October Newsletter
In This Issue
Increase Your Brain Volume
The Best Foods For Weight Loss
Better Than Viagra?
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. October really got away from me. It's hard to believe we are at the end of the month already. Part of the reason is I have been especially busy. I have become team physician for the Milwaukee Bucks so their season it just getting started. I'm usually winding down from baseball but now I find myself winding up for basketball. It's really a great organization and I am really excited to be part of this up and coming young team. We are close to having everyone healthy and back on the court. If you happen to be at a game be sure to say hi (I'm usually in section 202)!


The first section this month has two articles looking at the aging brain. In the brain, we have two types of tissue. Gray, which is our brain cells, and white, which are the long communicating parts called axons. As we age, our brains tend to atrophy and we have lower volumes of both gray and white tissue. Many people will also develop white matter lesions which may potentially interfere with communication within the brain. These can be thought of as potholes in the communicating roads of our brain. We can't say for sure what these lesions cause, it all depends on the clinical presentation. However, we can say that more brain atrophy is not better and more white matter lesions are not better. To find out ways to lessen your chances of both of these findings, read the first section.  


I'm often asked what are the best foods for me to eat to lose weight. The second article looks at some foods and actually showed how much weight was lost with various foods. For these foods, more may be better! Add this to the big glass of water before meals and you can be on your way. 


You can't watch a sporting event or open a magazine without being bombarded by ads for medications for ED. By now, we all know ED stands for erectile dysfunction and based on the sheer number of ads it must be the most crucial health issue in our society today. To find out a cheap, effective, natural way to help with the dreaded ED plague sweeping the country, read the third article. By the way, doing this when you are young can prevent problems in the future. 


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

Increase Your Brain Volume
older woman with weights
Higher brain volumes in seniors who follow Mediterranean diet, perform resistance exercise
I am going to highlight two studies this month that deal with brain volume. Higher brain volume is associated with less dementia and better cognitive function. It seems good to do things that either maintain or increase our brain volume as we age. These studies highlight some of the specifics. 

The first study, from the journal Neurology, found that people over 65 who ate a Mediterranean diet with more fish, vegetables, fruit, grains and olive oil may have larger brain volume as measured by MRI than those who did not follow the Mediterranean style diet. Substituting fish for meat was especially notable for improvement in brain structure. Those following the Mediterranean diet has findings in their brains similar to aging 5 years less than those following a traditional diet.  
Summary of findings:
  • Objective: To determine whether higher adherence to a Mediterranean-type diet (MeDi) is related with larger MRI-measured brain volume or cortical thickness. 
  • Methods: In this cross-sectional study, high-resolution structural MRI was collected on 674 elderly (mean age 80.1 years) adults without dementia who participated in a community-based, multiethnic cohort. Dietary information was collected via a food frequency questionnaire. Total brain volume (TBV), total gray matter volume (TGMV), total white matter volume (TWMV), mean cortical thickness (mCT), and regional volume or CT were derived from MRI scans using FreeSurfer program. We examined the association of MeDi (scored as 0-9) and individual food groups with brain volume and thickness using regression models adjusted for age, sex, ethnicity, education, body mass index, diabetes, and cognition.
  • Results: Compared to lower MeDi adherence (0-4), higher adherence (5-9) was associated with 13.11 (p = 0.007), 5.00 (p = 0.05), and 6.41 (p = 0.05) milliliter larger TBV, TGMV, and TWMV, respectively. Higher fish (b = 7.06, p = 0.006) and lower meat (b = 8.42, p = 0.002) intakes were associated with larger TGMV. Lower meat intake was also associated with larger TBV (b = 12.20, p = 0.02). Higher fish intake was associated with 0.019 mm (p = 0.03) larger mCT. Volumes of cingulate cortex, parietal lobe, temporal lobe, and hippocampus and CT of the superior-frontal region were associated with the dietary factors.  
  • Conclusions: Among older adults, MeDi adherence was associated with less brain atrophy, with an effect similar to 5 years of aging. Higher fish and lower meat intake might be the 2 key food elements that contribute to the benefits of MeDi on brain structure.  

The second article focuses on resistance training. This study, from the Journal of the American Geriatrics Society found that women who performed resistance training twice a week had less progression of white matter lesions over a 52-week period. This correlated with maintenance of gait speed but not with executive function. 

  • Objectives: To assess whether resistance training (RT) slows the progression of white matter lesions (WMLs) in older women.
  • Design: Secondary analysis of a 52-week randomized controlled trial of RT, the Brain Power Study.
  • Setting: Community center and research center.
  • Participants: Of 155 community-dwelling women aged 65 to 75 enrolled in the Brain Power Study, 54 who had evidence of WMLs on magnetic resonance imaging (MRI) at baseline were included in this secondary analysis.
  • Intervention: Participants were randomized to once-weekly RT (1× RT), twice-weekly RT (2× RT), or twice-weekly balance and tone (BAT). Assessors were blinded to participant assignments.
  • Measurements: WML volume was measured using MRI at baseline and trial completion. 
  • Results: At trial completion, the 2× RT group had significantly lower WML volume than the BAT group (P = .03). There was no significant difference between the BAT group and the 1× RT group at trial completion (P = .77). Among participants in the two RT groups, reduced WML progression over 12 months was significantly associated with maintenance of gait speed (correlation coefficient (r) = −0.31, P = .049) but not with executive functions (r = 0.30; P = .06).
  • Conclusion: Engaging in progressive RT may reduce WML progression.

