January Newsletter
In This Issue
Are All Carbs Bad?
Teens and Twitter
Fish Oil and Strokes
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 want to repeat a  couple of notes for my patients. We have changed over to a different electronic health record over the two months. As a result, at some point you may get an invitation to join the new patient portal. As we have gone through this transition, I am convinced that this record will be a much better choice for my office and my patients in the long run. Please also update our email contacts. You can reach the office at office@drniedfeldt.com. I can be reached directly at mark@drniedfeldt.com and Colleen can be reached directly at colleen@drniedfeldt.com. Our phone number and fax are unchanged. Thanks for your patience during this transition. After 10 years it isn't easy. 

What if I told you there was a medication you could take that would reduce your risk of diabetes, heart attacks, strokes, breast and colon cancer, and death by 15-30%? Would you be interested? How much would you be willing to pay for this medicine? Would you demand that your health insurance cover it? Would you lobby the FDA to fast track it for approval? I'll tell you all about it in the first article. 

Social media. Most of us probably use it in one form or another. Are teens and young adults are on it daily. How is it affecting them? The second study looked at over 11,000 kids to give us some insights into how social media affects them. 

Should we take fish oil? The answer may be yes if we want to reduce our risk of having an ischemic stroke. 

Click on the links the the left to check out our  web site .
Are All Carbs Bad?
Type of carbohydrate matters
There are many popular diet plans that condemn carbohydrates (carbs), making the case that all carbs are bad. However, is this thinking correct? Fiber is a carbohydrate, although it isn't digested. Soluble fiber absorbs water and slows the digestion of other carbohydrates (sugars). Additionally, it has the benefit of making us feel full. This study looked at one particular type of carbs, fiber. It is based on a series of systemic reviews and meta-analyses covering almost 135 million person-years of data from 243 studies and clinical trials. The results are quite convincing. Findings included a 15-30% reduction in all-cause and cardiovascular mortality between the highest fiber intake group and the lowest intake group. The greatest benefit came from daily fiber intake of 25-29 grams daily. There was a dose response finding which means more was found to be better. The authors found "striking reductions in, and dose-response relationships with, all-cause mortality, total cancer deaths, total cardiovascular disease deaths and incidence, stroke incidence, and incidence of colorectal, breast, and oesophageal cancer." 
  • Background: Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish an evidence base for quantitative recommendations for intakes of dietary fibre.
  • Methods: We did a series of systematic reviews and meta-analyses of prospective studies published from database inception to April 30, 2017, and randomised controlled trials published from database inception to Feb 28, 2018, which reported on indicators of carbohydrate quality and non-communicable disease incidence, mortality, and risk factors. Studies were identified by searches in PubMed, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, and by hand searching of previous publications. We excluded prospective studies and trials reporting on participants with a chronic disease, and weight loss trials or trials involving supplements. Searches, data extraction, and bias assessment were duplicated independently. Robustness of pooled estimates from random-effects models was considered with sensitivity analyses, meta-regression, dose-response testing, and subgroup analyses. The GRADE approach was used to assess quality of evidence.
  • Findings: Just under 135 million person-years of data from 185 prospective studies and 58 clinical trials with 4635 adult participants were included in the analyses. Observational data suggest a 15-30% decrease in all-cause and cardiovascular related mortality, and incidence of coronary heart disease, stroke incidence and mortality, type 2 diabetes, and colorectal cancer when comparing the highest dietary fibre consumers with the lowest consumers Clinical trials show significantly lower bodyweight, systolic blood pressure, and total cholesterol when comparing higher with lower intakes of dietary fibre. Risk reduction associated with a range of critical outcomes was greatest when daily intake of dietary fibre was between 25 g and 29 g. Dose-response curves suggested that higher intakes of dietary fibre could confer even greater benefit to protect against cardiovascular diseases, type 2 diabetes, and colorectal and breast cancer. Similar findings for whole grain intake were observed. Smaller or no risk reductions were found with the observational data when comparing the effects of diets characterised by low rather than higher glycaemic index or load. The certainty of evidence for relationships between carbohydrate quality and critical outcomes was graded as moderate for dietary fibre, low to moderate for whole grains, and low to very low for dietary glycaemic index and glycaemic load. Data relating to other dietary exposures are scarce.
  • Interpretation: Findings from prospective studies and clinical trials associated with relatively high intakes of dietary fibre and whole grains were complementary, and striking dose-response evidence indicates that the relationships to several non-communicable diseases could be causal. Implementation of recommendations to increase dietary fibre intake and to replace refined grains with whole grains is expected to benefit human health. A major strength of the study was the ability to examine key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomised trials in a single study. Our findings are limited to risk reduction in the population at large rather than those with chronic disease.

