September Newsletter
In This Issue
Fish Oil vs Anxiety
Heart-Red Meat Link
A Better Model of Medical Care
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. This has really been an exciting week with the Brewers qualifying for the post season and catching the Cubs!. Watching this team all year has been a blast. We have a great bunch of guys to cheer for and I'm looking forward to October baseball in Milwaukee again!

October 1st is the 10-year anniversary of the opening of my practice. It's hard to believe it has been that long. In 2008 I started my practice with the vision to offer a different type of medical experience, one that is individualized, attentive and caring. Where you are a person not a number, and the goal is to give you excellent care, rather than pinging you through the system. I thank all of you for joining me on this journey. I am also thankful for Colleen Klink. She has been with me since the beginning and stuck with me through thick and thin (and it was pretty thin at the start). I'm not sure where I would be without her. Thank you Colleen!

Anxiety is a very common problem today and the incidence seems to be rising. We live in a stressful world and it often seems impossible to keep up. Exercise is a great tool to help with anxiety symptoms. While we have several medications that can be used for anxiety, many people would like to avoid prescription medications. The first article looks at a simple, safe supplement which may be beneficial in helping to control anxiety symptoms. 

We worry about screen time for our kids. Medical societies tell us to ask parents about their children's screen time and to set limits. But what about parental screen time? Could too much parental screen time be detrimental to a child's development and behavior? The second article explores "technoference" with our children. 

Red meat has been deemed by many to be the enemy of heart health. The juicy steak is clogging your arteries, right? Yet some people eat red meat and seem to have no ill effects. Why is this? The third study looks at a possible link to explain why red meat may affect the coronary arteries of different people in different ways. 

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Fish Oil vs Anxiety 
Omega-3 polyunsaturated fatty acids reduce anxiety
fish oil
Anxiety has a lifetime prevalence of 1 in 3 people, so many of us will experience symptoms of anxiety at some point in our lives. There are medications for this but they often come with significant side-effects. This systematic review looked at the association between symptoms of anxiety and intake of omega-3 polyunsaturated fatty acids (PUFA). Nineteen studies were included in the analysis with 1203 adults treated with omega-3 PUFAs (intervention) and 1037 adults not treated. An association was observed between omega-3 PUFA use and a decrease in anxiety symptoms. 
  • Importance: No systematic review or meta-analysis has assessed the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) for anxiety.
  • Objective: To evaluate the association of anxiety symptoms with omega-3 PUFA treatment compared with controls in varied populations.
  • Data Sources: PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and databases were searched up to March 4, 2018.
  • Study Selection: A search was performed of clinical trials assessing the anxiolytic effect of omega-3 PUFAs in humans, in either placebo-controlled or non-placebo-controlled designs. Of 104 selected articles, 19 entered the final data extraction stage.
  • Data Extraction and Measures: Two authors independently extracted the data according to a predetermined list of interests. A random-effects model meta-analysis was performed and this study was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
  • Main Outcomes and Measures: Changes in the severity of anxiety symptoms after omega-3 PUFA treatment.
  • Results: In total, 1203 participants with omega-3 PUFA treatment (mean age, 43.7 years; mean female proportion, 55.0%; mean omega-3 PUFA dosage, 1605.7 mg/d) and 1037 participants without omega-3 PUFA treatment (mean age, 40.6 years; mean female proportion, 55.0%) showed an association between clinical anxiety symptoms among participants with omega-3 PUFA treatment compared with control arms (Hedges g, 0.374; 95% CI 0.081-0.666; P = .01). Subgroup analysis showed that the association of treatment with reduced anxiety symptoms was significantly greater in subgroups with specific clinical diagnoses than in subgroups without clinical conditions. The anxiolytic effect of omega-3 PUFAs was significantly better than that of controls only in subgroups with a higher dosage (at least 2000 mg/d) and not in subgroups with a lower dosage (<2000 mg/d).
  • Conclusions and Relevance: This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. Further well-designed studies are needed in populations in whom anxiety is the main symptom.  

Anxiety is a very common condition and is associated with lower quality of life. Treatment includes psychotherapy and medications. However, many of the medications prescribed for anxiety can have significant side-effects making people resistant to using them. The omega-3 polyunsaturated fatty acids (PUFAs) found in fish oil include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These PUFAs, especially EPA have been shown to be helpful in depression. This study found that the PUFAs worked better than placebo in treating anxiety disorders and didn't suggest that EPA was more important than DHA. The dose of fish oil which had the most benefit was 2000 mg or more of EPA + DHA. When looking at fish oil capsules, look at the label for the amount of EPA and DHA. Take the number of capsules to get you above 2000 mg of EPA/DHA, typically 3-4 capsules. I recommend that you use a high quality fish oil (avoid the bargain mega containers) and be sure not to use outdated fish oil as this can actually be inflammatory. If you would like specific recommendations let me know. 

Excessive use of technology by parents may affect children

This study surveyed 183 couples with a child aged 0-5 yrs to understand the association between excessive technology use by parents and child behavior. They found that parents stressed by their child's behavior may use technology to withdraw from parent-child interactions (technoference). This behavior resulted in more acting out by children. 

