brown stacked logo

September Newsletter
In This Issue
Water For Weight Loss
The Best Workout?
First Do No Harm
A New 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. It definitely feels like fall today, but we sure had a nice run. I am hoping we can squeeze a few more gorgeous days out in October. I still have a lot of outdoor activities I am taking part in. Best of luck to all of you running Fall marathons and century rides, I hope you have great weather and tailwinds!


The first article this month looks at a simple technique that could help you lose that stubborn 10 lbs you have been carrying around. Best of all, it costs nothing! 


I'm often asked about the best type of exercise. My answer is generally, the one that you enjoy and will keep doing. The second study looks at high intensity interval training (HIIT) which has more and more studies showing that it may be the best type of exercise for many of us. Check out the article and links at the end for more information. 


One of the tenants we learn in medical school is the idea of "first do no harm". Unfortunately, treatments can sometimes cause harm. The third study finds that what we physicians prescribe, may be the biggest threat to the elderly. It certainly bears consideration prior to reaching for a prescription. 


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

Water For Weight Loss
Drinking water before meals aids weight loss
Simple easy ways to help with weight loss are not easy to find. This study, from the journal Obesity, found that drinking 500 mL (a little over 16 oz) of water 30 minutes prior to a meal resulted in a 2.4 kg (approx 5 lbs) weight loss over 12 weeks. Doing this three times daily resulted in more loss, 4.5 kg (10 lbs) over the same time period. 
Summary of findings:
  • OBJECTIVE: To investigate the efficacy of water preloading before meals as a weight loss strategy for adults with obesity.
  • METHODS: A two-group randomized controlled trial was conducted in Birmingham, England. Eighty-four adults with obesity were recruited from general practices. All participants were given a face-to-face weight management consultation at baseline (30 min) and a follow-up telephone consultation at 2 weeks (10 min). At baseline, participants were randomized to either drinking 500 ml of water 30 min before their main meals or an attention control group where participants were asked to imagine their stomach was full before meals. The primary outcome was weight change at 12-week follow-up. Several measures of adherence were also used, including 24 h total urine collections.
  • RESULTS: 41 participants were randomized to the intervention group and 43 to the comparator group. The water preloading group lost -1.3 kg (95% CI -2.4 to -0.1, P = 0.028) more than comparators at follow up. Adjusting for ethnicity, deprivation, age, and gender resulted in the intervention group losing -1.2 kg 95% CI -2.4 to 0.07, P = 0.063) more than the comparator.
  • CONCLUSIONS: There is preliminary evidence that water preloading before main meals leads to a moderate weight loss at follow up.

This is a preliminary study of 41 people and looking at the effect of drinking water prior to meals. The findings are really pretty remarkable. This simple, safe, and cheap method resulted in an additional 10 lbs of weight loss over 3 months! Perhaps adding some fiber to the water (Metamucil, oat bran, ground flax seed, or similar) would even enhance this more as fiber tends to increase the feeling of fullness. So if you are trying to drop a few pounds or even maintain, drinking a big glass of water may be a nice strategy. 

The Best Workout?
Short bouts of high-intensity exercise may be best for some

What type of exercise is best? This study, published in Diabetologia, looked at shorter bouts of high-intensity 
exercise for type 2 diabetics to see if it would be beneficial. Findings showed that compared to controls, those participating in this type of exercise had improvement in cardiac structure and function greater reduction in liver fat. 

