Tag Archives: Teton Health

Insomnia Increases Risk of Diabetes

Today is World Sleep Day, and in recognition of this day our post will review recent research regarding insomnia as a risk factor for diabetes mellitus type 2.

The statistics for diabetes are a cause for alarm. According to the American DIabetes Association, over 9% of the U.S. population has diabetes, with 1.5 million new cases diagnosed yearly. Over 84 million Americans are classified as pre-diabetic, and are at high risk for progressing into diabetes. The total cost for diabetes for 2017 was estimated at $327 billion.

A research group in the Portland, Oregon area conducted a retrospective cohort study. The participants numbered over 81,000 and all had been diagnosed with pre-diabetes, and with and without insomnia. On average the subjects were followed over 4 years. The mean age was 57 1/2 years.

What the researchers discovered was that the subjects who had insomnia had nearly a 30% increased risk of developing type 2 diabetes, compared to the group that did not have insomnia, even after adjusting for risk factors such as age, body mass index, and cardiovascular issues.

The mechanism by which insomnia increases the risk of diabetes type 2 is not entirely clear, but may involve activation of the sympathetic nervous system (and hence increased stress hormones), increased inflammation in the body, increased appetite, decreased exercise due to fatigue, or perhaps some other factor. It may well involve multiple factors and not just one.

This study is robust- a large number of subjects were enrolled in a real world clinical setting. It examines a modifiable risk factor for diabetes. Those who have ongoing issues with insomnia may well want to consider the possible implications of developing diabetes from their lack of sleep.

“The worst thing in the world is to try to sleep and not to.” – F. Scott Fitzgerald

(Source- BMJ Open Diabetes Research&Care, 2018)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Eat Your Veggies- Help Your Heart

In recognition of registered dietician nutritionist day, our post today will look at how some dietary factors impact cardiovascular health.

A recent study examined a group of Swedish women and their dietary habits. Nearly 39,000 women completed a 96 item food frequency questionnaire. The questionnaire asked about how certain food or beverages had been consumed over the prior year. Researchers then calculated estimates of the total antioxidant capacity of each respondents diet. Four categories including fruit and vegetable consumption, whole grain consumption, and coffee consumption were used. The participants in the study were followed for approximately ten years. Women in the highest ranking group of total antioxidant capacity of diet, compared to the lowest ranking group, had a 20% lower risk of a heart attack.

This study is an interesting one as it examines a group of women. Women have been typically underrepresented in medical research. This was also a large study of nearly 39,000 subjects, and large is better in this regard.

Finally, which one of us has not encouraged our children to “eat more vegetables”? Now we can add that it is good for their heart as well!

“I eat more vegetables than the average vegetarian.”– Dr. Robert Atkins

(Source- American Journal of Medicine, Vol 125, No. 10, Oct. 2012)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

 

Acupuncture for Insomnia

Insomnia Awareness Day is Monday, March 11th. This is an appropriate designation for the day after Daylight Saving Time begins for the year. In recognition of this day, today’s post will examine the use of acupuncture for primary insomnia.

Insomnia is a common disorder among adults. It is estimated that about 30% of adults have brief periods of insomnia, and upwards of 10% of adults have chronic insomnia, lasting more than three months. It has also been estimated that greater than $60 billion is lost yearly in work production due to insomnia. Insomnia is felt to be a factor in worsening mental health disorders, as well in medical disorders such as hypertension and diabetes mellitus type II.

A recently published study looked at using a short course of acupuncture as an intervention for primary insomnia. 72 subjects with primary insomnia were randomized into either a acupuncture treatment group or a sham (fake) acupuncture group. For the acupuncture treatment group, points were used on the scalp, wrist and lower leg. For the sham acupuncture group the same points were used, but the needle tube was only tapped to give the sensation of a needle being placed. The participants wore eye masks so they could not see whether or not needles were in place.

Participants were treated three times each week, for four weeks. Each treatment session lasted thirty minutes. Questionnaires were filled out every two weeks for a total of eight weeks. The primary outcome measure was the Insomnia Severity Index (ISI). The ISI is a validated assessment tool, consisting of 7 questions, and scored on a scale of 0 (no significant insomnia) to 28 (severe insomnia). The subjects also completed self-rating anxiety and depression scales, to assess their mental health.