  • BACKGROUND AND OBJECTIVES:  Heavy parent digital technology use has been associated with suboptimal parent-child interactions and internalizing/externalizing child behavior, but directionality of associations is unclear. This study aims to investigate longitudinal bidirectional associations between parent technology use and child behavior, and understand whether this is mediated by parenting stress.
  • METHODS: Participants included 183 couples with a young child (age 0-5 years, mean = 3.0 years) who completed surveys at baseline, 1, 3 and 6 months. Cross-lagged structural equation models of parent technology interference during parent-child activities, parenting stress, and child externalizing and internalizing behavior were tested.
  • RESULTS:  Controlling for potential confounders, we found that across all time points (1) greater child externalizing behavior predicted greater technology interference, via greater parenting stress; and (2) technology interference often predicted greater externalizing behavior. Although associations between child internalizing behavior and technology interference were relatively weaker, bidirectional associations were more consistent for child withdrawal behaviors.
  • CONCLUSIONS: Our results suggest bidirectional dynamics in which (a) parents, stressed by their child's difficult behavior, may then withdraw from parent-child interactions with technology and (b) this higher technology use during parent-child interactions may influence externalizing and withdrawal behaviors over time.
We often worry about how the use of technology is affecting our children. Are video games causing the increase in attention deficit disorder (ADD)? Are "educational" apps and games actually educational? Can our children wait more than 2 minutes without watching or playing with a screen? Can we? This study took a different approach and looked at parental use of technology. They found that higher use of technology by parents led to more externalizing (acting out) behavior by children and this seemed to be mediated by parental stress levels. This is a bit of a chicken and egg problem. More acting out by children led to more parental stress and withdrawal to technology which led to even more acting out. Every parent has times where their children drive them a bit crazy. However, as parents, we need to be aware of times we may be using technology as an escape from difficult parenting duties. The cost may be more problems down the road.  
Heart-Red Meat Link
Allergen in red meat may be tied to heart disease
This is a very interesting preliminary study which looked at levels of immunoglobulins in people undergoing cardiac catheterization. The researchers found that 26% of these people had antibodies to α-Gal, which indicates a sensitivity to red meat. The people with this sensitivity had 30% higher levels of arterial plaque versus non-sensitized people. These plaques also tended to be more structurally unstable, which increases the likelihood of heart attack and stroke. The association between α-Gal-specific IgE and plaque remained significant after adjusting for confounding factors including sex, diabetes, hypertension, statin use, and total IgE.


  • Objective:  Emerging evidence suggests a link between coronary artery disease and type 2 immunity. We sought to test the hypothesis that IgE sensitization to the mammalian oligosaccharide galactose-α-1,3-galactose (α-Gal)-the target allergen of delayed anaphylaxis to red meat-is associated with coronary artery disease.
  • Approach and Results: Total IgE and specific IgE to α-Gal were assayed on sera from 118 subjects who presented for cardiac catheterization and underwent intravascular ultrasound. IgE to α-Gal was detected in 26%, and atheroma burden was higher in sensitized subjects (P=0.02). Because α-Gal sensitization relates to an environmental exposure that could be a risk factor for early-onset coronary artery disease (ie, tick bites), we age stratified the cohort. In subjects ≤65 years of age, the strength of the association with atheroma burden was stronger (P<0.001), and plaques in the sensitized group had less stable features based on intravascular ultrasound. To address the specificity of the association with IgE to α-Gal, IgE to inhalants and peanut were assayed and were not associated with coronary artery disease. Total IgE and α-Gal-specific IgE were strongly associated with each other, but the strength of the relationship with atheroma burden was stronger for α-Gal-specific IgE. This association was significant when adjusted for sex, diabetes mellitus, hypertension, statin use, and total IgE (regression coefficient, 12.2; SE, 5.2; P=0.02). 
  • Conclusions: Increased atheroma burden and plaques with more unstable features were associated with IgE to α-Gal-an effect most pronounced in subjects ≤65 years of age. IgE sensitization to α-Gal may represent a novel, and potentially modifiable, risk factor for coronary atherosclerosis.

This is a  preliminary study but I found it quite interesting. Red meat has been vilified as a cause of heart disease for many years. With more people interested in paleo and keto type diets, some people are eating more red meat and many see improvements in their cholesterol levels and levels of inflammation. So this makes one wonder, is it saturated fat that is the culprit? We know that some studies are showing that it may not be. Other studies have shown a link between red meat and cardiovascular disease. This study may provide an answer for some of these questions. Perhaps some of us are actually "allergic" to red meat, which means when we eat red meat we develop more plaque in our arteries and the plaque is more unstable making it more dangerous. This may be why some people have negative consequences to eating red meat while others don't. It will be interesting to see if in the near future we are able to test people to see if they have this sensitivity. 

IgE to the Mammalian Oligosaccharide Galactose-α-1,3-Galactose Is Associated With Increased Atheroma Volume and Plaques With Unstable Characteristics-Brief Report. Arteriosclerosis, Thrombosis, and Vascular Biology. 2018;38:1665-1669.

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. Feel free to pass this on to anyone you think would benefit from this information. 

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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.