Life With Chronic Conditions: Life Style Medicine Works

If you are tired of the “pill for every ill,” you may want to consider the growing movement of Lifestyle medicine.

Lifestyle Medicine is a scientific approach to decreasing disease risk and illness burden by utilizing lifestyle interventions such as nutrition, physical activity, stress reduction, rest, smoking cessation, and avoidance of alcohol abuse. Lifestyle medicine is the recommended foundational approach to preventing and treating many chronic diseases. American College of Preventive Medicine 

Data indicates that 80% of chronic diseases are a result of lifestyle with the big factors being:

• Lack of exercise (people are sitting an average of 9 hours a day)

• Poor nutrition (processed food is high in fact, sugar and salt)

• Lack of rest and restoration-sleep

Research is showing that there are more effective strategies than a pill

• For Chronic Pain, A change in Habits can beat Opioids for Relief.  discusses how a low tech approach focused on lifestyle change can be more effective than opioids when treating chronic pain. In fact the gold standard of treatment is a combination of exercise, rehabilitation therapies, yoga, and cognitive behavioral therapies.

• Harvard Health recently updated their article Nutritional Psychiatry: Your Brain on Food which provides a variety of evidence that eating a diet of highly processed foods and meats significantly increases risk of depression. Many practitioners are embracing that the future of mental health treatment lies in nutrition as well as other lifestyle changes.

• The one study  that has shown a reversal in Alzheimer’s Disease, follows a 36 point program, where many of the steps include lifestyle changes-diet, exercise, sleep etc.

• The Blue Zones Project has been championing lifestyle as a means to improve quality as well as length of life for years . Leveraging secrets discovered in Blue Zones around the world—rare longevity hotspots—Blue Zones Project® is helping transform communities across the U.S. into areas where the healthy choice is easy and people live longer with a higher quality of life.  The Blue Zones research found nine characteristics of communities where people lived to advanced old age- Move naturally (no gym required): a sense of purpose; a plant slant diet; ate until they felt 80% full; drink wine @ fine; Down shift; Family first; Right Tribe; Belong. Interestingly, access to health care wasn’t noted as a characteristic.

In order to make this meaningful for American companies and communities, where Blue Zones Project are offered, the Power Nine have been distilled down to making the healthy choice the easy choice. These including configuring environments so that people move naturally and exercise is built into their day; eating wisely;  connecting with others, “belong to live long;” and having the right outlook using tools such as mindfulness and purpose workshops.

                                              How to Live to be 100+ 

Learn more about Lifestyle Medicine

Successful Balanced and Healthy Lifestyle Program

Center for Lifestyle Medicine and Wellness Care

Your Guide to Living Well with Heart Disease

Journal Watch April 2018

 CHRONIC PAIN

Noninvasive Brain Stimulation May Help Prevent Migraines: Single-pulse transcranial magnetic stimulation device is safe and easy to use. The efficacy and tolerability of single pulse transcranial magnetic stimulation (sTMS) for the preventive treatment of migraine among 263 individuals with migraine (December 2014 to March 2016) was studied. Participants completed a one-month baseline headache diary followed by three months of treatment, including preventive (four pulses twice daily) and acute (three pulses repeated up to three times for each attack) treatment. The researchers observed a mean reduction of 2.75 headache days from baseline versus the performance goal (0.63 fewer headache days; P < 0.0001). Similarly, the 50 percent responder rate of 46 percent also significantly exceeded (P < 0.0001) the performance goal (20 percent). Compared to the performance goal, there were also significant reductions in acute medication use (P < 0.0001) and total headache days of any intensity (P < 0.0001). There were no serious adverse events reported, but there were reports of lightheartedness (3.7 percent), tingling (3.2 percent), and tinnitus (3.2 percent). Cephalalgia. 

Erenumbab Shows Promise for Hard to Treat Migraine: For patients with episodic migraine who have failed prior preventive migraine treatments (PMTs), erenumab is associated with an increase in the proportion of patients achieving a ≥50 percent reduction in mean monthly migraine days (MMDs), according to a study presented at the annual meeting of the American Academy of Neurology

Study finds 31% Don’t use Opioids After Surgery: Almost 63 percent of patients did not use opioids after having an elective procedure, according to a study presented at the annual meeting of the American Surgical Association 

Opiate Use Linked to Early Mortality in IBD Patients: Heavy use in Crohn's, heavy or moderate use in ulcerative colitis tied to increased risk of death. Clinical Gastroenterology and Hepatology 

Ibuprofen, acetaminophen more effective thanopioids in treating dental pain: Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain than opioids, according to new research that included 460 published studies. JOADA

 COMPLEMENTARY & ALTERNATIVE MEDICINE

Medical marijuana gets wary welcome from older adults, poll shows: Few older adults use medical marijuana, a new national poll finds, but the majority support its use if a doctor recommends it, and might talk to their own doctor about it if they developed a serious health condition. And two-thirds say the government should do more to study the drug's health effects. Science Daily 

Position statement: Avoid using medical marijuana to treat sleep apnea: Medical cannabis and synthetic marijuana extracts should not be used for the treatment of obstructive sleep apnea, according to a position statement from the American Academy of Sleep Medicine.

