January Newsletter
In This Issue
Add More Length to Your Life
Hot Sauce!
Rebuild Your Brain
A Better Model of Medical Care
Old-fashioned medicine with 21st Century convenience and technology
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Many of us start the new year with new goals. Unfortunately, many of our goals fall by the wayside before the month of January is gone. I found four research based goal-setting techniques that can help us with success in setting and achieving our goals. 
  • Make your goals specific and challenging. Don't just say "I want to lose weight". Put a number on it. "I want to lose 12 lbs by March 1st". 
  • Goals should be moderately challenging. Make your goal not too easy, but not too hard. If a goal is too easy we won't work at it, if it is too hard, we often say "why bother, I'll never make my goal". Make your goal challenging enough to be worth the work. 
  • Your goals should be important (to you) and attainable. If a goal isn't important we won't work for it. If it isn't attainable we won't even try. Instead of saying "I'm going to run a marathon", set a goal of walking 20 minutes daily. 
  • And finally, remember the process. Process goals (I'm going stop drinking soda) may lead to outcomes we want (weight loss), but we should focus on the behavior and the process. 
I hope this is helpful in setting goals for 2020!
Would you like more healthy time with your spouse, children and grandchildren? How about more time to enjoy hobbies and activities? How can we get more lifespan or more importantly, how can we get more healthy life? Living in a healthy. disease-free state as long as possible should be our goal. What specifically can we do to add more of this healthy, disease-free time to our lives? The first article gives us five specific lifestyle behaviors that could add a decade to our healthy lifespan!

I like spicy food. Can my love of spice save my life? The second study looked at the relationship between chili pepper intake and cardiovascular, cerebrovascular, and overall mortality. Guess what? You may want to stock up on habanero peppers...

Dementia is something most of us worry about as we age. With aging, we often focus on simply maintaining our function as long as possible. When we start down the path of decline we only hope to slow the roll. What if there is something we could do that not only slowed the decline but actually appears to rebuild our brain connections? What if we could do something that over time shows anatomic and functional improvement of our brain connections? Would you be interested? 

Click on the links the the left to check out our  web site .
Add More Length to Your Life
Healthy lifestyle adds up to 10 years of disease-free life
This large prospective cohort study used data from the Nurses' Heath Study and the Health Professionals Follow-Up Study to look at associations between five low-risk lifestyle factors and life expectancy free of cardiovascular disease, cancer, and diabetes. The lifestyle factors were moderate alcohol intake, a higher diet-quality score, never smoking, having a body mass index between 18.5 and 24.9 and engaging in moderate to vigorous physical activity for at least 30 minutes.day. At age 50, women who had 4 or 5 of the healthy lifestyle factors had life expectancy of 34.4 years free of cardiovascular disease, diabetes, and cancer. Those who had none of the lifestyle factors had a life expectancy of 23.7 free of disease. Men at age 50 with 4 or 5 of the healthy lifestyle factors had life expectancy of 31.1 years free of cardiovascular disease, diabetes, and cancer while men with none of the lifestyle factors had 23.5 years on average. Current smoking and obesity had the greatest effects on disease-free life expectancy. 
  • Objective: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases.
  • Design: Prospective cohort study.
  • Setting and participants: The Nurses' Health Study (1980-2014; n=73,196) and the Health Professionals Follow-Up Study (1986-2014; n=38,366).
  • Main exposures: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).
  • Main outcome: Life expectancy free of diabetes, cardiovascular diseases, and cancer.
  • Results: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50.
  • Conclusion: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.

I suppose it isn't a newsflash that healthy habits make you life longer. However, this study, from the journal BMJ, examines the quantity of disease free life we can potentially expect by adopting healthy habits. It's important to understand that this study isn't just looking at volume of lifespan. No one wants to live in a debilitated state of chronic illness. Rather, this study showed that people who do 4 of 5 healthy behaviors actually average around 10 years of additional healthy, disease free life. That definitely sounds like a good thing. 

