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May Newsletter
In This Issue
How to Avoid Strokes
Keep Your Wits as You Age
How to Improve Teen Behavior
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. It's hard to believe Memorial Day is already past us. Many of us are getting ready for graduations and summer plans. My daughter is actually registering for college today! When did that happen? 


This month I have three articles focusing on ways that we can stay healthy. And of course, they all involve what we eat. I am constantly amazed at the research coming out month after month that proves that diet and prevention is better than any medications we have. 


The first article looks at strokes, the fifth leading cause of death in our country and certainly one of the medical conditions I think most of us fear. We have all seen stroke victims and I'm sure have thought that we don't want that to happen to us. We are getting better at diagnosing and instituting treatment faster, but we are not doing much to prevent them except putting people on medications. While certainly, certain medications are necessary in certain cases, how about prevention. This article shows a way to prevent up to 72% of strokes! I think that is worth a read.


Another condition I think most of us fear as we age is dementia. Again, looking at ways to prevent this is paramount. The second article looks at an addition to a well-founded diet that holds a lot of promise in helping to not only prevent onset of this condition, but looks to actually improve our cognition. 


Finally, as the father to a couple of teenagers, I found the third article very interesting. A change in what teens snack on may help with later diet control as well as having beneficial effects on mood and cognition. Just remember, although (I hope) we aren't as moody as our teens, changing our snacks will have the same effect!  


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

How to Avoid Strokes 

Healthy lifestyle trumps medications
Strokes are the 5th leading cause of death in the United States. They are also one of the conditions leading to a great deal of difficulty for victims and caregivers. Finding ways to prevent strokes is one of the things being emphasized currently. We have seen the development of "stroke centers" in our communities and heard public service messages about "brain attacks"  instructing  us to seek immediate medical care when we have these symptoms. There are articles coming out (I just saw one this week) expounding on the virtues of statin  medications  in prevention of strokes. But isn't there something else we can do? The answer is a firm YES! This study, from the journal Neurology , shows that lifestyle changes can lower risk of stroke much more than even our most powerful medications.  

Summary of findings:

  • OBJECTIVE: To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke because of other cardiovascular diseases or conditions.

  • METHODS: Our study population comprised 11,450 men in the Cohort of Swedish Men who had a history of hypertension, high cholesterol levels, diabetes, heart failure, or atrial fibrillation. Participants had completed a questionnaire about diet and lifestyle and were free from stroke and ischemic heart disease at baseline (January 1, 1998). We defined a healthy lifestyle as a low-risk diet (?5 servings/d of fruits and vegetables and <30 g/d of processed meat), not smoking, ?150 min/wk of physical activity, body mass index of 18.5 to 25 kg/m(2), and low to moderate alcohol consumption (>0 to ?30 g/d). Ascertainment of stroke cases was accomplished through linkage with the National Inpatient Register and the Swedish Cause of Death Register. 
  • RESULTS: During a mean follow-up of 9.8 years, we ascertained 1,062 incident stroke cases. The risk of total stroke and stroke types decreased with increasing number of healthy lifestyle factors. The multivariable relative risk of total stroke for men who achieved all 5 healthy lifestyle factors compared with men who achieved 0 or 1 factor was 0.28 (95% confidence interval 0.14-0.55). The corresponding relative risks (95% confidence interval) were 0.31 (0.15-0.66) for ischemic stroke and 0.32 (0.04-2.51) for hemorrhagic stroke. 
  • CONCLUSIONS: A healthy lifestyle is associated with a substantially reduced risk of stroke in men at higher risk of stroke.
The researchers followed 11,450 Swedish Men with risk factors for stroke including high cholesterol, high blood pressure, diabetes, heart failure, and atrial fibrillation over almost 10 years. They found that those with 5 lifestyle habits were 72% less likely to have a stroke than a person with one or none of these habits. Another group in the same study had a 79% reduction in heart attacks. 
Other studies have shown similar results for heart disease (83% reduction), and diabetes (58% reduction). 