Summary of findings      
  • Aims/hypothesis:  Cardiac disease remains the leading cause of mortality in type 2 diabetes, yet few strategies to target cardiac dysfunction have been developed. This randomised controlled trial aimed to investigate high intensity intermittent training (HIIT) as a potential therapy to improve cardiac structure and function in type 2 diabetes. The impact of HIIT on liver fat and metabolic control was also investigated. 
  • Methods:  Using an online random allocation sequence, 28 patients with type 2 diabetes (metformin and diet controlled) were randomised to 12 weeks of HIIT (n = 14) or standard care ( n = 14). Cardiac structure and function were measured by 3.0 T MRI and tagging. Liver fat was determined by 1H-magnetic resonance spectroscopy and glucose control by an OGTT. MRI analysis was performed by an observer blinded to group allocation. All study procedures took place in Newcastle upon Tyne, UK.
  • Results:  Five patients did not complete the study and were therefore excluded from analysis: this left 12 HIIT and 11 control patients for the intention-to-treat analysis. Compared with controls, HIIT improved cardiac structure (left ventricular wall mass 104+/-17 g to 116+/-20 g vs 107+/-25 g to 105+/-25 g, p < 0.05) and systolic function (stroke volume 76+/-16 ml to 87+/-19 ml vs 79+/-14 ml to 75 +/-5 ml, p < 0.01). Early diastolic filling rates increased (241+/-84 ml/s to 299+/-89 ml/s vs 250+/-44 ml/s to 251+/-47 ml/s, p < 0.05) and peak torsion decreased in the treatment group. Following HIIT, there was a 39% relative reduction in liver fat and a reduction in HbA1c (7.1% to 6.8% vs 7.2% to 7.4%). Changes in liver fat correlated with changes in HbA1c and 2 h glucose. No adverse events were recorded.
  • Conclusions/interpretation:  This is the first study to demonstrate improvements in cardiac structure and function, along with the greatest reduction in liver fat, to be recorded following an exercise intervention in type 2 diabetes. HIIT should be considered by clinical care teams as a therapy to improve cardiometabolic risk in patients with type 2 diabetes. .

This study examined short bouts of intense exercise, often known as HIIT to see if it was a good type of exercise for diabetics and certainly found that it is a viable type of exercise. I do like this as it is shorter duration (good for busy people) and yet is intense. This study add to the many studies showing this form of exercise is a great way for people to achieve fitness goals, even if there is a chronic disease like diabetes present. This type of exercise is certainly much more intense than just walking, but you can do it for a shorter period of time so it is a favorite of mine. Typically, a series of exercises (often body weight) are done for 20-45 second followed by a 10-20 second recovery period between sets. You must move directly from one exercise to the next which really keeps your heart rate up. For more information on HIIT, check out these links.

First Do No Harm...
Treatment, not errors are biggest risk to elderly older walkers
Treatments prescribed in primary care may be a bigger risk to elderly than treatment errors or negligence. The study, published in Annals of Family Medicine used data from New Zealand which has a no-fault system and found that medication injuries were the main source of all treatment injuries among the elderly, with antibiotics posing the highest risk.  
Summary of findings:   
  • New Zealand's treatment injury compensation claims data set provides an uncommon no-fault perspective of patient safety incidents.
  • Analysis of primary care claims data confirmed medication as the leading threat to the safety of older patients in primary care and drew particular attention to the threat posed by antibiotics. 
  • For most injuries there was no suggestion of error. 
  • The no-fault perspective reveals the greatest threat to the safety of older patients in primary care to be, not error, but the risk posed by treatment itself. 
  • To improve patients' safety, in addition to reducing error, clinicians need to reduce patients' exposure to treatment risk, where appropriate.            
The Hippocratic Oath states, 'First, do no harm". This study shows that these may be very wise words. The researchers used data from New Zealand and found that 34% of all treatment injuries were due to medications, and that of these, 51% were due to antibiotics. The next highest group was the anti-inflammatories such as ibuprofen at 9% and angiotensin-converting enzyme inhibitors such as lisinopril at 9%. Antibiotics were also most likely to cause serious injuries for patients over 65 at 39% of all injuries. Elderly people are likely to be more vulnerable since they often take multiple medications and there may be interactions. This brings into focus the idea that medications and especially antibiotics are not benign and can often cause harm.   
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. 


Want to lose weight? Drink your water. Maybe add some fiber. 'Nuff said. 


If you haven't tried HIIT, give it a try. I really enjoy the workouts. Intense but compact. Great for busy people. 


This article really hit me. It's important to be sure that ANY medication we are giving to elderly patients is truly necessary, especially the antibiotics. 


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.