The healthy lifestyle score was based on five factors:
  • Diet, as assessed using the Alternate Healthy Eating Index, with a score in the upper 40% indicating a healthy diet;
  • Smoking (never vs ever);
  • Moderate to vigorous physical activity (≥ 30 minutes/day);
  • Moderate alcohol consumption (5-15 g/day for women, 5-30 g/day for men); and
  • Body mass index (18.5-24.9 kg/m2).
Looking at specific disease processes, the 4-5 lifestyle people had 8.3 years more in women and 6.0 years more in men for avoidance of cancer. Cardiovascular disease was 10.0 years in women and 8.6 years in men. Type 2 diabetes avoidance was 12.3 years in women and 10.3 years in men. The biggest difference makers in the healthy behaviors were smoking and obesity which lowered the expected extension of life by 25%. Take home points are if you smoke, stop. Some activity is better than no activity. Limit alcohol to 1 drink daily. Catch weight gain early. It's easier to lose 1 pound 50 times than to have to eventually lose 50 lbs. I think we all know that healthy lifestyle is better than unhealthy habits, but when you put the numbers front and center, it really becomes obvious, good habits can add a decade to your life. Most importantly, this is a decade of disease free life!

Here is an illustration from the Harvard School of Public Health illustrating the Healthy Eating Index used in the study and this article has descriptions of what to eat and what to avoid. 

Hot Sauce!
Frequently eating chili peppers reduces mortality and heart disease

Are chili peppers good for you? More importantly, can one's love of spice save their life? This study, published in the Journal of the American College of Cardiology,looked at the chili pepper intake of over 22,000 people. They placed the subjects in four categories: No chili peppers, chili peppers up to two times weekly, chili peppers two-four times weekly, and more than four times per week. They accounted for differences in metabolic activity, dietary differences, smoking, hypertension, and diabetes. After accounting for all of these differences, the chili pepper eaters still had lower mortality rates. Those eating the most chili peppers had 23% lower mortality than non consumers of chili peppers. Specifically, cardiovascular death was reduced by 34%, ischemic heart disease was reduced 44% and stroke death was reduced by a whopping 61%. 

  • Background: Chili pepper is a usual part of a traditional Mediterranean diet. Yet epidemiological data on the association between chili pepper intake and mortality risk are scarce, with a lack of studies from Mediterranean populations.
  • Objectives: This study sought to examine the association between chili pepper consumption and risk of death in a large sample of the adult Italian general population, and to account for biological mediators of the association.
  • Methods: Longitudinal analysis was performed on 22,811 men and women enrolled in the Moli-sani Study cohort (2005 to 2010). Chili pepper intake was estimated by the EPIC (European Prospective Investigation Into Cancer) Food Frequency Questionnaire and categorized as none/rare consumption, up to 2 times/week, >2 to ≤4 times/week, and >4 times/week.
  • Results: Over a median follow-up of 8.2 years, a total of 1,236 deaths were ascertained. Multivariable hazard ratios (HRs) for all-cause and cardiovascular disease (CVD) mortality among participants in the regular (>4 times/week) relative to none/rare intake were 0.77 (95% confidence interval [CI]: 0.66 to 0.90) and 0.66 (95% CI: 0.50 to 0.86), respectively. Regular intake was also inversely associated with ischemic heart disease (HR: 0.56; 95% CI: 0.35 to 0.87) and cerebrovascular (HR: 0.39; 95% CI: 0.20 to 0.75) death risks. The association of chili pepper consumption with total mortality appeared to be stronger in hypertension-free individuals (p for interaction = 0.021). Among known biomarkers of CVD, only serum vitamin D marginally accounted for such associations.
  • Conclusions: In a large adult Mediterranean population, regular consumption of chili pepper is associated with a lower risk of total and CVD death independent of CVD risk factors or adherence to a Mediterranean diet. Known biomarkers of CVD risk only marginally mediate the association of chili pepper intake with mortality.

