connection, it should come as no surprise that mind-body tools such as meditation, mindfulness, breathing exercises, yoga, and gut-directed hypnotherapy have all been shown to help improve GI symptoms, improve mood, and decrease anxiety. They decrease the body’s stress response by dampening the sympathetic nervous system, enhancing the parasympathetic response, and decreasing inflammation.

Other integrative approaches

We’ve also learned that certain kinds of foods can trigger specific reactions in the gut of sensitive individuals. In those cases, specific diets, such as low-FODMAP for IBS or avoiding acidic foods for GERD, can be helpful for managing symptoms. Diet also profoundly affects the gut microbiome. For example, eating a more plant-based diet with few refined carbohydrates and little or no red meat often leads to a healthier microbiome. These dietary changes in turn reduce intestinal inflammation and may help reduce systemic symptoms such as fatigue or depression and the risk of cardiovascular disease.

Although each person’s situation is unique, I often find a combination of integrative approaches can be helpful for reducing GI symptoms and reestablishing both a healthy gut and a healthy mind.

Follow me on Twitter @DrCalm123

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My Health - Can you strong-arm diabetes?

There is a strong link between diabetes and fitness. Many studies have shown that people with type 2 diabetes lose more muscle mass and strength over time than people with normal blood sugars. This is thought to be a major reason why diabetes is associated with functional limitation, impaired mobility, and loss of independence. Studies have also shown that combining aerobic and resistance training can not only improve blood sugars in people who have diabetes, but can also prevent diabetes from developing.

For these reasons, scientists are very interested in the relationship between diabetes and fitness, teasing out the differences between muscle strength and cardiorespiratory fitness.

In a 2019 study published in the journal Mayo Clinic Proceedings, researchers looked at 4,681 adults, measured their muscle strength and cardiovascular fitness, and followed them over about eight years. Both upper and lower body muscle strength were measured using bench and leg presses at increasing loads, and participants were scored as having low, medium, or high strength based on the maximum weight lifted per kilogram of body weight.

They found that those with medium strength had a 32% reduced risk of developing diabetes than those with low strength. This is all fine and good and consistent with prior research. However, they did not see that those with high strength had any further reduction of diabetes risk. As a matter of fact, there was no association at all.

How could this be?

The authors focus largely on the also very important cardiorespiratory fitness factor. They point out that those participants with medium strength also tended to have good cardiorespiratory fitness, with good correlation between the two. However, in the low and high strength groups, it was a bit of a mix, with some people in the low strength group having high cardiorespiratory fitness, and vice versa. They point out that there may be added benefit to having both good muscle strength and good cardiorespiratory fitness, not just good muscle strength alone.

But another consideration is how things like strength and cardiorespiratory fitness are measured. It’s important to note that just about every study looking at muscle strength uses a different method than this study. Hand grip strength is very common, for example. One large 2018 study of 8,208 Korean adults found that stronger hand grip strength was significantly associated with lower fasting blood sugars, HbA1c levels, and fasting insulin levels (all markers of prediabetes and diabetes). It’s possible that hand grip is somehow a superior method of measuring strength than bench and leg press, or vice versa.

Maybe cardiorespiratory fitness is the more important factor after all?

This has been found to be particularly important in diabetes prevention. One large 2018 study out of Japan looked specifically at cardiorespiratory fitness (as measured by oxygen uptake while exercising on a cycle ergometer) in 7,804 men, and followed them over about 20 years, checking several times to see if anyone developed diabetes. They found that higher cardiorespiratory fitness was significantly associated with lower risk of developing diabetes at all follow-up periods. This is a pretty powerful association, though it would be good to do this study in women and in other ethnic groups.

Let’s look at the big picture

Being in good overall shape, meaning having both decent muscle strength and cardiorespiratory fitness, is just good for you. Both can very likely lower your risk of developing diabetes, and even if you have diabetes, being fit can improve your blood sugars.

