May Newsletter
In This Issue
Stairs Are Better Than Caffeine
Exercise Makes Your Smart
Energy Drink Dangers
A Better 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. I hope everyone enjoyed the long weekend and it is definitely nice to see some sunshine, even if it is in between rain showers. I have a tradition of doing the "Murph" workout on Memorial Day. This is a Cross-fit workout named after Lt. Michael P. Murphy, a Navy Seal killed in action in 2005, who posthumously received the Medal of Honor (if you have seen the movie Lone Survivor, Lt. Murphy is one of the characters in the movie). It is a simple workout, but pretty brutal: 1 mile run, 100 pull-ups, 200 push-ups, 300 squats, then ending with another 1 mile run, all done for time. While doing it I focus my mind on the sacrifices made by all of our servicemen and women. It's definitely a "good tired" when I finish it. Thanks to all who have served. 

This month the first article looks at ways to get an energy boost during the day. When you are feeling fatigued during the day many of us reach for a hit of caffeine through soda, coffee, tea, or energy drinks. The article shows another way that is healthier than all of them. 

The second article looks at the role of exercise and our thinking processes. Exercise may actually make you smarter!

Recent news reports about a teenager who died after consuming multiple sources of caffeine got me thinking and doing some research. Why are there deaths after consuming energy drinks but we don't hear about deaths from drinking too much coffee? The third article has a possible explanation. 

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Stairs Are Better Than Caffeine 
Walking stairs more energizing than hitting the caffeine        
Many of us reach for caffeine in various forms during the day if we feel we are dragging. This study, from Physiology & Behavior, compared a 10 minute low to moderate intensity stair walk to 50 mg of caffeine, similar to the amount of caffeine in a soda or black tea. The researchers found after walking the stairs the subjects felt more vigorous than when using caffeine. 
  • Introduction:  The acute energizing effect of exercise and caffeine has never been examined in a single study of adults with chronic sleep deprivation but evidence from a study of this type could help individuals choose between these two common alertness-enhancing options.    
  • Aim: The apriori primary aim of this experiment was to compare the influence of 10-min of low-to-moderate intensity stair walking to the consumption of capsules containing 50 mg caffeine or flour (placebo) on feelings of energy in physically active, college female caffeine users with chronic insufficient sleep. Effects on secondary outcomes related to feelings of energy also were assessed. 
  • Material-method: A repeated measures crossover experiment was conducted with 18 college women (18-23 years) who reported (i) daily caffeine consumption that was not extreme (40-400 mg), (ii) typical leisure time physical activity that was not extreme (at least 2 weekly mild 15-min or longer bouts and no > 5 strenuous 15-min or longer bouts), and (iii) sleeping < 45 h per week. Mood states (POMS-BF), focused on energy feelings (vigor), as well as working memory (N-back), sustained attention (CPT), simple reaction time (SRT), and motivation to complete the cognitive tasks were measured before and after a 10-min exercise condition (20 min seated rest followed by 10 min of low-to-moderate intensity stair walking) and compared to both a caffeine condition (50 mg caffeine capsule followed by 30 min of seated rest) and a similar flour (placebo) capsule condition. Condition (exercise, caffeine, placebo) × Time (Baseline, Post-1, Post-2, and for mood Post-3) ANCOVAs (controlling for Condition order) tested the hypothesized effects.
  • Results: Condition × Time interactions showed that stair walking increased POMS-BF vigor at Post-1 compared to both placebo and caffeine. Other interactions were not significant. 
  • Conclusion:A brief bout of low-to-moderate intensity stair walking has transient energizing effects that exceed a low dose of caffeine for active young women with chronic insufficient sleep.

This study shows that getting some activity is more energizing than reaching for caffeine. Many people reach for that Diet Coke when they are feeling fatigued. It looks like a better choice may be to do some brief physical activity. This study looked at stair walking as it can be done in any weather but even walking for a few minutes would likely be helpful. Try walking to your colleagues desk instead of sending an email or message. Instead of sitting during a discussion, try having a walking meeting. This technique has been used by many successful people and will keep everyone's brain activated. The next time you need some energy, try walking for your afternoon lift!
Exercise Makes You Smart
Improvement in cognition seen in people who exercise

