April Newsletter
In This Issue
Artificial Sweeteners - Not So Sweet?
What Did You Say?
Does This Cancer Make Me Look Fat?
A Better Model of Medical Care
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. I'm writing this from Orlando where I am attending the American Medical Society for Sports Medicine Annual Meeting. It's a great chance to catch up and compare notes with colleagues as well as checking out some of the cutting edge advances in sports and exercise medicine. Oh yeah, the weather is a lot better too...

As we look at ways to lose weight, some people will turn to artificial sweeteners such as NutraSweet or Splenda. These sweeteners are now being found in more and more products, not just diet sodas and pink, blue and yellow packets. They are in cereals, yogurt, and other bakery products.  Since they are low calorie, we assume they are good for weight loss. But are they? How do they effect us physiologically? Are they dangerous? Read on for more discussion. 

Continuing our exploration of causes of dementia, the second study looks at the effects of hearing loss on our cognitive function and how hearing aids may slow the progression of dementia. 

The third study looks at the unfortunate increase in the incidence of cancer in our younger population and the link between obesity and cancer. This is a major problem for our society and half of our kids are now obese. This could be a huge cancer bomb ready to explode over the next 20 years. 

Click on the links the the left to check out our  web site ...
Artificial   sweeteners  - Not So Sweet? 
Nonnutritive sweeteners may increase weight and metabolic disease
We see these packets on most restaurant tables and we likely have them in our homes. The are being used more and more in baked goods, soft drinks and other processed foods such as yogurt and cereals. Artificial sweeteners are everywhere today. Many people use them to try to decrease their caloric intake and weight. But are they effective for weight loss? More importantly, are they safe? This article, from the journal Obesity, was a non industry sponsored review. When reviewing the observational studies, the authors found an association between nonnutritive sweeteners and long-term higher body weight and metabolic disease including heart disease, diabetes and nonalcoholic liver disease even though the subjects took in fewer calories. Controlled studies suggest that they may be beneficial as compared to sugared beverages for weight loss in the context of calorie restriction. So what does that mean? We likely need more studies to determine how they are used in the "real world" to determine if there is any place for them.  
  • OBJECTIVE: The objective of this review was to critically review findings from recent studies evaluating the effects of nonnutritive sweeteners (NNSs) on metabolism, weight, and obesity-related chronic diseases. Biologic mechanisms that may explain NNS effects will also be addressed.
  • METHODS: A comprehensive review of the relevant scientific literature was conducted.
  • RESULTS: Most cross-sectional and prospective cohort studies report positive associations between NNS consumption, body weight, and health conditions, including type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease. Although findings in cellular and rodent models suggest that NNSs have harmful effects on metabolic health, most randomized controlled trials in humans demonstrate marginal benefits of NNS use on body weight, with little data available on other metabolic outcomes.
  • CONCLUSIONS: NNS consumption is associated with higher body weight and metabolic disease in observational studies. In contrast, randomized controlled trials demonstrate that NNSs may support weight loss, particularly when used alongside behavioral weight loss support. Additional long-term, well-controlled intervention studies in humans are needed to determine the effects of NNSs on weight, adiposity, and chronic disease under free-living conditions.

Artificial sweeteners are getting harder to escape. There seems to be mixed findings when studies are reviewed. Observational studies, which look at what people do but don't necessarily intervene, have generally found negative effects of artificial sweeteners. Controlled studies, which control the variable have found some effectiveness as a weight loss aid. However, these tend to be shorter duration and don't necessarily show negative long-term effects. 

So what are possible mechanisms of the metabolic disturbances? 
  • Alteration of sweet receptors and possible release of hormones causing effects
  • Disturbance of relationship between sweetness and calories which may disrupt appetite regulation and metabolic signals
  • Change in taste preferences. Artificial sweeteners are very sweet at low concentrations relative to sugar. We have an innate liking for sweetness and exposure to sweet compounds, especially early in life may promote even more preference for sweet foods. 
  • Changes in gut bacterial composition. As I have discussed in previous newsletters, we are learning more and more about the systemic effects of the GI bacterial make up and systemic disease. Most of these studies are animal studies, but I suspect this may be a bigger factor than we may know. 
So what are we to do? My suggestion is to avoid sugared beverages. There is nothing healthy about sugar. Artificial sweeteners may have some benefit on weight in the short term, however, I don't think artificial sweeteners are a good option on a long-term basis as they seem to be linked with later weight gain and metabolic dysfunction. Previous studies have shown a correlation between artificial sweeteners, strokes and dementia. My suggestion: if you want some flavor in your water, try some lemon or lime. Fruit or cucumber infused water can be stored in the refrigerator when you want something different and refreshing. Here are some ideas you can try

What Did You Say?
Use of a hearing aid may slow the rate of cognitive decline

Hearing loss is the leading midlife finding linked with development of dementia. By age 65, 30% will have measurable hearing impairment and this increases to 70-90% over age 85. This study, using data from the Michigan Health and Retirement Study used memory screens of individuals who started using hearing aids during the 18 year follow up of the study. At baseline, none used hearing aids or had cognitive deficits. Memory scores declined before and after initial hearing aid use, but the use of hearing aids slowed the decline.   