What if I told you there was a medication you could take that would reduce your risk of diabetes, heart attacks, strokes, breast and colon cancer, and death by 15-30%? Would you be interested? How much would you be willing to pay for this medicine? Would you demand that your health insurance cover it? Would you lobby the FDA to fast track it for approval? 

What if I told you that this "medication" exists, and it doesn't even require a prescription? As an added bonus it will help remove excess waste and potential toxins from your body and improve your intestinal bacterial health (act as a prebiotic). This "medication" has been shown in another study to lower insulin resistance and fasting glucose better than some medications. Interested? 

This "medication" is soluble fiber and it's available at any grocery store or pharmacy. There are may forms of soluble fiber including psyllium, guar gum, ground flax seed, beta-glucan and pectin. The one you may be most familiar with is probably psyllium. This is the main ingredient in Metamucil. So how should we use this "medicine"? Start slow. Let your system get used to it. While capsules are the most convenient, you really have to take a lot of them. Start with a tablespoon mixed in at least 8-10 oz of water daily. This will get you around 5-6 extra grams of fiber. Let your system get used to this for a few days. If you tolerate this, you could take more or take it 2-3 times daily to really boost your fiber intake. The study of diabetes found a significant reduction in blood sugars and insulin resistance with 15 g additional fiber. Foods that are high in fiber include 1/2 cup bran (10 g), 3 dried figs (10 g), 1 apple or pear (5 g), 1 cup raspberries (8 g), 1 cup raisin bran (5 g), 2 Brazil nuts (2.5 g), 23 almonds (3.5 g), 1 cup peas (16 g), 1 cup black beans (15 g), 1 artichoke (10 g), 1 cup broccoli (5 g). Remember, the goal is to get over 25 grams of fiber daily to get the full health benefits. 

Be careful with Metamucil brand of fiber. Unfortunately, many of their products have a lot of sugar in them and others have artificial colors and artificial sweeteners you may not want. This defeats what you are trying to do. 

Here is an interesting thought, a previous study I highlighted in my newsletter showed that drinking 16 oz of water prior to meals resulted in a 10 lb weight loss over 12 weeks. Perhaps if this was combined with fiber the effect would be even more dramatic!

Teens and Twitter
Higher social media use leads to more depression

This study looked at social media use in 14 year-old kids to assess whether social media use is associated with depressive symptoms. The researchers found that social media use was associated with depression more frequently in girls than boys and was associated with online harassment, poor sleep, and poor body image. Longer amounts of time spent on social media strengthened the association, especially if use was > 5 hours daily. 


  • Background: Evidence suggests social media use is associated with mental health in young people but underlying processes are not well understood. This paper i) assesses whether social media use is associated with adolescents' depressive symptoms, and ii) investigates multiple potential explanatory pathways via online harassment, sleep, self-esteem and body image.
  • Methods: We used population based data from the UK Millennium Cohort Study on 10,904 14 year olds. Multivariate regression and path models were used to examine associations between social media use and depressive symptoms.
  • Findings: The magnitude of association between social media use and depressive symptoms was larger for girls than for boys. Compared with 1-3 h of daily use: 3 to < 5 h 26^ increase in scores vs 21%; >/= 5 h 50% vs 35% for girls and boys respectively. Greater social media use related to online harassment, poor sleep, low self-esteem and poor body image; in turn these related to higher depressive symptom scores. Multiple potential intervening pathways were apparent, for example: greater hours social media use related to body weight dissatisfaction (>/= 5 h 31% more likely to be dissatisfied), which in turn linked to depressive symptom scores directly (body dissatisfaction 15% higher depressive symptom scores) and indirectly via self-esteem.
  • Interpretation: Our findings highlight the potential pitfalls of lengthy social media use for young people's mental health. Findings are highly relevant for the development of guidelines for the safe use of social media and calls on industry to more tightly regulate hours of social media use.

Teen depression rates are rising world wide. This study of almost 11,000 adolescents found that more time on social media platforms resulted in higher depression symptoms, especially for girls. There were four measures associated with use which seemed to play a significant role: disrupted sleep, cyberbullying/harassment, poor body image, and low self-esteem. This study used self-report so although there is correlation, causation can't be proven. However, like other studies, this one shows a strong link between time of use and negative psychological symptoms, especially among younger teens. A previous study I highlighted showed lowered depressive symptoms in college students when they limited their social media use. 

