October Newsletter
October, 2021
Welcome to the October newsletter. This newsletter aims to provide information and analysis of timely topics from recent articles published in the medical literature. I hope you find this information useful and helpful in your health journey. If you have comments or questions, please let us know!

Thankfully, here in Wisconsin, our Delta surge looks to be going in the right direction. It has taken a bit longer than I expected based on curves in other countries but all signs are positive at this time. Since last month there has been the expanded approval of a third dose of the Moderna vaccine 6 months after the second dose. The recommendations for the Moderna 3rd vaccination are the same as the Pfizer vaccine; if you are 65 or older, have an underlying medical condition, are 18+ living in long-term care settings, or working in high-risk settings.

A second dose of any of the three available vaccines is recommended for those who received the Janssen/J&J vaccine two months after the initial vaccination.

Should people who had the virus get a second or third dose of vaccine? We don't know for sure but the idea of "hybrid" immunity looks to be excellent. Our memory B cells are able to produce high levels of antibodies if we see it again and these memory B cells will produce antibodies adapted against the variants! Memory B cells are like blueprints for making antibodies but can be modified on the fly. Additionally, as I mentioned previously, exposure to the virus generated T-cell memory even without a detectable viral infection. This makes an argument for living as normally as possible. At this time I am not recommending third doses for people who have normal immune systems and previously had the virus. As we move forward, the combination of vaccination, previous infection, and hybrid immunity will be our way out of the pandemic. Based on the long-term immunity findings outlined above, I don't see the need for continual boosters moving forward.

For most people, vaccines provide excellent protection against severe illness and death. I will not be able to give Moderna boosters to people who got their primary series at my office. The state requirements for the minimum number of vaccines that need to be ordered are too high for my small office to handle. I would be happy to assist you in finding sites giving Moderna boosters when available and you can monitor locations at https://www.vaccines.gov/search/. If you have questions regarding the vaccinations, please let me know.

I have gotten a lot of questions about vaccinating teens and children. The Pfizer vaccine was approved today for children ages 5-11 and the vaccination program will begin next week. For people who are considering vaccinating their children, I would recommend waiting longer than recommended between doses (11-12 weeks) rather than 3 weeks as this could boost antibody responses after the second inoculation more than threefold (shown in those older than 80, so children would likely have an even more robust response).

I am happy to announce that I have secured access to one of the newest diagnostic tests available. The Galleri test is a blood test that can detect over 50 types of cancer before they are apparent through regular screening testing (and many cancers don't have a screening test). The test detects methylation patterns of cell-free DNA which can indicate cancer and thus has the potential to detect cancers at the earliest stages. If you are interested in learning more about this test please let us know. I'm constantly on the lookout for cutting-edge tests and procedures for my patients and I have a few more things on the horizon that I am evaluating.
Does Diet Coke Keep You Fat?
Artificial or nonnutritive sweeteners are consumed by over 40% of US adults as an alternative way to enjoy the taste of sugary drinks but avoid the calories of sugar. But are they good for weight loss? How do these nonnutritive sweeteners affect our appetite, glucose metabolism, and most importantly, our weight? Most of the existing studies were done on non-obese men. How do these artificial sweeteners affect people who are obese? Are the effects different for women? Do these groups respond differently to these sweeteners? How do these effects compare to drinking sugary drinks?

Do Statins Cause Dementia?
Cognitive decline is a major concern of aging and affects over 10% of people over age 60. Atorvastatin (Lipitor) is the most prescribed medication in the United States and statin medications have been established as the “standard of care” for cardiovascular diseases. In 2012 the FDA released a statement that there were cases of short-term cognitive impairment with statin therapy; however, the cardiovascular benefits outweighed this risk, so patients were instructed to continue their medication. Further systemic reviews studies found either no effect or beneficial effect. What do we make of this? We have the combination of a very commonly prescribed medication and a possible side-effect that could contribute to the problem of cognitive health which is the top concern of most of us as we age. This study provides some guidance to help us decide what is the best option. 

statin drugs
How Many Steps Are Enough?
We have all heard about the 10,000 steps daily goal and although it is not an official recommendation from the CDC, they do recommend 150 minutes of moderate activity weekly. But I tend to have an interest in the MED (minimum effective dose) which is the smallest amount of an input is required to achieve the desired outcome. How much (or little) does one need to walk to reduce mortality over time? Is more better? Will it get me in shape? 

To Your Health...
Thank you for taking the time to read through this newsletter. We hope you have found this information useful. Feel free to pass this on to anyone you think would benefit from this newsletter.

Mark Niedfeldt, M.D.

Old-fashioned medicine with 21st Century convenience and technology