This article shows that people eating spicy food, specifically chili peppers had lower mortality rates, especially involving the cardiovascular and cerebrovascular systems. The difference between those eating chili peppers four times weekly and not at all is truly remarkable. But why are chili peppers a seemingly magic food? The exact mechanism isn't clear, but the active ingredient in chili peppers is capsaicin. Capsaicin is known to have anti-inflammatory and analgesic properties. It is found in many topical patches and lotions for musculoskeletal problems. It has been shown to promote weight loss and improve the control of insulin. It has protective properties toward vascular linings. It has been shown to promote tumor cell death. Recently studies have found that it also seems to promote a favorable gut microbiome. While we can't tell which of these properties caused the findings it appears that control of insulin and inflammation are front and center for a mechanism. It is quite likely that there are multiple pathways to account for these findings and it seems clear that consuming chili peppers more frequently is quite beneficial to health. So consider adding more spice to your life!

Rebuild Your Brain
Yoga has positive effects on brain structure and function
guy doing yoga
Can the practice of yoga rewire or rebuild our neural connections? This study reviewed the effects of yoga on brain structure and function through functional imaging using MRI, fMRI and SPECT scanning. MRI scans are excellent at showing our brain anatomy. Functional MRI  (fMRI ) measures brain activity  by detecting changes associated with blood flow. 
A single-photon emission computerized tomography (SPECT) scan is a type of nuclear imaging test, which means it uses a radioactive substance and a special camera to create 3-D pictures.  While imaging tests such as MRI can show what the structures inside your body look like, a  SPECT  scan produces images that show  what areas of your brain are more active or less active.

The studies reviewed show evidence that yoga had positive effects on the structure and/or function of many areas of the brain involved in age-related cognitive decline and dementia. 

  • Yoga is the most popular complementary health approach practiced by adults in the United States. It is an ancient mind and body practice with origins in Indian philosophy. Yoga combines physical postures, rhythmic breathing and meditative exercise to offer the practitioners a unique holistic mind-body experience. While the health benefits of physical exercise are well established, in recent years, the active attentional component of breathing and meditation practice has garnered interest among exercise neuroscientists. As the scientific evidence for the physical and mental health benefits of yoga continues to grow, this article aims to summarize the current knowledge of yoga practice and its documented positive effects for brain structure and function, as assessed with MRI, fMRI, and SPECT. We reviewed 11 studies examining the effects of yoga practice on the brain structures, function and cerebral blood flow. Collectively, the studies demonstrate a positive effect of yoga practice on the structure and/or function of the hippocampus, amygdala, prefrontal cortex, cingulate cortex and brain networks including the default mode network (DMN). The studies offer promising early evidence that behavioral interventions like yoga may hold promise to mitigate age-related and neurodegenerative declines as many of the regions identified are known to demonstrate significant age-related atrophy.
This is a very interesting study showing that the practice of yoga may actually not just slow or stop any age related cognitive decline, it may actually rebuild connections. Yoga practice appears to be linked to anatomical changes in the frontal cortex, hippocampus, anterior cingulate cortex and insula. Research has found MRI changes that can predict dementia prior to symptoms being evident. These changes include cerebral atrophy and damage to the brain's white matter. The white matter of the brain provides a pathway connecting the different areas of the brain (right to left, areas within the same cortex, and connecting brain to spinal cord). Problems with these connections are part of the cause of dementia. Yoga seems to improve white matter volume and density and improves cortical thickness (atrophy is seen in dementia). The volume of the hippocampus   a structure that plays an important role in memory and the prefrontal cortex were significantly greater in people practicing yoga. Improved ac tivity in the prefrontal cortex during cognitive activity was seen and overall, it appears that yoga provides cortical neuro-protective effects. Perhaps yoga should be a part of all of our exercise routines for healthy aging!

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.