Over 89% of teens have their own smartphones and 70% use social media more than once daily. As parents it isn't practical to ban all social media use, but it seems to make sense to provide some guidelines to try to minimize negative impact. Monitor time on social media platforms, create screen-free time periods when use is restricted (meals, homework) and make sure you follow those rules as well, shut down or silence devices at bedtime (sleep deprivation is a risk factor for depression). While cyberbullying may be less than it was a few years ago, kids are now more likely to be exposed to racist, sexist, homophobic or anti-religion content on social media. Take the time to talk to your kids about these topics. Encourage them to block, report, or simply unfriend people who spread these messages. Let them know that sharing these types of messages, even as a joke can have negative consequences. Help them to understand privacy settings (this may take some learning on the parent's part) and know which platforms your kids are using (they only use Facebook to message Grandma and despite the title, many are not on Twitter - thankfully). Help them practice disagreeing with people respectfully 
constructively. Then teach our political leaders, media pundits, and celebrities that skill... 
Fish Oil and Strokes
Fish oil liked to reduction in ischemic strokes
oily fish
This study of fish oils and ischemic stroke used data on adipose tissue levels of fatty acids to determine benefit. Over 57,000 participants were followed over 13 years. Higher levels of fish oil, specifically the EPA portion was found to be related to a reduction in ischemic stroke. The highest EPA content group had a 26% decrease in rate of strokes. 

  • Background and Purpose: We hypothesized that total marine n-3 polyunsaturated fatty acids (PUFA), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the diet and in adipose tissue (biomarkers of long-term intake and endogenous exposure) were inversely associated with the risk of ischemic stroke and its subtypes.
  • Methods: The Diet, Cancer and Health cohort consisted of 57,053 participants aged 50 to 65 years at enrolment. All participants filled in a food frequency questionnaire and had an adipose tissue biopsy taken at baseline. Information on ischemic stroke during follow-up was obtained from The Danish National Patient Register, and all cases were validated. Cases and a random sample of 3203 subjects from the whole cohort had their fatty acid composition of adipose tissue determined by gas chromatography.
  • Results: During 13.5 years of follow-up 1879 participants developed an ischemic stroke. Adipose tissue content of EPA was inversely associated with total ischemic stroke (hazard ratio [HR], 0.74; 95% CI, 0.62-0.88) when comparing the highest with the lowest quartile. Also, lower rates of large artery atherosclerosis were seen with higher intakes of total marine n-3 PUFA (HR, 0.69; 95% CI, 0.50-0.95), EPA (HR, 0.66; 95% CI, 0.48-0.91) and DHA (HR, 0.72; 95% CI, 0.53-0.99), and higher adipose tissue content of EPA (HR, 0.52; 95% CI, 0.36-0.76). Higher rates of cardioembolism were seen with higher intakes of total marine n-3 PUFA (HR, 2.50; 95% CI, 1.38-4.53) and DHA (HR, 2.12; 95% CI, 1.21-3.69) as well as with higher adipose tissue content of total marine n-3 PUFA (HR, 2.63; 95% CI, 1.33-5.19) and DHA (HR, 2.00; 95% CI, 1.04-3.84). The EPA content in adipose tissue was inversely associated with small-vessel occlusion (HR, 0.69; 95% CI, 0.55-0.88).
  • Conclusions: EPA was associated with lower risks of most types of ischemic stroke, apart from cardioembolism, while inconsistent findings were observed for total marine n-3 PUFA and DHA.


Fish oil intake and cardiovascular disease has been controversial for some time, but this is another study which is pointing to the benefits of fish oil consumption. Many of these studies look at the intake of fish and use different parameters to examine amounts of fish oil in tissues. This one actually looked at the content of adipose tissue. It appears that the EPA portion of fish oil is beneficial in small vessel disease (30% decrease), large vessel disease (34% decrease), as well as ischemic stroke (26% decrease). Both DHA and EPA lower triglycerides which is likely beneficial per previous studies. While it is not perfect to equivocate dietary fish intake with a supplement, in my mind, a high quality fish oil supplement would make sense for those of us who fall short in our fish intake and would like to reduce our risk of ischemic stroke, large vessel disease, and small vessel disease (possibly linked to dementia).  

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.