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January Newsletter
In This Issue
The Really Dangerous While Crystals
More Bad News for Obesity
Is Your iPad Ruining Your Sleep?
A New Model of Medical Care
Dr. Niedfeldt
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. January is often a time that people pledge their new year "resolutions". Typically, they fall off the wagon within a month (so it's OK to go back to the gym now). This month I am going to highlight a couple of articles that may give you some increased motivation to continue or even increase your healthy habits. 


The first article studies almost 89,000 women and the results were shocking. We all know healthy habits are good. But this study found six healthy habits led to a 92% decrease in cardiovascular risk. That's incredible! Check out the details below. 


The good news for healthy habits continues in my second article. This one looked development of back pain. We will all likely experience intermittent back pain during our lives and I think we all want to be sure we will keep these episodes to a minimum and avoid developing chronic back pain. Guess what, there are some habits that will help to do just that. While only women were shown to benefit in this study, it would make sense for men to consider them as well. 


I just broke down and finally got a tablet. I already am on my laptop a lot in the evening working so my exposure to "screens" in the evening can be significant. Most of us (and our kids) are on phones, tablets, e-readers, or computers in the evening. The third study shows that the blue light emitted by these screens may be disturbing our sleep and making us less alert in the morning. The amount of potential disturbance is significant. Check out my commentary for possible solutions as well. Maybe that explains my teenagers in the morning...


Click on the links the the left to check out our web site...

How To Lower Risk of Heart Disease by 92%

Women have dramatic lowering of cardiovascular disease with healthy lifestyle behaviors
This article, from the Journal of the American College of Cardiology, adds even more evidence of the importance of lifestyle in cardiovascular disease, showing dramatic lowering of risk. 


Summary of findings:

  • Background

    • Overall mortality rates from coronary heart disease (CHD) in the United States have declined in recent decades, but the rate has plateaued among younger women. The potential for further reductions in mortality rates among young women through changes in lifestyle is unknown.

  • Objectives
    • The aim of this study was to estimate the proportion of CHD cases and clinical cardiovascular disease (CVD) risk factors among young women that might be attributable to poor adherence to a healthy lifestyle.
  • Methods: 
    • A prospective analysis was conducted among 88,940 women ages 27 to 44 years at baseline in the Nurses' Health Study II who were followed from 1991 to 2011.
    • Lifestyle factors were updated repeatedly by questionnaire. 
    • A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index-2010, and 0.1 to 14.9 g/day of alcohol. 
    • To estimate the proportion of CHD and clinical CVD risk factors (diabetes, hypertension, and hypercholesterolemia) that could be attributed to poor adherence to a healthy lifestyle, we calculated the population-attributable risk percent.
  • Results
    • During 20 years of follow-up, we documented 456 incident CHD cases. 
    • In multivariable-adjusted models, nonsmoking, a healthy body mass index, exercise, and a healthy diet were independently and significantly associated with lower CHD risk. 
    • Compared with women with no healthy lifestyle factors, the hazard ratio for CHD for women with 6 lifestyle factors was 0.08 (95% confidence interval: 0.03 to 0.22).
    • Approximately 73% (95% confidence interval: 39% to 89%) of CHD cases were attributable to poor adherence to a healthy lifestyle. 
    • Similarly, 46% (95% confidence interval: 43% to 49%) of clinical CVD risk factor cases were attributable to a poor lifestyle.
  • Conclusions 
    • Primordial prevention through maintenance of a healthy lifestyle among young women may substantially lower the burden of CVD. 
Most studies of cardiovascular disease have focused on men. This study, looked at over 88,000 young women enrolled in the Nurses' Health Study between the ages of 27-44 and followed them for over 20 years. The evaluation included six healthy lifestyle behaviors: no smoking, normal BMI, exercise > 150 minutes/week, TV < 7 hours/week, healthy diet, and alcohol < 1 drink/day. 73% of heart disease cases were directly attributed to these lifestyle habits. Women who had all 6 healthy behaviors had their risk reduced by a whopping 92% as compared to women with none of the behaviors. Think about that! This study shows that in women, healthy lifestyle behaviors are definitely VERY important when it comes to cardiovascular disease. And men, there is no reason to think that these lifestyle factors don't apply to you. No matter what your age or sex, changes in lifestyle can be valuable. We can all benefit!
Reduce Your Risk of Chronic Low Back Pain
Healthy Behaviors Improved Prognosis


This study, from BMJ has another benefit for women who have healthy behaviors, less chronic low back pain. Virtually, all of us will have episodes of low back pain at some point in our lives, and thankfully, most of this resolves without long term consequences. After having back pain, most of us will be very interested in anything that will reduce any recurrences. Ways to decrease the risk of developing chronic pain are certainly useful to anyone who does or could experience low back pain. Guess what, it isn't a pill...


Summary of findings  

    • To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain among men and women in a general population.
    • General population in Stockholm County, Sweden.
    • The study sample comprised 3938 men and 5056 women aged 18-84 from the Stockholm Public Health Cohort reporting occasional low back pain in the baseline questionnaire 2006.
    • Lifestyle factors and potential confounders were assessed at baseline. 
    • The lifestyle factors smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables were dichotomised using recommendations for a health-enhancing lifestyle and combined to form the exposure variable 'healthy lifestyle behaviour'. 
    • The exposure was categorised into five levels according to the number of healthy lifestyle factors met. 
    • The follow-up questionnaire in 2010 gave information about the outcome, long duration troublesome low back pain. 
    • Crude and adjusted binomial regression models were applied to estimate the association between the exposure and the outcome analysing men and women separately.
    • The risk of developing long duration troublesome low back pain among women with occasional low back pain decreased with increasing healthy lifestyle behaviour (trend test: p=0.006). 21% (28/131) among women with no healthy lifestyle factor experienced the outcome compared to 9% (36/420) among women with all four factors. 
    • Compared to the reference group, the risk was reduced by 35% (RR 0.65, 95% CI 0.44 to 0.96) for women with one healthy lifestyle factor and 52% (RR 0.48, 95% CI 0.31 to 0.77) for women with all four healthy lifestyle factors. 
    • There were no clear associations found among men.
    • Healthy lifestyle behaviour seems to decrease the risk of developing long duration troublesome low back pain among women with occasional low back pain and may be recommended to improve the prognosis.         

