June Newsletter
In This Issue
Working For the Weekend
Lifting Depression Away
Can Taking Bugs Prevent Bugs?
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. It finally feels like summer! This is such a great time of year in Wisconsin. There are activities for everyone and no reason not to get outside. If you haven't gone previously, check out the Tour of America's Dairyland. This is an 11 day bike race throughout Southeast Wisconsin wrapping up this weekend. If you haven't been to the Downer Classic you are missing out on a great time! Of course Summerfest is in full swing for the best music festival around. Personally, I'm looking forward to some time it the Kettle Moraine. The unique terrain and natural beauty is one of my favorite things about this state. Oh yeah, the Brewers are in 1st place!!

We have all lost sleep during the work or school week. Some of us have probably tried to catch up on our sleep over a weekend. Should we bother? Is this effective? Check out the first article for more information. 

Depression affects many people in our society today. While there are lots of medications for depression, exercise has been shown to be beneficial for mood. Most recommendations have been for aerobic type of exercise. But could weight training be beneficial as well. Should people looking for a boost get their lift on? 

Respiratory infections can affect most of us, mainly during the winter. Influenza is common over this period as well. Can a simple supplement prevent 1/3 of these infections? If you have had a cold, you may want to check out the third article. 

Click on the links the the left to check out our  web site ...
Working For the Weekend
Sleeping in on the weekend may lower mortality risk
sleeping man
Can you "catch up" on your sleep? The traditional answer has always been no, however, a new study published in the Journal of Sleep Research questions this. Researchers followed 43,880 subjects over 13 years. They found that people less than 65 years old who had less than 5 hours of sleep on weekends had a 52% higher mortality rate compared to people who got 7 hours of sleep. Longer sleep didn't decrease mortality further. When comparing people who got less sleep during the week (5 hours or less) but more on the weekend, their mortality was the same as those consistently getting around 7 hours of sleep. 
  • Previous studies have found a U-shaped relationship between mortality and (weekday) sleep duration. We here address the association of both weekday and weekend sleep duration with overall mortality. A cohort of 43,880 subjects was followed for 13 years through record-linkages. Cox proportional hazards regression models with attained age as time-scale were fitted to estimate multivariable-adjusted hazard ratios and 95% confidence intervals for mortality; stratified analyses on age (<65 years, ≥65 years) were conducted. Among individuals <65 years old, short sleep (≤5 hr) during weekends at baseline was associated with a 52% higher mortality rate (hazard ratios 1.52; 95% confidence intervals 1.15-2.02) compared with the reference group (7 hr), while no association was observed for long (≥9 hr) weekend sleep. When, instead, different combinations of weekday and weekend sleep durations were analysed, we observed a detrimental association with consistently sleeping ≤5 hr (hazard ratios 1.65; 95% confidence intervals 1.22-2.23) or ≥8 hr (hazard ratios 1.25; 95% confidence intervals 1.05-1.50), compared with consistently sleeping 6-7 hr per day (reference). The mortality rate among participants with short sleep during weekdays, but long sleep during weekends, did not differ from the rate of the reference group. Among individuals ≥65 years old, no association between weekend sleep or weekday/weekend sleep durations and mortality was observed. In conclusion, short, but not long, weekend sleep was associated with an increased mortality in subjects <65 years. In the same age group, short sleep (or long sleep) on both weekdays and weekend showed increased mortality. Possibly, long weekend sleep may compensate for short weekday sleep.             
Sleeping in on the weekend. It's something we've been told doesn't make up for missing sleep during the week. This is likely the first study to look at sleep duration in a different way. Most studies only look at weekday sleep habits. Instead of looking at people who only sleep the same amount nightly, regardless of time spent sleeping, this study also looked at people who slept more on the weekends, which is likely more consistent with what many people do. When people were chronically sleep deprived, sleeping and extra hour or two on the weekend lowered their mortality back down to the levels seen in people who consistently got more sleep. The other interesting finding is that people who sleep more than 8 hours had higher mortality as well. While a more steady sleep schedule is generally best, if we do get behind, we can "catch up" a bit on the weekend. 

Lifting Depression Away
Resistance training reduces depression levels

Encouraging people who are depressed to exercise is a well-established part of treatment. Exercise has been shown to be synergistic with medications used for both depression and anxiety. But the type of exercise studied has generally been aerobic exercise. "Take a walk" is the most common advice. This study, published in JAMA Psychiatry, examined the efficacy of resistance (weight) training with depressive symptoms and found that resistance exercise training was associated with a significant reduction in depressive symptoms and supports this type of exercise as an alternate or additional therapy for depressive symptoms.