Both of these studies show that lifestyle changes can potentially make a significant difference in brain health as we age. Eating a diet rich in fish, vegetables and fruits, olive oil and taking part in exercise, specifically resistance training, can be beneficial for both overall brain volume and the progression of white matter lesions.
The Best Foods For Weight Loss
Not all fruits and vegetables are created equal
fruits and vegetables

Most of my patients and newsletter readers have heard me talk or write about the importance of vegetables and fruits in the diet. This study, published in PLOS Medicine looks at weight changes in a large population over several years and compares this to the types of vegetables and fruits that were eaten. It is true that some fruits and vegetables are better than others!

Summary of findings      
  • Background:  Current dietary guidelines recommend eating a variety of fruits and vegetables. However, based on nutrient composition, some particular fruits and vegetables may be more or less beneficial for maintaining or achieving a healthy weight. We hypothesized that greater consumption of fruits and vegetables with a higher fiber content or lower glycemic load would be more strongly associated with a healthy weight. 
  • Methods and Findings:  We examined the association between change in intake of specific fruits and vegetables and change in weight in three large, prospective cohorts of 133,468 United States men and women. From 1986 to 2010, these associations were examined within multiple 4-y time intervals, adjusting for simultaneous changes in other lifestyle factors, including other aspects of diet, smoking status, and physical activity. Results were combined using a random effects meta-analysis. Increased intake of fruits was inversely associated with 4-y weight change: total fruits -0.53 lb per daily serving (95% CI -0.61, -0.44), berries -1.11 lb (95% CI -1.45, -0.78), and apples/pears -1.24 lb (95% CI -1.62, -0.86). Increased intake of several vegetables was also inversely associated with weight change: total vegetables -0.25 lb per daily serving (95% CI -0.35, -0.14), tofu/soy -2.47 lb (95% CI, -3.09 to -1.85 lb) and cauliflower -1.37 lb (95% CI -2.27, -0.47). On the other hand, increased intake of starchy vegetables, including corn, peas, and potatoes, was associated with weight gain. Vegetables having both higher fiber and lower glycemic load were more strongly inversely associated with weight change compared with lower-fiber, higher-glycemic-load vegetables (p < 0.0001). Despite the measurement of key confounders in our analyses, the potential for residual confounding cannot be ruled out, and although our food frequency questionnaire specified portion size, the assessment of diet using any method will have measurement error.
  • Conclusions: Increased consumption of fruits and non-starchy vegetables is inversely associated with weight change, with important differences by type suggesting that other characteristics of these foods influence the magnitude of their association with weight change.

This population-based study looked at the effects of various fruits and vegetables on body weight. The thought was that more high fiber, lower glycemic index fruits and vegetables would be beneficial. This hypothesis was proven correct. Eating certain fruits and vegetables were associated with weight loss.  Overall, each serving of fruits was associated with about 1/2 lb weight change and vegetables with 1/4 lb weight change over 4 years.  Especially beneficial were apples, pears, berries, soy/tofu and cauliflower which were all associated with at least a 1 lb weight
 difference per serving over the 4 year period. They also found that consuming low-fiber, sta
rchy vegetables such as potatoes, corn and peas were actually associated with weight gain over the same time period. Pass the fruit salad!

Better Than Viagra? 
Physical activity prevents erectile dysfunction
Ok, so the headline brought you here. Medications like Cialis and Viagra are big business for pharmaceutical companies. Erectile dysfunction is often associated with chronic diseases such as obesity, diabetes and heart disease. This study, from The Journal of Sexual Medicine, found an inverse relationship between physical activity and erectile dysfunction (ED). 

Summary of findings:   
  • Introduction: Emerging work suggests an inverse association between physical activity and erectile dysfunction (ED). The majority of this cross-sectional research comes from convenience samples and all studies on this topic have employed self-report physical activity methodology.             
  • Aim: Therefore, the purpose of this brief-report, confirmatory research study was to examine the association between objectively measured physical activity and ED in a national sample of Americans. 
  • Methods: Data from the 2003-2004 National Health and Nutrition Examination Survey were used. Six hundred ninety-two adults between the ages of 50 and 85 years (representing 33.2 million adults) constituted the analytic sample. Participants wore an ActiGraph 7,164 accelerometer (ActiGraph, Pensacola, FL, USA) for up to 7 days with ED assessed via self-report. 
  • Main Outcome Measure: The main outcome measure used was ED assessed via self-report.
  • Results: After adjustments, for every 30 min/day increase in moderate-to-vigorous physical activity, participants had a 43% reduced odds of having ED (odds ratio adjusted = 0.57; 95% confidence interval: 0.40-0.81; P = 0.004).
  • Conclusion: This confirmatory study employing an objective measure of physical activity in a national sample suggests an inverse association between physical activity and ED
This study confirms what previous studies have shown. This study also used actual data from accelerometers (similar to FitBit) to track activity, so the accuracy is improved. Physical activity helps prevent and even treat erectile dysfunction. Every 30 minutes of daily exercise reduces the risk of ED by 43%. Not bad. So if you need some motivation to get moving (or getting your husband moving), think about that reduction! Additionally, the Mediterranean diet has been shown to be helpful and Kegel exercises may help as well. Have a nice Mediterranean style meal, take a walk together, and later you can get busy ;)...   
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. 


It seems like almost every month I find more evidence that a Mediterranean style diet is beneficial for our long-term health and that exercise is beneficial. This month the articles looking at brain health were no exception. 


Last month we talked about water as a weight loss aid. This month we show which specific fruits and vegetables are beneficial. 


Exercise IS beneficial in maintenance of our sexual function. Kind of gives a new spin to use it or lose it...


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.