Results of the study showed that the Insomnia Severity Index was significantly improved after receiving acupuncture treatment. Sleep efficiency was improved in the acupuncture group beginning at two-weeks post-treatment. Also, sleep awakenings were significantly lower in the acupuncture group, beginning at four weeks post-treatment.

It also appears that acupuncture can improve mental health, as participants in both groups had lower scores on the self-rating scales for both anxiety and depression, compared to baseline scores. It is also important to note that no one withdrew from the study due to some possible adverse side effect from acupuncture.

The study authors did a good job in setting up the sham or placebo acupuncture in a way to keep it blinded to patients. It would be helpful to know how long these beneficial effects of acupuncture on insomnia last, and if there is a certain frequency or schedule that would be optimal. These may be topics of future research.

We have a seemingly low risk treatment for insomnia, that is worthy of consideration. Perhaps consider acupuncture rather than medication for insomnia next time around.

“The best cure for insomnia is to get a lot of sleep.”–  W.C. Fields

(Source- Sleep Medicine 37 (2017), pp. 193-200)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

 

Sauna Good For Mental Health

This is the third and final post in recognition of Helsinki Sauna Day, which is March 9th. We will again look at some of the benefits of sauna baths, this time in the realm of mental health.

The sauna continues to be an important part of Finnish culture. The sauna cuts across socio-economic classes- the prime minister has a sauna at his/her disposal as do most companies. Saunas are felt to be very egalitarian.

This particular study again utilizes the Kuopio Ischemic Heart Disease cohort and is a prospective study. Over 2100 men completed the study, ages 42-61 years. None of the men had any history of psychotic disorders at the time of enrollment. Participants completed a questionnaire that assessed smoking history, use of alcohol, physical activity levels, medical and medication history. The weekly frequency and duration of sauna bathing sessions was also collected. The men were followed for nearly 25 years, on average.

Results of the study showed that frequent sauna bathing is strongly associated with a decreased risk of psychosis, in middle age males.

It would be helpful to carry out a similar study in females. It would also be useful to perform the study amongst a more diverse population, such as we have in the United States.

It is felt that the sauna baths promote relaxation and decrease stress, and perhaps in doing so increase mental health. Saunas are also an opportunity to spend time with friends and family, which also promotes wellness. Given these results, and the low risk nature of sauna bathing, perhaps you may want to consider incorporating this as part of an overall healthy lifestyle.

“A sauna- the poor man’s pharmacy.”–  Finnish Proverb

(Source- Medical Principles and Practice, Sept. 2018)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Sauna Lowers Risk of High Blood Pressure

This is the second post in recognition of Helsinki Sauna Day, which is March 9th. In this post we will examine research regarding sauna bathing and subsequent development of hypertension.

Sauna is a part of life in Finland, and an important element in Finnish culture. Saunas go back at least 2000 years, and perhaps even much longer. The first saunas were simply dug into embankments, and later free-standing log structures were developed. There are more saunas than cars in FInland.

A prospective cohort study was completed as part of the Kuopio Ischemic Heart Disease Study, this was the same study group that was discussed in our last post. The sample size included over 1600 men, ages from 42 to 60 years. It is important to note that these men did not have high blood pressure at baseline.

The subjects were enrolled in the study between 1984 to 1989. Information such as smoking habits, body mass index, serum creatinine (kidney function), glucose and cholesterol were collected. Sauna bathing habits were assessed via a self-administered questionnaire. The median age was 52.9 years. The average duration of a single sauna session was 14.4 minutes.

The mean time of follow-up was 22 years. During this time, subjects were monitored for the development of hypertension. The researchers discovered that the higher frequency of sauna bathing was independently associated with a lower risk of the development of high blood pressure, in a dose-response manner.

This is an important study- none of the subjects had hypertension when they enrolled into the study. Also, the more sauna sessions a participant had each week, the lower the risk of developing hypertension.

While this study shows impressive results in an all-male study, it should be repeated in a population of female participants to see if the results would still apply. Also, it would be interesting to see if the results would apply in a more diverse population, such as we have in the United States. In any case, taking a sauna bath certainly seems like a low risk endeavour that could potentially lead to the prevention of high blood pressure.

“Build the sauna, then the house.”–  Finnish Saying

(Source- American Journal of Hypertension 30(11), November 2017)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Sauna Is Good For Your Heart

March 9th is Helsinki Sauna Day, and in recognition of this day our post will review research related to Finnish sauna bathing and cardiovascular events. This will be our first of three posts on the benefits of sauna bathing.