  • Objectives: To estimate the association of efficacy of RET with depressive symptoms and determine the extent to which logical, theoretical, and/or prior empirical variables are associated with depressive symptoms and whether the association of efficacy of RET with depressive symptoms accounts for variability in the overall effect size.
  • Data Sources  Articles published before August 2017, located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science.
  • Study Selection  Randomized clinical trials included randomization to RET (n=947) or a nonactive control condition (n=930).
  • Data Extraction and Synthesis  Hedges d effect sizes were computed and random-effects models were used for all analyses. Meta-regression was conducted to quantify the potential moderating influence of participant and trial characteristics.
  • Main Outcomes and Measures  Randomized clinical trials used validated measures of depressive symptoms assessed at baseline and midintervention and/or postintervention. Four primary moderators were selected a priori to provide focused research hypotheses about variation in effect size: total volume of prescribed RET, whether participants were healthy or physically or mentally ill, whether or not allocation and/or assessment were blinded, and whether or not the RET intervention resulted in a significant improvement in strength.  
  • R esults  Fifty-four effects were derived from 33 randomized clinical trials involving 1877 participants. Resistance exercise training was associated with a significant reduction in depressive symptoms with a moderate-sized mean effect ∆ of 0.66 (95% CI, 0.48-0.83; z=7.35; P<0.001). Significant heterogeneity was indicated (total Q = 216.92, df=53; P < .001;I2=76% [95% CI, 72.7%-79.0%]), and sampling error accounted for 32.9% of observed variance. The number needed to treat was 4. Total volume of prescribed RET, participant health status, and strength improvements were not significantly associated with the antidepressant effect of RET. However, smaller reductions in depressive symptoms were derived from randomized clinical trials with blinded allocation and/or assessment.
  • Conclusions and Relevance  Resistance exercise training significantly reduced depressive symptoms among adults regardless of health status, total prescribed volume of RET, or significant improvements in strength. Better-quality randomized clinical trials blinding both allocation and assessment and comparing RET with other empirically supported treatments for depressive symptoms are needed.

People who are depressed often fall into a deep, black hole. There have been many studies showing that exercise, especially when done outside can be beneficial for mood. Go outside and take a walk has been common advice given by me and other doctors. But what about weight training? Can that help? Some have felt that depressed people can't be pushed and that this type of exercise may be too difficult. Weight  training may have benefits beyond the exercise itself. It requires goal setting, structured routine, mastery of skill, progressive improvement and can be social. People can use a work out buddy to help with compliance. It may also be beneficial for body composition which can help with mood. While it may not be for everyone, it's nice to see a study that expands exercise options for people. Start slow, set goals, and get started!
Can Taking Bugs Prevent Bugs?
Probiotics may help prevent respiratory infections
This study evaluated the effectiveness of probiotics to decrease respiratory viral infections including influenza in older adults. Probiotics are live strains of bacteria. The researchers found laboratory documented viral respiratory infections in 15% of the probiotic group vs. 22.9% of the placebo group. It appears that probiotics may be beneficial in prevention of respiratory infections. 


  • Objectives:  To assess the feasibility of conducting a large clinical trial to evaluate the effectiveness of probiotics to reduce influenza and other respiratory virus infections in residents of long-term and chronic care facilities (LTCFs).
  • Design:  Randomized, double-blind, placebo-controlled pilot trial.
  • Setting:  Fourteen nursing homes in Hamilton and surrounding region, Ontario, Canada.
  • Participants:  Nursing home residents aged 65 and older (N=209). Those who were taking immunosuppressives (steroids or other immunosuppressives) or had a hematological malignancy, structural heart disease, or gastroesophageal or intestinal injury and others at high risk of an endovascular infection were excluded.
  • Intervention:  Participants were randomized to receive study probiotics-2 capsules of Lactobacillus rhamnosus GG (estimated 10 billion colony forming units of L. rhamnosus GG per capsule) or placebo (calcium carbonate) daily for 6 months.
  • Measurements:  Laboratory-confirmed respiratory viral infections.
  • Results:  One hundred ninety-six individuals were included in the analysis: 100 in the probiotics group and 96 in the placebo group. Laboratory-confirmed respiratory viral infections were observed in 14 (15.0%) residents in the probiotic group and 21 (22.9%) in the placebo group (hazard ratio=0.65, 95% confidence interval=0.32-1.31).
  • Conclusion:  A larger trial is warranted to determine whether probiotics reduce influenza and other respiratory virus infections in residents of LTCFs.        
There is more evidence being found regarding the gut-immune system connection. This study provides more evidence of this. In this small study, one group of elderly people received 20 billion colonies of multiple species of probiotics and the other received a placebo. The result was a 35% decrease in respiratory infections including influenza. This is a significant decrease for an intervention that is inexpensive, has very low side-effect profile and can be beneficial to people in several other ways including enhanced immunity, less constipation, and less inflammation. Taking a probiotic may be an easy way to cut back on respiratory infections. 

Probiotics to Prevent Respiratory Infections in Nursing Homes: A Pilot Randomized Controlled Trial J Am Geriatr Soc 2018 May 09;[EPub Ahead of Print].

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.