December Newsletter
In This Issue
A Dog's Purpose
Plank Your Stress Away!
Die Cancer Cells, Die!
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. This is always a special time of year. We spend time with family and friends and have the chance to reflect on the blessings we have received during the past year.  It is also a time many of us turn our focus to those less fortunate and in the spirit of the season help and give generously. As we turn toward 2020, I hope we can all pick one thing we would like to improve in our lives. It doesn't have to be a big thing, in fact, it is probably better to keep it small and simple. Every big change starts with small changes. Wishing you and your families a wonderful 2020! 
Can a dog save your life? No, we aren't talking about Lassie, a police or service dog. We are talking about the pooch you may have living in your home. Yep, the same one that just finished chewing up your favorite pair of heels. Can that dog save your life? It may surprise you how much of a difference having a dog in your life can make in your risk of death. If you have heart disease, definitely check out this article. 

How can we improve out mood? Is there something to get us out out of the cycle of stress, anxiety, and even major depression? Well, actually there is. Last month we discussed physical activity as an intervention to overcome our genetic disposition to depression and this month we will continue examining another intervention that is shown to improve out mood.This study even looked at the dosage of the intervention needed for results. 

I generally try to highlight articles that have things we can directly incorporate into our lives. Because cancer is always one of my patient's major concerns and will certainly affect all of us either directly or indirectly through loved ones, I feel that this third study is worth space in my newsletter. Researchers have found a way to cause self-destruction of cancer cells for one of mankind's most ruthless cancer killers. We should definitely structure our lifestyle for prevention, but it's good to know that should cancer strike us, there are treatments on the horizon that may save us.

Click on the links the the left to check out our  web site .
A Dog's Purpose
Dog ownership associated with lower risk of death
Dogs have been part of human society since well before the agricultural revolution and over the centuries have offered us companionship in return for food and shelter. Currently, almost half of all households in the US have a least one dog. Studies have linked dog ownership to lower blood pressure, improved lipid profiles and improved responses to stress. But can owning a dog actually reduce your risk of dying? This analysis, published in the journal Circulation, pooled data from 10 studies involving over 3 million participants and found that dog ownership was associated with a 24% risk reduction for all-cause mortality compared to non owners. This was especially true of dog owners who had previous coronary events. These individuals had a 65% reduced risk of all cause mortality and a 31% decrease in cardiovascular death. 
  • Background: Dog ownership has been associated with decreased cardiovascular risk. Recent reports have suggested an association of dog companionship with lower blood pressure levels, improved lipid profile, and diminished sympathetic responses to stress. However, it is unclear if dog ownership is associated with improved survival as previous studies have yielded inconsistent results. Thus, we performed a systematic review and meta-analysis to evaluate the association of dog ownership with all-cause mortality, with and without prior cardiovascular disease, and cardiovascular mortality.
  • Methods and Results: Studies published between 1950 and May 24, 2019 were identified by searching Embase and PubMed. Observational studies that evaluated baseline dog ownership and subsequent all-cause mortality or cardiovascular mortality. Two independent reviewers extracted the data. We assessed pooled data using random-effects model. A possible limitation was that the analyses were not adjusted for confounders. Ten studies were included yielding data from 3,837,005 participants (530,515 events; mean follow-up 10.1 years). Dog ownership was associated with a 24% risk reduction for all-cause mortality as compared to nonownership (relative risk, 0.76; 95% CI, 0.67-0.86) with 6 studies demonstrating significant reduction in the risk of death. Notably, in individuals with prior coronary events, living in a home with a dog was associated with an even more pronounced risk reduction for all-cause mortality (relative risk, 0.35; 95% CI, 0.17-0.69; I2, 0%). Moreover, when we restricted the analyses to studies evaluating cardiovascular mortality, dog ownership conferred a 31% risk reduction for cardiovascular death (relative risk, 0.69; 95% CI, 0.67-0.71; I2, 5.1%).
  • Conclusions: Dog ownership is associated with lower risk of death over the long term, which is possibly driven by a reduction in cardiovascular mortality.
In 2016, 48 million US households had a total of 77 million dogs, 28% of whom were rescued from animal shelters. Dogs offer companionship, reduce anxiety and loneliness, increase self-esteem, and improve overall mood. Even a single exposure to therapy dogs reduces stress response and pain during pediatric phlebotomy or postarthroplasty physical therapy. This systematic review and meta-analysis examined the association of dog ownership with all-cause and cardiovascular mortality. It had a large number of participants, mainly from 4 European studies.The studies were prospective observational studies, which are not the strongest form of evidence. So really, the question is not whether dog ownership is associated with improved survival but whether dog ownership results in improved survival. This analysis found the association between dog ownership and improved survival was replicated in multiple countries and populations, so this is unlikely to be simply due to chance. Looking to see if the owning a dog causes the outcome is much more difficult. Some of the studies analyzed did sort out socioeconomic and demographic factors and still found the association. It is certainly also possible that dog ownership improves cardiovascular health, time spent outdoors and improvement in physiologic parameters such as blood pressure, resting heart rate and lipids as well as psychological parameters including depression and anxiety all of which improve health. Exposure to germs from the dog may actually improve our gut microbiome which as we are learning may be very beneficial to overall health. 

Even though very high-quality evidence is lacking and we can't definitively state that owning a dog makes us live longer, I certainly find my days richer due to the dogs in my household. Given the evidence that dogs are associated with the improved health measures mentioned above, it only makes sense that they would be associated with lower rates of mortality. Owning a dog is a long-term commitment and shouldn't be undertaken lightly or just to reduce cardiovascular disease risk. But it is hard to beat the unconditional love that a dog can bring into your life. 