Resources

Association of Muscular Strength and Incidence of Type 2 Diabetes. Mayo Clinic Proceedings, March 11, 2019.

Accelerated Loss of Skeletal Muscle Strength in Older Adults with Type 2 Diabetes. Diabetes Care, June 2007.

Patients With Type 2 Diabetes Show a Greater Decline in Muscle Mass, Muscle Strength, and Functional Capacity With Aging. Journal of the American Medical Directors Association, August 2013.

Muscle dysfunction in type 2 diabetes: a major threat to patient’s mobility and independence. Acta Diabetologica, December 2016.

Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients with Type 2 Diabetes. JAMA, November 24, 2010.

Association between muscle strength and type 2 diabetes mellitus in adults in Korea. Medicine, June 2018.

Long-term Impact of Cardiorespiratory Fitness on Type 2 Diabetes Incidence: A Cohort Study of Japanese Men. Journal of Epidemiology, May 5, 2018.

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My Health - Easy daily ways to feel more connected

I’ve got some legitimate skills: in no particular order, making pesto, finding lost LEGO pieces, and having debates in my head. That last one might be my specialty. I work for myself and by myself, tumbling around thoughts and words all day. But it doesn’t stay at my desk. I get into internal beefs, turning imagined conversations and arguments over and over. I need to find ways to pull out of my head, to feel more connected and less isolated every day.

Getting out of your head

One difficulty is that it’s normal to be in your head. “It’s always there and comfortable. It’s reassuring to you and makes you feel good,” says Sara Lazar, PhD, assistant professor of psychology at Harvard Medical School. “We all have that voice. The problem is that voice is a distraction and drowns out everything else.”

Engaging with others challenges your assumptions, she says. It forces you to say, “I never thought of that.” Also, it diminishes some loneliness.

“You feel heard, seen, and respected,” Lazar says. “It helps the other person feel connected to you, and with that, you feel less disconnected from the world.”

Forging a connections

A couple of years ago, I experimented with saying hi to 10 people for 10 days. It worked beautifully. People became three-dimensional. The place I live felt warmer and I felt more a part of it. I still try to keep it up, just to remain engaged. And I looked for other chances to feel more connected and less isolated with help from two experts.

• Thank people. Whether it’s the bus driver or a person holding the door — which could be you as well — thanking people recognizes their existence and that things don’t magically happen. “It reminds us we live in the interconnected universe,” says Sharon Salzberg, co-founder of the Insight Meditation Society and the author of Real Happiness: The Power of Meditation.
• Pick up a conversation. If a person puts out a verbal fist bump, don’t let them hang. Again, they feel visible, a good feeling to have, Lazar says. More than that, conversations beget conversations that beget commonalities. “It makes the world bigger but more intimate,” Salzberg says.
• Take note of three things to appreciate throughout each day. People are wired to scan for threats, a necessary skill to avoid being eaten. But not everything is predator or prey. Having a different target reorients your perspective. “It focuses on what we do have rather than what we don’t have,” Salzberg says.

Connecting: The simple part and the challenge

None of these are complicated, but that’s not the challenge. “It’s not hard to do. It’s hard to remember to do,” Salzberg says. People get frustrated, anxious, tired. The phone and earbuds are attractive escapes. It takes a strong intention, and possibly technological assistance –– setting reminders on your computer or phone –– to create a habit.

These tips from Lazar can help smooth your path:

• Do what feels comfortable. Or more specifically, do what doesn’t feel wholly uncomfortable because there’s always a fear of the unknown. It could be saying hi to 10 people, but five or even just two might be more realistic. “It’s baby steps,” she says. “Start with where you are and what works for you.”
• Play interactions out in your head. What’s the worst realistic thing that could happen? The person doesn’t say hi? Snaps at you? After you imagine the possibilities, they can feel less overwhelming.
• Begin with friendly faces. This can be people whom you know a little or people who work in customer service. You can sense who might be more receptive. “Start in the bath, not the ocean,” Lazar says.