The sauna is an important part of Finnish culture. One of the first recorded writings on sauna baths are from the monk Nestor the Chronicler in 1112. Some versions of the Finnish sauna are thought to go back at least two thousand years. There is an average of one sauna per household in FInland, where saunas are a place to relax with family and friends. A traditional Finnish sauna usually has warm (80-100 C), dry (10-20% humidity) air.

A recent study looked at the association of the frequency as well as duration of sauna bathing and several cardiovascular markers, such as sudden cardiovascular death and fatal cardiovascular diseases. A prospective cohort study was performed by enrolling over 2300 men, ages 42-60 years, from eastern Finland. Subjects were from the Finnish Kuopio Ischemic Heart Disease Risk Factor Study.

The subjects were subdivided into groups based on the frequency of sauna bathing (1, 2-3, and 4-7 times each week) and also the duration of the sauna sessions (<11, 11-19, and >19 minutes per session). Baseline evaluations were conducted beginning in 1984 through 1989. On average, participants were followed for 18.8 years.

Results of the study demonstrated that the subjects with a higher frequency of sauna bathing per week had a lower risk of both fatal coronary heart disease and fatal cardiovascular disease. In fact, the risk of fatal coronary heart disease was 23% lower for 2-3 sauna sessions per week, and 48% lower for 4-7 sauna bathing sessions per week.

In addition, the frequency of sauna bathing was also inversely associated with all-cause mortality, with a 40% reduction in all-cause mortality when comparing 4-7 sessions per week of sauna bathing to one session per week.

The mechanism by which sauna bathing confers these protective cardiovascular benefits is not entirely clear. Heart rate may rise to 100-150 beats per minute during a sauna bath, which is comparable to some types of low and moderate exercise training. It is also believed that sauna bathing is beneficial for the endothelial lining of the blood vessels.

It would be helpful to perform this same study in a population of female participants, to see if the results would be comparable.

While sauna bathing may not be for everyone, again we have a simple low risk intervention that may yield great benefits. Happy Helsinki Sauna Day!

“The ideal sauna is a small building made of logs, set near a lakeshore, facing towards the sunset.”  Bernhard Hillila

(Source- JAMA Internal Medicine 2015: 175(4):542-548)

This bog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Worried About Your Heart? Don’t Skip Breakfast!

Today’s post is another in recognition of American Heart Month. Many of us can recall being reminded by our mother to “eat your breakfast” when we were young, usually as teenagers. It turns out that as is usually the case, mom was giving us good advice.

An interesting study from a research group primarily located in Spain and the US used data from PESA (Progression of Early Subclinical Atherosclerosis) and looked at the association of breakfast styles and cardiovascular risk factors and the presence of subclinical atherosclerosis.

The PESA study is an ongoing observational investigation of over 4000 employees who work at the Bank Santander Headquarters in Madrid, Spain. Female and male participants in the study were ages 40-54, and were free from cardiovascular disease at the time of enrollment in the study. The participants were asked to complete a computerized food questionnaire, which included over 800 food items. Based on this data the “energy consumed during breakfast” was calculated.

Three different categories of breakfast patterns were established. First were the “breakfast skippers”, whose breakfast intake did not exceed 5% of the their total daily energy intake. The next category was the “low energy” breakfast group, who consumed between 5% and 20% of their total daily energy intake at breakfast. The third group was the “high energy” breakfast group which consisted of those who consumed more than 20% of their total energy intake at breakfast. Of the over 4000 study subjects, 3% were in the “breakfast skipper” group, 69% were in the “low energy” group, and 28% were in the “high energy” breakfast group.

Ultrasound was used to assess for atherosclerotic plaques in the carotids, the abdominal aorta, and the illiofemoral arteries. The prevalence of subclinical atherosclerosis for the PESA subjects was 62.5% in the “breakfast skippers” group, 60.3% in the “low energy” group, and 13.4% in the “high energy” group.

Importantly, regularly skipping breakfast was associated with 2.57 higher odds for generalized atherosclerosis, and 1.55 higher odds for noncoronary atherosclerosis, independent of traditional cardiovascular risk factors (such as diabetes, high cholesterol, high blood pressure, and smoking).

So, make some time in the morning for breakfast. It turns out mom was right, again.

