October Newsletter
In This Issue
Move or Die!
Stones and Groans
Runners High
A Better Model of Medical Care
Dr. Niedfeldt
Old-fashioned medicine with 21st Century convenience and technology
Quick Links
Join Our List
View my profile on LinkedIn 
Follow me on Twitter
I hope this newsletter finds you and your family well. 

The first article builds on some things I have highlighted in the past. It is imperative that we move. Many of us have sedentary jobs and this is putting our health at risk. This article is a large, well done study showing that sitting all day is putting us at risk of increased mortality. So yes, your sedentary job may really be killing you...  

Anyone who has had a kidney stone will be interested in the second article. If you haven't had one, you don't want one. I have had people tell me it was the worst pain they have experienced in their lives. This article gives us 5 lifestyle changes that can reduce the risk of getting kidney stones by over 50%. 

Virtually all of us have been affected by depression, either personally, or through friends and family. A very simple intervention may be quite effective in reducing one's risk of this disease. With our fall colors in full effect, now is a great time for this particular intervention. 

Click on the links the the left to check out our web site ...
Move or Die!
Total sedentary time and uninterrupted sedentary time linked to higher mortality       couch potato
This study, from the Annals of Internal Medicine, followed almost 8000 participants and included over half women and one-third African Americans. The mean age was low 60's and the subjects were followed for 4 years. Accelerometers (like the Fit Bit) were uses to assess sedentary time. This is a big change from previous studies which used questionnaires to assess activity levels. Prolonged sedentary time over 12.5 hours daily as well as prolonged bouts of sedentary time were related to increased mortality, especially when people had both findings. Even people who had higher levels of physical activity or fitness were still at significantly higher risk of death. 
  • Background:  Excessive sedentary time is ubiquitous in Western societies. Previous studies have relied on self-reporting to evaluate the total volume of sedentary time as a prognostic risk factor for mortality and have not examined whether the manner in which sedentary time is accrued (in short or long bouts) carries prognostic relevance.
  • Objective: To examine the association between objectively measured sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality. 
  • Design: Prospective cohort study.
  • Setting: Contiguous United States.
  • Participants: 7985 black and white adults aged 45 years or older.
  • Measurements: Sedentary time was measured using a hip-mounted accelerometer. Prolonged, uninterrupted sedentariness was expressed as mean sedentary bout length. Hazard ratios (HRs) were calculated comparing quartiles 2 through 4 to quartile 1 for each exposure (quartile cut points: 689.7, 746.5, and 799.4 min/d for total sedentary time; 7.7, 9.6, and 12.4 min/bout for sedentary bout duration) in models that included moderate to vigorous physical activity.
  • Results: Over a median follow-up of 4.0 years, 340 participants died. In multivariable-adjusted models, greater total sedentary time (HR, 1.22 [95% CI, 0.74 to 2.02]; HR, 1.61 [CI, 0.99 to 2.63]; and HR, 2.63 [CI, 1.60 to 4.30]; P for trend < 0.001) and longer sedentary bout duration (HR, 1.03 [CI, 0.67 to 1.60]; HR, 1.22 [CI, 0.80 to 1.85]; and HR, 1.96 [CI, 1.31 to 2.93]; P for trend < 0.001) were both associated with a higher risk for all-cause mortality. Evaluation of their joint association showed that participants classified as high for both sedentary characteristics (high sedentary time [≥12.5 h/d] and high bout duration [≥10 min/bout]) had the greatest risk for death.
  • Limitation: Participants may not be representative of the general U.S. population.
  • Conclusion: Both the total volume of sedentary time and its accrual in prolonged, uninterrupted bouts are associated with all-cause mortality, suggestive that physical activity guidelines should target reducing and interrupting sedentary time to reduce risk for death.

This well done study shows more definitively what others have found. Using accelerometers rather than surveys the authors found that being sedentary is very dangerous for our health and carries a higher risk of death. People who are sedentary for over 10-12 hours daily are in a big danger zone. Getting a regular bout of exercise helps a bit but doesn't completely reverse the risk. Therefore, for those of us with sedentary jobs, it is very important that we break up our day to avoid prolonged bouts of sitting. Get up and move around every 30 minutes. Walk over to talk to a colleague instead of sending an email. Use the stairs to go between floors. Park farther away. Consider standing while doing some activities such as phone calls, anything to get moving and break up the length of the periods you are inactive. If you are sedentary at work, it is even more important to be more active in your leisure hours. If you need more reasons, remember that long work hours increases your risk of atrial fibrillation and watching TV increases visceral fat.  