So keep these habits in mind: 
1: Over 5 servings/day of vegetables and fruit ( what is a serving?)
2: No smoking
3: >150 minutes/week of activity (such as walking or biking)
4: Normal BMI between 18.5 and 25 kg/m2 ( what's my BMI?)
5: Low to moderate alcohol consumption (0-2 drinks/day) 

Statins (i.e. Lipitor) have been shown to reduce strokes by 17% and heart attacks by 20%, while lifestyle can reduce strokes by 72% and heart attacks by 79%. So there you have it. Lifestyle trumps medication!

Keep Your Wits as You Age
Olive oil and nuts aid cognition
Mediterranean diet


Age-related cognitive decline is something we all are concerned about as we age. Ways to prevent this are of interest to all of us. In this article, taken from  JAMA Internal Medicine, researchers found that a Mediterranean diet supplemented with either olive oil or nuts improved cognition over several years as opposed to a control diet (low fat) where subjects showed cognitive decline in all phases of testing. 

Summary of findings   

  • Importance:  Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline, a strong risk factor for development of dementia. Epidemiologic studies suggest that a Mediterranean diet, an antioxidant-rich cardioprotective dietary pattern, delays cognitive decline, but clinical trial evidence is lacking.   
  • Objective: To investigate whether a Mediterranean diet supplemented with antioxidant-rich foods influences cognitive function compared with a control diet. 
  • Design, Setting, and Participants: Parallel-group randomized clinical trial of 447 cognitively healthy volunteers from Barcelona, Spain (233 women [52.1%]; mean age, 66.9 years), at high cardiovascular risk were enrolled into the Prevenci?n con Dieta Mediterr?nea nutrition intervention trial from October 1, 2003, through December 31, 2009. All patients underwent neuropsychological assessment at inclusion and were offered retesting at the end of the study.
  • Interventions: Participants were randomly assigned to a Mediterranean diet supplemented with extra virgin olive oil (1 L/wk), a Mediterranean diet supplemented with mixed nuts (30 g/d), or a control diet (advice to reduce dietary fat). 
  • Main Outcomes and Measures: Rates of cognitive change over time based on a neuropsychological test battery: Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT), Animals Semantic Fluency, Digit Span subtest from the Wechsler Adult Intelligence Scale, Verbal Paired Associates from the Wechsler Memory Scale, and the Color Trail Test. We used mean z scores of change in each test to construct 3 cognitive composites: memory, frontal (attention and executive function), and global. 
  • Results: Follow-up cognitive tests were available in 334 participants after intervention (median, 4.1 years). In multivariate analyses adjusted for confounders, participants allocated to a Mediterranean diet plus olive oil scored better on the  RAVLT (P=.049) and Color Trail Test part 2 (P=.04) compared with controls; no between-group differences were observed for the other cognitive tests. Similarly adjusted cognitive composites (mean z scores with 95% CIs) for changes above baseline of the memory composite were 0.04 (-0.09 to 0.18) for the Mediterranean diet plus olive oil, 0.09 (-0.05 to 0.23; P=.04) vs controls) for the Mediterranean diet plus nuts, and -0.17 (-0.32 to -0.01) for the control diet. Respective changes from baseline of the frontal cognition composite were 0.23 (0.03 to 0.43; P=.003 vs controls), 0.03 (-0.25 to 0.31), and -0.33 (-0.57 to -0.09). Changes from baseline of the global cognition composite were 0.05 (-0.11 to 0.21; P=.005 vs controls) for the Mediterranean diet plus olive oil, -0.05 (-0.27 to 0.18) for the Mediterranean diet plus nuts, and -0.38 (-0.57 to -0.18) for the control diet. All cognitive composites significantly (P<.05) decreased from baseline in controls. 
  • Conclusions and Relevance: In an older population, a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognitive function.
This study shows again that what we eat can have major effects on our lives. Here, those who ate a normal recommended diet (low fat) showed significant decreases in all cognitive testing while those who ate a Mediterranean diet supplemented with extra virgin olive oil showed improvement in all areas and those who ate the Mediterranean diet supplemented with mixed nuts showed modest in memory and frontal cognition but a small decline in global cognition. This is remarkable. Not only did the diet stop most decline, it actually 
improved all areas tested! This shows again that the 'low fat" diet is a failure in yet another area. No matter where we are in life, we may be able to improve our thinking by what we are eating. Bon appetit! 


Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial JAMA Intern Med 2015 May 11;[EPub Ahead of Print], C Valls-Pedret, A Sala-Vila, M Serra-Mir, et al 

How to Improve Teen behavior 
High protein snacks improve aspects of appetite, behavior, mood, and cognition


Teen angst. It's not just a song. It's moody, angry, happy, grumpy, dramatic, forgetful, sleepy, mumbly, silent...(parents, you can chime in anytime). Many of us have wondered what we can to to help out teens through this "interesting" time in their lives. They are also forming habits for diet that may stay with them for years. Well, as it turns out, their snacking may be one thing that could help. This article, from The Journal of Nutrition, shows that high-protein snacks help teens with appetite, mood, and cognition.  

Summary of findings:  

  • Background: The effects of afternoon snacking on ingestive behavior, mood, and cognition are limited. 

  • Objective: The purpose of this study was to compare 1088 kJ of high-protein (HP) or high-fat (HF) afternoon snacks vs. no snacking on appetite, food intake, mood, and cognition in adolescents.

  • Methods: Thirty-one healthy adolescents (age: 17 ? 1 y) consumed the following afternoon snacks (in randomized order) for 3 d: HP snack (26 g of protein/6 g of fat per 27 g of carbohydrates), HF snack (4 g of protein/12 g of fat per 32 g of carbohydrates), and no snack (NoS). On day 4 of each treatment, the participants completed an 8-h testing day containing pre- and postsnack appetite questionnaires, food cue-stimulated functional MRI brain scans, mood, cognitive function, and eating initiation. Ad libitum dinner and evening snacks were provided and assessed.  

  • Results: HP, but not HF, delayed eating initiation vs. NoS (P < 0.05). Both snacks reduced appetite vs. NoS (P < 0.001) with HP eliciting greater reductions than HF (P < 0.05). Only HF led to reductions in corticolimbic activation in brain regions controlling food motivation/reward vs. NoS (P < 0.01). Although no treatment differences in daily energy intake were detected, HP led to greater protein consumption than NoS (P < 0.05) and greater protein and lower fat consumption than HF (both, P < 0.05). HP led to fewer HF/high-sugar evening snacks than NoS (P < 0.01) and HF (P = 0.09). Although no treatment effects were detected for mood and cognition, HP tended to reduce confusion-bewilderment (P = 0.07) and increase cognitive flexibility (P = 0.09), whereas NoS reduced tension-anxiety (P < 0.05) and vigor-activity (P < 0.05).

  • Conclusion: Afternoon snacking, particularly on HP soy foods, improves appetite, satiety, and diet quality in adolescents, while beneficially influencing aspects of mood and cognition. This trial was registered at as NCT01781286.         

This study shows that changing what teens snack on may help with their overall mood, thinking and especially later food choices. Anyone who has been around teens knows what they tend toward when snacking; sweets (sugar) and chips, crackers, breads, and pasta (simple starch and unhealthy fats). Feeding teens a high protein snack, in this case a chocolate-peanut-caramel flavored pudding formulated with soy protein improved their later diets and controlled appetite. This can help to prevent some of the weight gain we are seeing in this age group. An additional benefit  was that lowered confusion-bewilderment and increased cognitive flexibility was noted. While this study was done with soy protein, it should translate to other proteins. When the kids get home from school, have some high protein snacks available for them. Try some cottage cheese with fruit, edamame, hard boiled eggs, peanut or almond butter (go organic with these), pumpkin seeds, mixed nuts, a couple slices of deli meat and cheese rolled in lettuce, hummas and carrots or celery, string cheese, greek yogurt...use your imagination. It may pay off not only in a better diet, but maybe could decrease the drama (always welcome around my house). 
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. 


Preventing strokes is something we should always be looking toward. The five things mentioned in the article are great advice not just for strokes but for heart disease and some cancers. Need I say more?  


Our diets are so important to our health and healthy aging. No on wants to get old and sit in a nursing home with a stroke and/or dementia. Make changes in your diet now to prevent this. This study shows it is never too late to make improvements!  


While the teen years can be challenging (to them and us), getting them to eat better (high protein) may be helpful for several reasons. It isn't easy, but the results could be important. Oh yeah, don't forget about breakfast! It's hard enough to concentrate in school. 


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.