Plank Your Stress Away!
Yoga practice reduces symptoms of depression and anxiety

Yoga and breathing techniques have been used for centuries in many cultures to manage stress, anxiety, depression, and pain. There is growing evidence that yoga is an effective treatment for major depressive disorder (MDD), but the optimal dosage of the intervention is unknown. This study sought to assess the effects of an intervention combining Iyengar yoga and coherent breathing on psychological function in subjects with MDD and determine the optimal dose of the intervention for future randomized controlled trials. Participants ranged in age from 18 to 65 years of age. The intervention was differing numbers of yoga classes and homework sessions weekly. Both groups showed significant improvement in psychological symptom evaluation with a slight but not significant trend toward more improvement with the higher dose of yoga. 

  • Background: Evidence suggests that yoga may be an effective treatment for major depressive disorder (MDD). Studies evaluating the "dosing" of yoga treatment and efficacy for MDD are needed. The goal of this study was to assess the effects of an intervention combining Iyengar yoga and coherent breathing in participants with MDD and determine the optimal intervention dose.
  • Methods: Thirty-two participants (18 to 65 y of age) diagnosed with MDD were randomized to a high-dose group (HDG) or a low-dose group (LDG) of yoga and coherent breathing for 12 weeks. The HDG (n=15) involved three 90-minute yoga classes and four 30-minute homework sessions per week. The LDG (n=15) involved two 90-minute yoga classes and three 30-minute homework sessions per week. Participants were evaluated at baseline, week 4, week 8, and week 12 with the following instruments: Positivity Self-Test, Spielberger State Anxiety Inventory, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index, and Exercise-induced Feeling Inventory. Data were analyzed using intent-to-treat methods.
  • Results: Significant improvements in all outcome measures were found for both groups, with acute and cumulative benefits. Although the HDG showed greater improvements on all scales, between-group differences did not reach significance, possibly due to lack of power because of the small sample size. Cumulative yoga minutes were correlated with improvement in outcome measures.
  • Limitation: This dosing study did not include a non-yoga control.
  • Conclusions: Improvement in psychological symptoms correlated with cumulative yoga practice. Both interventions reduced symptoms of depression and anxiety and increased feelings of positivity. The time commitment for yoga practice needs to be weighed against benefits when designing yoga interventions.

Last month I highlighted a study that showed physical activity and exercise (mainly aerobic) were helpful in the treatment of depression. This month we are looking at yoga as a specific intervention. Iyengar yoga is a form of hatha (gentle) yoga which holds poses for longer periods of time and can be modified by using props (blocks, straps) which makes it appropriate for people of all ages. This study divided 32 subjects into 2 groups for a 12 week intervention. One group did a high dose intervention consisting of 3-90 minute yoga sessions and 4-30 minute homework sessions while the lower dose group did 2-90 minute class sessions and 3-30 minute homework session. Both groups showed good improvement in symptoms suggesting that Iyengar yoga is an effective intervention for anxiety and major depressive disorder. 

Unfortunately, they did not include a control group and there was not that much difference between the interventions. I would have liked to have seen a group included with a less intense intervention compared to the more time intensive interventions used. I would also be interested to see if continued home practice is beneficial in preventing relapse of symptoms and hope they do follow up on this. There are many benefits of exercise, breathing techniques and specifically yoga which combines the two. These types of activities should be part of our first-line intervention for people suffering from many psychological issues. 

Die Cancer Cells, Die! 
New treatment triggers self-destruction of pancreatic cancer cells
Pancreatic cancer is one of mankind's deadliest cancers with an overall mortality rate of almost 95%. This cancer is quite difficult to diagnose as it often shows no symptoms until the advanced stages resulting in the low survival rate. This study involves an exciting new breakthrough in the potential treatment of pancreatic cancer. The study was conducted using human pancreatic cancer cells transplanted into immunocompromised mice. The mice were then treated with a molecule called PJ34, which affects human cancer cells exclusively. It causes an anomaly in the duplication of cancer cells resulting in rapid cell death. The mice were injected with PJ34 daily for 14 days. One month later, the pancreatic cancer cells were decreased by 80- 90% with one mouse having complete disappearance of the cancer. No adverse effects were noted and benign cells were not harmed. 

  • Recent reports demonstrate an exclusive eradication of a variety of human cancer cells by the modified phenanthridine PJ34. Their eradication during mitosis is attributed to PJ34 preventing NuMA clustering in the mitotic spindle poles of human malignant cells, which is crucial for their normal mitosis. Here, the effect of PJ34 is tested in cell cultures and xenografts of human pancreas ductal adenocarcinoma. Evidence is presented for a substantial reduction (80-90%) of PANC1 cancer cells in xenografts, measured 30 days after the treatment with PJ34 has been terminated. Benign cells infiltrated into the PANC1 tumors (stroma) were not affected. Growth, weight gain and behavior of the treated nude mice were not impaired during, and 30 days after the treatment with PJ34. The efficient eradication of malignant cells in human pancreas cancer xenografts presents a new model of pancreas cancer treatment.
This is an exciting potential breakthrough in the treatment of human cancers, specifically pancreatic cancer. The model being used and the molecule in this study is specific for pancreatic ductal adenocarcinoma but there are ongoing studies looking at other glandular cancers including thyroid cancer and prostate cancer. This represents an important new approach in the treatment of cancer. Finding treatments that can greatly affect the mechanism of cancer spread (cell reproduction) without harming benign cells is truly the "holy grail" of cancer treatment. I'm certainly going to be following this research in the years to come. 

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. 

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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.