Well, ladies, more good news for you! Don't smoke, keep alcohol intake down, stay active, eat lots of fruits and vegetables, and lower your risk of chronic back pain. So, we can decrease risk of heart disease by 92% AND lower risk of chronic back pain by over 50% just through lifestyle! Sounds like a win to me. This study didn't show significant differences for men and it isn't clear why this is the case. But, as a man, it sure makes sense to follow the lead of the ladies on these two studies.  


Does a Healthy Lifestyle Behaviour Influence the Prognosis of Low Back Pain Among Men and Women in a General Population? A Population-Based Cohort Study BMJ Open 2014 Jan 01;4(12)e005713, T Bohman, L Alfredsson, I Jensen, J Hallqvist, E Vingļæ½rd, E Skillgate  

Is Your iPad Ruining Your Sleep?  
Using e-readers and tablets in the evening could harm sleep quality


Approximately 1/3 of adults report difficulty falling asleep or staying asleep. This study, published in Proceedings of the National Academy of Sciences, found after monitoring people in a sleep lab that common e-readers and tablets could suppress melatonin, shift circadian rhythm and reduce morning alertness. At the end of the article I'll give you some ways to decrease this problem. 

Summary of findings:  

  • In the past 50 yrs, there has been a decline in average sleep duration and quality, with adverse consequences on general health. 

  • A representative survey of 1,508 American adults recently revealed that 90% of Americans used some type of electronics at least a few nights per week within 1 hour before bedtime. 

  • Mounting evidence from countries around the world shows the negative impact of such technology use on sleep. 

  • This negative impact on sleep may be due to the short-wavelength-enriched light emitted by these electronic devices, given that artificial-light exposure has been shown experimentally to produce alerting effects, suppress melatonin, and phase-shift the biological clock. 

  • A few reports have shown that these devices suppress melatonin levels, but little is known about the effects on circadian phase or the following sleep episode, exposing a substantial gap in our knowledge of how this increasingly popular technology affects sleep. 

  • Here we compare the biological effects of reading an electronic book on a light-emitting device (LE-eBook) with reading a printed book in the hours before bedtime. 

  • Participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness than when reading a printed book. 

  • These results demonstrate that evening exposure to an LE-eBook phase-delays the circadian clock, acutely suppresses melatonin, and has important implications for understanding the impact of such technologies on sleep, performance, health, and safety. 

The use of tablets and e-readers has increased dramatically over the past few years. 
In the study, 12 healthy young adults were randomized to two conditions: 1) reading an e-book for 4 hours before bedtime; or 2) reading a printed book for 4 hours before bedtime on 5 consecutive evenings. Participants then switched conditions.The e-book suppressed evening levels of melatonin by 55%, whereas the printed book showed no suppression, and the e-book shifted the melatonin onset to more than 1.5 hours later. Compared with the printed book, the e-book also significantly increased sleep latency (10 minutes longer), decreased REM sleep by 11 minutes, decreased evening sleepiness, and increased morning sleepiness.

The study used iPads, which are back lit devices as are other tablets such as the Kindle Fire and Nook Color. These devices can potentially cause these problems. Laptop and desktop computers also emit blue light. Some of the e-ink readers such as Kindle Paperwhite are actually front lit and have not been shown to cause these issues. The older e-readers which require an external light to read, similar to a book, also do not cause any issues. Many people read when they can't fall asleep. The unfortunate this is that grabbing your iPad to read may potentially cause more sleep issues. Another big issue is decreased morning alertness. Even if people fall asleep, they may be less alert and have more problems arising. This could be a big problem with kids and teens, who are on electronic devices up to 7+ hours daily.  

So you love your iPad, reader or iPhone, or you have to work on projects late at night; what is the solution? First, turn the lighting down on your device. Some do this automatically. There are apps which will reduce the blue light emitted by your device. I recently installed one (f.lux)on my laptop which lowers light level based on the ambient light and cuts blue light. There are blue light blocking screens that clip onto iPads, iPhones, and other tablets which can be used in the evening (but some might affect some touch functions so check carefully). If you have problems sleeping, you could further reduce the blue light with specific bulbs in your bedroom or bedside lamp that lower the blue light emitted by regular bulbs. This can be helpful even if you haven't joined the e-reader revolution. Finally, there are always those cool 
blue blocker glasses (yes, they 
actually work!) and can be worn the entire evening. 
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. 


This edition showed some nice studies dedicated to women, showing that healthy behaviors and habits can greatly reduce risk of chronic disease. I am glad we are seeing more and more evidence that we are in control of many of these things. 


Screens in the evening are a reality and here to stay. There is significant evidence that many of these screens may disturb our sleep. As a society we sleep less than we have in the past. Bright lights and screens may be part of the problem. If you do have problems sleeping or are feeling groggy in the morning, it may make sense to try some strategies to reduce your exposure to blue light. Lower the overall light level in the evening and consider non-blue spectrum bulbs in the bedroom. Consider apps or screen covers on your electronics. Or you could wear those cool glasses. It can't hurt and it looks like it can be helpful. I'm going to try them... 


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.