Connecting creates ripples

And here’s one more thing to remember: a response isn’t guaranteed. People are shy, dealing with their own problems, or just might not be ready. You also might not be into it at every moment. I recently didn’t pick up a conversation because I didn’t feel like talking about plastic cups in the ocean at 7 a.m. at the gym. But it’s a big-picture pursuit. That person who didn’t respond yesterday might tomorrow. Someone who saw the attempt could be motivated to connect with someone else.

“There are ripples,” Lazar says. “What you’re trying to do is build up your muscles so it becomes a habit. You’re not going for a perfect score.”

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My Health - Will blue light from electronic devices increase my risk of macular degeneration and blindness?

Every day, retinal specialists are asked about the risks from blue light emitted from electronic devices. (Retinal specialists treat conditions affecting the retina, a thin tissue at the back of the eye that is responsible for vision.) Many people ask whether blue light will increase their risk of age-related macular degeneration and blindness.

The short answer to this common question is no. The amount of blue light from electronic devices, including smartphones, tablets, LCD TVs, and laptop computers, is not harmful to the retina or any other part of the eye.

What is blue light?

Blue light is visible light between 400 and 450 nanometers (nm) in frequency on the visible light spectrum. As the name suggests, this type of light is perceived as blue in color. However, blue light may be present even when light is perceived as white or another color.

Blue light is of concern because it has more energy per photon of light than other colors in the visible spectrum, i.e. green or red light. Blue light, at high enough doses, is therefore more likely to cause damage when absorbed by various cells in our body.

How do we perceive color?

Our perception of color relies primarily on four main light-sensitive cells: three cone photoreceptors and one rod photoreceptor. These cells reside within the retina.

During the daytime, the three cone photoreceptors actively sense light, and each has a peak sensitivity in either the blue, green, or red portions of the visible light spectrum. On the most basic level, our sense of color is determined by the balance of activity of these three cells. When the light is too dim to stimulate the cones, our sense of color is extinguished. We perceive the world in shades of gray because only one type of photoreceptor, the rod, is maintaining our visual function.

LED technology and blue light

Most incandescent light sources, like sunlight, have a broad spectrum of light. However, light emitting diodes (LEDs) produce relatively narrow peaks of light that are crafted by the manufacturer. This allows light from LEDs to be perceived as almost indistinguishable from white light, or daylight. (They can also be made to mimic traditional artificial light sources.)

White LEDs may actually emit more blue light than traditional light sources, even though the blue light might not be perceived by the user. This blue light is unlikely to pose a physical hazard to the retina. But it may stimulate the circadian clock (your internal biological clock) more than traditional light sources, keeping you awake, disrupting sleep, or having other effects on your circadian rhythm.

The screens of modern electronic devices rely on LED technology. Typical screens have individually controlled red, green, and blue LEDs tightly packed together in a full-color device. However, it is the bright white-light LEDs, which backlight the displays in smartphones, tablets, and laptop computers, that produce the greatest amount of blue light.

Risks from blue light

It all comes down to this: consumer electronics are not harmful to the retina because of the amount of light emitted. For example, recent iPhones have a maximum brightness of around 625 candelas per square meter (cd/m²). Brighter still, many retail stores have an ambient illumination twice as great. However, these sources pale in comparison to the sun, which yields an ambient illumination more than 10 times greater!

High-intensity blue light from any source is potentially hazardous to the eye. Industry sources of blue light are purposely filtered or shielded to protect users. However, it may be harmful to look directly at many high-power consumer LEDs simply because they are very bright. These include “military grade” flashlights and other handheld lights.

Furthermore, although an LED bulb and an incandescent lamp might both be rated at the same brightness, the light energy from the LED might come from a source the size of the head of a pin compared to the significantly larger surface of the incandescent source. Looking directly at the point of the LED is dangerous for the very same reason it is unwise to look directly at the sun in the sky.