This study, from the British Journal of Sports Medicine, found that physical exercise improved cognitive function in people over age 50. The authors reviewed and analyzed 39 studies and found improvements across several types of exercise including aerobic exercise, resistance training, multi component training and tai chi. Benefits were seen with moderate intensity and duration of 45-60 minutes. 
  • Background: Physical exercise is seen as a promising intervention to prevent or delay cognitive decline in individuals aged 50 years and older, yet the evidence from reviews is not conclusive.
  • Objectives: To determine if physical exercise is effective in improving cognitive function in this population.
  • Design: Systematic review with multilevel meta-analysis.
  • Data sources: Electronic databases Medline (PubMed), EMBASE (Scopus), PsychINFO and CENTRAL (Cochrane) from inception to November 2016.
    Eligibility criteria Randomised controlled trials of physical exercise interventions in community-dwelling adults older than 50 years, with an outcome measure of cognitive function.
  • Results: The search returned 12,820 records, of which 39 studies were included in the systematic review. Analysis of 333 dependent effect sizes from 36 studies showed that physical exercise improved cognitive function 90.29; 95% CI 0.017 to 0.41; P<0.01). Interventions of aerobic exercise, resistance training, multicomponent training and tai chi, all had significant point estimates. When exercise prescription was examined, a duration of  45-60 min per session and at least moderate intensity, were associated with benefits to cognition. The results of the meta-analysis were consistent and independent of the cognitive domain tested or the cognitive status of the participants.
  • Conclusions: Physical exercise improved cognitive function in the over 50s, regardless of the cognitive status of participants. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that patients obtain both aerobic and resistance exercise of at least moderate intensity on as many days of the week as feasible, in line with current exercise guidelines.

We know that exercise is good for us, now we know that it may make us smarter! This study reviewed 39 studies and found improvement across various types of exercise. It seems that the type of exercise may not matter for our brains, just the fact we are doing something. So, don't put it off. Get some physical activity most or all the days of the week. Your brain will thank you! 
Energy Drink Dangers
Prolonged QT interval from energy drinks not related to caffeine
The death this month of a teenager from South Carolina brought energy drinks to the forefront again. There have been multiple deaths of mainly teens and young adults after consuming energy drinks. Why is this? Many people consume several cups of coffee daily and we don't see deaths from this. This study, from the Journal of the American Heart Association explores possible reasons for this. When participants drank an energy drink they had more elevation of blood pressure and more importantly, an increase in their corrected QT interval. This finding could be a possible precursor to sudden cardiac death and wasn't seen from ingesting caffeine alone. 
  • Background: Caffeine in doses <400 mg is typically not considered arrhythmogenic, but little is known about the additional ingredients in energy drinks. We evaluated the ECG and blood pressure ( BP ) effects of high-volume energy drink consumption compared with caffeine alone. 
  • Methods and Results This was a randomized, double-blind, controlled, crossover study in 18 young, healthy volunteers. Participants consumed either 946 mL (32 ounces) of energy drink or caffeinated control drink, both of which contained 320 mg of caffeine, separated by a 6-day washout period.  ECG , peripheral  BP , and central  BP  measurements were obtained at baseline and 1, 2, 4, 6, and 24 hours post study drink consumption. The time-matched, baseline-adjusted changes were compared. The change in corrected  QT  interval from baseline in the energy drink arm was significantly higher than the caffeine arm at 2 hours (0.44±18.4 ms versus −10.4±14.8 ms, respectively; P=0.02). The  QT c changes were not different at other time points. While both the energy drink and caffeine arms raised systolic  BP  in a similar fashion initially, the systolic  BP  was significantly higher at 6 hours when compared with the caffeine arm (4.72±4.67 mm Hg versus 0.83±6.09 mm Hg, respectively; P=0.01). Heart rate, diastolic  BP , central systolic  BP , and central diastolic  BP  showed no evidence of a difference between groups at any time point. Post energy drink, augmentation index was lower at 6 hours.
  • Conclusions The corrected QT interval and systolic BP were significantly higher post high-volume energy drink consumption when compared with caffeine alone. Larger clinical trials validating these findings and evaluation of noncaffeine ingredients within energy drinks are warranted.                 

There have been multiple deaths over the past few years due to consumption of energy drinks. In the case mentioned, the teen drank a McDonald's latte, a Diet Mountain Dew, and a larger energy drink within two hours (approx 470 mg caffeine). It may have been the rapid consumption of  caffeine that contributed, but it seems there may be something else going on that is unique to energy drinks. Many of these are considered supplements and thus fall outside the purview of the FDA. Many may contain substances which are not on the label. This study showed that there was prolongation of the QT interval. Prolonged QT is a known cause of sudden death. Maybe there is something there causing a temporary change in the cardiac rhythm due to a substance present in energy drinks. The cases of deaths have been from various brands of energy drinks, not just one specific one, so there seems to be a class effect. Hopefully, we will figure it out soon. Until then, be careful with teens and caffeine, especially from energy drinks. Maybe we should have kids walk stairs for a few minutes before classes...  

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. 


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.