Stones and Groans
Reducing kidney stones through lifestyle choices

Anyone who has had a kidney stone will tell you it was one of the worst episodes of pain they have ever had. What if we could reduce the risk of stones by over 50% through lifestyle changes? This study, from the Journal of Urology, found that to be the case. The study evaluated 192,126 people and found that 5 lifestyle factors could reduce the incident of kidney stones by half. 

  • PURPOSE:  Several dietary and lifestyle factors are associated with a higher risk of kidney stones. We estimated the population attributable fraction and the number needed to prevent for modifiable risk factors, including body mass index, fluid intake, DASH (Dietary Approaches to Stop Hypertension) style diet, dietary calcium intake and sugar sweetened beverage intake.  
  • MATERIALS AND METHODS: We used data on the HPFS (Health Professionals Follow-Up Study) cohort and the NHS (Nurses' Health Study) I and II cohorts. Information was obtained from validated questionnaires. Poisson regression models adjusted for potential confounders were used to estimate the association of each risk factor with the development of incident kidney stones and calculate the population attributable fraction and the number needed to prevent. 
  • RESULTS: The study included 192,126 participants who contributed a total of 3,259,313 person-years of followup, during which an incident kidney stone developed in 6,449 participants. All modifiable risk factors were independently associated with incident stones in each cohort. The population attributable fraction ranged from 4.4% for a higher intake of sugar sweetened beverages to 26.0% for a lower fluid intake. The population attributable fraction for all 5 risk factors combined was 57.0% in HPFS, 55.2% in NHS I and 55.1% in NHS II. The number needed to prevent during 10 years ranged from 67 for lower fluid intake to 556 for lower dietary calcium intake.
  • CONCLUSIONS: Five modifiable risk factors accounted for more than 50% of incident kidney stones in 3 large prospective cohorts. Assuming a causal relation, our estimates suggest that preventive measures aimed at reducing those factors could substantially decrease the burden of kidney stones in the general population.
Five factors were found to reduce the risk of kidney stones by 50%.
  • Drink 2 liters of water daily 
  • Maintain a healthy weight (BMI < 25)
  • Eat the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in vegetables, fruits, and low-fat dairy, and low in salt and animal protein
  • Eat a diet rich in calcium (> 1200 mg daily)
  • Avoid sugar sweetened beverages such as soda, punch and juices
The most important factor was the water intake. A good way to get this is to drink a large glass of water upon awakening and before each meal. I recommend getting calcium sources from foods (dairy and green, leafy vegetables) whenever possible. The fructose in many fruit juices has been found to be problematic for many people and nothing good comes from eating sugar. If you have ever had a kidney stone, you will be happy to follow these recommendations. If you haven't had one, drinking plenty of water is still a good idea. Trust me, you don't want to experience a kidney stone.  
Runners High
Small doses of exercise guards against depression
As little as one hour a week of low-intensity exercise may be enough to prevent depression. Those who didn't exercise at all had a 44% increased risk of developing depression compared to those who exercised 1-2 hours weekly. The positive effect of the exercise was seen regardless of exercise intensity and there were no differences in effect between sexes or age groups. 


  • Objective: The purpose of the present study was to address 1) whether exercise provides protection against new-onset depression and anxiety and 2) if so, the intensity and amount of exercise required to gain protection and, lastly, 3) the mechanisms that underlie any association.
  • Method:A "healthy" cohort of 33,908 adults, selected on the basis of having no symptoms of common mental disorder or limiting physical health conditions, was prospectively followed for 11 years. Validated measures of exercise, depression, anxiety, and a range of potential confounding and mediating factors were collected.
  • Results: Undertaking regular leisure-time exercise was associated with reduced incidence of future depression but not anxiety. The majority of this protective effect occurred at low levels of exercise and was observed regardless of intensity. After adjustment for confounders, the population attributable fraction suggests that, assuming the relationship is causal, 12% of future cases of depression could have been prevented if all participants had engaged in at least 1 hour of physical activity each week. The social and physical health benefits of exercise explained a small proportion of the protective effect. Previously proposed biological mechanisms, such as alterations in parasympathetic vagal tone, did not appear to have a role in explaining the protection against depression.
  • Conclusions: Regular leisure-time exercise of any intensity provides protection against future depression but not anxiety. Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.


Depression is the leading cause of disability worldwide. In the US, over 16 million people (6.9%) of the population live with major depression. The numbers are higher for milder forms of depression. This study shows that a simple, inexpensive intervention could potentially reduce the incidence of depression by up to 44%. Doing 1 hour of low level exercise weekly reduces the risk of depression significantly. This could be especially beneficial for our young people. A simple 15 minute walk daily is more than enough. If you know someone who is feeling down, invite them out for a walk. It could be the best thing for them. 


Exercise and the Prevention of Depression: Results of the HUNT Cohort Study. Am J Psych Published online: October 03, 2017 .
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.