Compared to the risk from aging, smoking, cardiovascular disease, high blood pressure, and being overweight, exposure to typical levels of blue light from consumer electronics is negligible in terms of increased risk of macular degeneration or blindness. Furthermore, the current evidence does not support the use of blue light-blocking lenses to protect the health of the retina, and advertisers have even been fined for misleading claims about these types of lenses.

The bottom line

Blue light from electronic devices is not going to increase the risk of macular degeneration or harm any other part of the eye. However, the use of these devices may disrupt sleep or disturb other aspects of your health or circadian rhythm. If you are one of the large number of people who fall into this category, talk to your doctor and take steps to limit your use of devices at night, when blue light is most likely to impact your biological clock.

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My Health - Lead exposure and heart disease

When we think about the health effects of lead contamination, the biggest worry is for babies and young children. Lead, a heavy metal that is widespread in the environment, can harm developing brains. But growing evidence suggests that low levels of lead in the blood may also raise the risk of heart disease in adults.

Last year, a study in Lancet Public Health found a link between lead exposure and a higher risk of death from cardiovascular disease. The data came from more than 14,000 people in the United States who were adults in the late 1980s. The association persisted after researchers controlled for many confounding factors, and was evident even among people with blood lead levels of less than 5 micrograms per deciliter (µg/dL). Until 2013, only levels higher than 10 µg/dL were considered worrisome, and mainly for children.

Lead’s legacy

“Today, average blood lead levels are just over 1 µg/dL, down from an average of 10 µg/dL in the 1980s,” says Dr. Rose Goldman, associate professor of medicine at Harvard Medical School. But there is no safe blood level of lead, according to the Centers for Disease Control and Prevention. And even though the body eliminates about half of the blood lead in the urine after one to two months, a portion of it goes into the bones, where it can stay for decades, she says. Bone tissue constantly remodels itself, and that stored lead can be released back into the bloodstream in response to different conditions, including pregnancy, breastfeeding, hyperthyroidism, and aging.

Although deaths from cardiovascular disease dropped by 43% between the mid-1980s and the early 2000s, improvements in traditional risk factors, such as cholesterol and blood pressure, cannot fully account for that decrease. According to a 2017 study in the International Journal of Epidemiology, nearly one-third of the drop over that time period may be explained by the reductions in exposure to lead and cadmium, another heavy metal. Those reductions are the result of public health policies such as smoking bans, air pollution improvements, hazardous waste cleanups, renovations in drinking water infrastructures, and the ban on lead in gasoline.

Get the lead out

Despite those successes, lead remains an insidious presence in daily life. Because even low levels of lead can be dangerous, people should take steps to minimize their lead exposure throughout life, says Dr. Goldman.

Lead paint is still found in buildings and steel bridges constructed before 1978. Following natural disasters such as hurricanes, lead from these structures can enter the environment and raise soil lead levels. Amateur home renovators who scrape and sand old painted surfaces can inhale lead dust. Don’t risk the DIY approach; hire an EPA-certified lead abatement professional. Lead can also contaminate drinking water due to erosion from lead pipes, mainly in homes built before 1986. Consider testing your water, especially if young children live in your home.

Other possible sources of lead exposure include:

• The FDA’s recommended limit for lead in lipstick (which may be ingested when a woman licks her lips) is 10 parts per billion, but some brands contain much higher amounts. Consider seeking out lead-free brands.
• In October 2018, the FDA banned lead acetate from hair coloring products. But companies still have a year to comply with the ruling, so check labels if you use these products, which are mainly drugstore brands that gradually cover gray.
• Indoor and outdoor firing ranges can expose people to dust from lead bullets. Wild game shot with leaded bullets may also be contaminated with lead.
• Both Ayurvedic remedies (an alternative form of medicine from India) and traditional Chinese medicinal herbs may be contaminated with lead, as evidenced by high blood levels seen in some users.
• Cooking or eating off lead-glazed ceramics (usually decorative traditional pottery, not commercially made products) has caused lead poisoning. Hardware stores carry lead testing kits you can use to check such products.

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