  • OBJECTIVES: To test whether hearing aid use alters cognitive trajectories in older adults.
  • DESIGN: US population-based longitudinal cohort study SETTING: Data were drawn from the Health and Retirement Study (HRS), which measured cognitive performance repeatedly every 2 years over 18 years (1996-2014).
  • PARTICIPANTS: Adults aged 50 and older who who took part in a minimum of 3 waves of the HRS and used hearing aids for the first time between Waves 4 and 11 (N=2,040).
  • MEASUREMENTS: Cognitive outcomes were based on episodic memory scores determined according to the sum of immediate and delayed recall of 10 words.
  • RESULTS: Hearing aid use was positively associated with episodic memory scores (β=1.53, p<.001). Decline in episodic memory scores was slower after (β=-0.02, p<.001) than before using hearing aids (β=-0.1, p<.001). These results were robust to adjustment for multiple confounders and to attrition, as accounted for using a joint model.
  • CONCLUSIONS: Hearing aids may have a mitigating effect on trajectories of cognitive decline in later life. Providing hearing aids or other rehabilitative services for hearing impairment much earlier in the course of hearing impairment may stem the worldwide rise of dementia.


This study reminds us how prevalent hearing loss is in our population. Hearing loss is accelerated by smoking, hypertension, diabetes, and exposure to loud noises such as gunshots, power tools, industrial noises, and loud music. Men have double the risk of women. Hearing aids may prevent the adverse effects of auditory deprivation resulting in lower rate of depression symptoms, greater social engagement and higher self-efficacy, which help to protect cognitive function. 


We should consider hearing screening certainly by age 65 and likely earlier in smokers or if there has been exposure to loud noises at work or during recreational activities. Many times hearing screens can be done free at locations like Costco. Studies show us that up to 40% of hearing aids go unused so let's be sure they get used after they are dispensed. Additionally, if you are younger, protect your hearing! Use hearing protection when using power tools, attending concerts, and consider turning down the volume in your ear buds. Additionally, exercise may help protect your hearing and protect you from dementia. 

Does This Cancer Make Me Look Fat? 
Obesity linked to cancer in young adults
fat guy eating hamburger
This study reviewed over 100 publications and evaluated the association between obesity and appearance of cancers in adults less than age 50. The authors suggest that the increase obesity rate is a likely cause of the increasing numbers of cancers seen in people under the age of 50. 

  • OBJECTIVE: The purpose of this article is to review the association of the obesity pandemic with appearance of cancers in young adults under age 50 and to define potential mechanisms by which obesity may accelerate the development of malignancy.
  • METHODS: A comprehensive narrative review was performed to integrate preclinical, clinical, and epidemiologic evidence describing the association of obesity with cancer in young adults based on a search of PubMed and Google databases.
  • RESULTS: Results from more than 100 publications are summarized. Although they differ in age groups analyzed and incidence of obesity, sufficient data exists to suggest an influence of the obesity pandemic on the increase of cancer among young adults.
  • CONCLUSIONS: Cancer in young adults is occurring with increasing frequency. Overweight and obesity have become major public health issues reaching pandemic proportions. Excess weight is associated with increased cancer risk, morbidity, and mortality. Multiple murine models indicate that obesity not only increases cancer incidence but also accelerates its development. Thus, the possibility exists that overweight and obesity may be contributing to the appearance of specific malignancies at younger ages. This prospect, in association with the worldwide expansion of obesity, suggests an impending explosive increase in obesity-associated cancers in young adults.


Both obesity and cancer rates are increasing in young adults. The rate of cancers, generally seen in people over age 50, has been increasing rapidly over the past few years. At this point, there are 13 cancers associated with obesity including breast, colon, endometrial, kidney, thyroid, and, ovary. Mouse models have shown that obesity increases both the incidence of cancer and accelerates the development of cancer. With the explosion of obesity around the world, there is likely an explosion in the number of cancers ready to occur in the younger population. This all likely ties into the idea of insulin resistance and resulting high insulin levels as a potential carcinogenic environment. Avoiding obesity may be one of the best cancer avoidance strategies out there.   

Young Adult Cancer: Influence of the Obesity Pandemic Obesity 2018 Apr 01;26(4)641-650.
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. Feel free to pass this on to anyone you think would benefit from this information. 

You can find previous newsletters archived on my website here


As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email , phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.