“Sometimes I’ve believed as many as six impossible things before breakfast”. Lewis Carroll

(Source- Journal of the American College of Cardiology, Vol. 70, No. 15, 2017)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Adding Sugar Increases Cardiovascular Events

February is National Heart Health Month. In honor of heart health, and Valentine’s Day, this post is about cardiovascular disease

In this study published in JAMA Internal Medicine in 2014 researchers looked at the effect of added sugar in the American diet and its relationship to cardiovascular disease. Participants who consumed 17-21% of calories from added sugar had a 38% higher risk of cardiovascular mortality, compared to those who only consumed 8% of calories from added sugar. For those who consumed 21% or more of calories from added sugar, the relative risk was doubled.

Much of the added sugar in the American diet is from soda, other sources include desserts, fruit juices and candy. Just one soda a day constitutes 7% of the total calories of a 2000 kcal/day diet.

The reason for increased cardiovascular risk with increasing sugar intake is probably due to several causes, such as obesity, increased blood pressure, worsening cholesterol, and higher inflammation in the body.

This is a robust study which looked at data from the National Health and Nutrition Examination Survey (NHANES) which is felt to be a nationally representative sample of US adults. It provides more solid evidence of the harms of sugar and simple carbs to cardiovascular health. Happy Valentine’s!

“Wherever you go, go with all your heart.”  Confucius

(Source- JAMA Internal Medicine, April 2014, Volume 174, Number 4)

An Orange a Week May Prevent Macular Degeneration

February is AMD/Low Vision Awareness Month, and in recognition of this our post today will examine the effects of dietary flavonoids on age-related macular degeneration (AMD).

Age-related macular degeneration is one of the leading causes of vision loss in the US. It is estimated that approximately 1.75 million Americans age 40 and older suffer with macular degeneration. The World Health Organization ranks AMD as the third leading cause of blindness worldwide, after cataracts and glaucoma. AMD is characterized by the loss of the central field of vision. Risk factors for AMD include advanced age, smoking, high blood pressure, and a diet low in fruits and vegetables. Family history is also a factor.

Foods that are considered to be good sources of flavonoids include apples, blueberries, brocoli, cabbage and chocolate (make that dark chocolate) and tea. In turn, flavonoids can be sub-divided into six classes including anthocyanins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones.

A research group in Australia examined the association of dietary intake of flavonoids and the subsequent development of age-related macular degeneration. Over 2800 subjects were enrolled at baseline, and over 2000 were followed up to 15 years. Dietary information was collected via a 145-item self-administered food frequency questionnaire. The sum of the flavonoid compound for each food was computed. Enrollees in the study were invited to follow-up at 5 years, 10 years and finally 15 years.

The researchers found a protective and significant association between the total flavonoids intake, and in addition the total flavonol and total flavanone intake, and AMD prevalence. Interestingly, those participants who consumed at least one serving of oranges a week but less than one serving each day had reduced odds of 92% of the development of late AMD, compared to those who did not consume any oranges.

Given the commonality of AMD, incorporating some simple dietary choices into your daily regimen seems like an easy intervention. In particular, finding time to eat an orange or two a week could be very beneficial.

“Orange is the happiest color”.  Frank Sinatra

(Source- American Journal of Clinical Nutrition 2018; 108)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone.

Acupuncture for Post-Operative Pain

 

As the new year begins the opioid epidemic continues to be a significant problem in the United States. Statistics from 2016-2017 provided by the Department of Health and Human Services paint a grim picture- 11.4 million people misused prescription opioids while approximately 2 million abused them for the first time.

Opioid medications are commonly used for post-operative pain, and one of the strategies considered to decrease the use of opioids is to use other drug-free interventions after surgery, in place of opioids.

A study published in 2017 looked at the use of such drug-free therapies to reduce pain after total knee arthroplasty. The research group, affiliated primarily with Stanford University and the University of Bologna (Italy) performed a meta-analysis of 39 random controlled trials, involving nearly 2400 subjects. Five different non-drug interventions were examined, including acupuncture, continuous passive motion, cryotherapy, electrotherapy, and preoperative exercise.

The researchers concluded that there was “modest but clinically significant evidence” that both acupuncture and electrotherapy could potentially reduce and delay the amount of post-operative opioid consumption.

As we look at multiple strategies to stem the tide of opioid abuse, it is encouraging to see research studies again supporting the use of alternative therapies, such as acupuncture.

 

(Source- JAMA Surgery, 2017; 152 (10))

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.