 School-based yoga can help children better manage stress and anxiety: Participating in yoga and mindfulness activities at school helps third-graders exhibiting anxiety improve their well-being and emotional health, according to a new study. Psychology Research and Behavior Management 

Practicing Tai Chi helps improve respiratory function in patients with COPD: Currently, pulmonary rehabilitation (PR) is used where available to improve exercise capacity and quality of life, but the treatment requires access to trained staff and specialized facilities. A new study looked at Tai Chi as a lower cost, more easily accessed treatment option. Investigators found that this slow, methodical form of exercise is equivalent to PR for improving respiratory function in patients with COPD. Chest  

Mind and Body Approaches for Substance Use Disorders from the National Center for Complementary and Integrative Health: Mindfulness-based approaches have shown some success when applied to the treatment of substance abuse and addiction. To date, there is not enough consistent data to support the use of acupuncture for substance use outcomes; however, there are some findings that suggest acupuncture may have positive effects as an adjunctive therapy for withdrawal/craving and anxiety symptoms. Only a few high-quality studies on acupuncture for smoking cessation have been conducted, so firm conclusions about its effectiveness cannot be drawn.

Small link for cannabis use, reduced cognitive functioning: For adolescents and young adults, frequent or heavy cannabis use has a small association with reduced cognitive functioning, according to research published online April 18 in JAMA Psychiatry.

FDA ACTION

• Approves the first medical device to use artificial intelligence to detect greater than a mild level of diabetic retinopathy in adults who have diabetes.

• Authorizes new use of test, first to identify the emerging pathogen Candida auris

• Approves first therapy for rare inherited form of rickets, x-linked hypophosphatemia

• Takes steps to protect consumers against dietary supplements containing dangerously high levels of extremely concentrated or pure caffeine

• Clears first contact lens with light adaptive technology

• Restricts sale and distribution of Essure

• Expands approval of Bilincyto for treatment of a type of leukemia in patients who have a certain risk factor for relapse

• Authorizes first fully interoperable continuous glucose monitoring system

• Expands approval of Adcetris for first line treatment of Stage III or IV classical Hodgkin lymphoma in combination with chemotherapy

PREVENTION

Music intensifies effects of anti-hypertensive medication: Research shows anti-hypertensive drugs improve heart rate more in patients who listen to music after taking medication. Among musical genres, classical music is the one with greatest efficiency at reducing arterial pressure; authors of the study speculate whether music acts on the patients' parasympathetic system, increasing their capability of absorbing medication. Scientific Reports 

Lingering negative responses to stress linked with health a decade later: People whose negative emotional responses to stress carry over to the following day are more likely to report health problems and physical limitations later in life compared with peers who are able to 'let it go.'  Psychological Science

Number of Cigarettes Smoked Daily Tied to Stroke Risk: Among men younger than 50, more cigarettes smoked linked to increased risk of ischemic stroke. Stroke 

Exercise Prevents Falls in Elderly: The U.S. Preventive Services Task Force (USPSTF) concludes that exercise interventions may be beneficial for preventing falls in older adults; however, the evidence is insufficient to weigh the benefits and harms of vitamin D, calcium, and combined supplementation. These findings form the basis of two recommendation statements published April 17 in the Journal of the American Medical Association.

Exercise Best Defense for those at Genetic Risk for CVD: Fitness and physical activity are tied to lower risk of incident cardiovascular disease in the general population and among individuals with elevated genetic risk for cardiovascular diseases, according to a study published online April 9 in Circulation.

TBI Associated with Increased Risk of Subsequent Dementia: Traumatic brain injury (TBI) is associated with increased risk of dementia, according to a study published online April 10 in The Lancet Psychiatry.

NUTRITION/SUPPLEMENTS/VITAMINS

Dietary supplement shows promise for reversing cardiovascular aging:A novel nutraceutical called nicotinomide riboside (NR_ has been found to kick-start the same biological pathways as calorie restriction does, and boost arterial health in people with mild hypertension. Supplementation also tends to improve blood pressure and arterial health, particularly in those with mild hypertension, the study found. The researchers found that 1,000 mg daily of NR boosted levels of another compound called nicotinamide adenine dinucleotide (NAD+) by 60 percent. NAD+ is required for activation of enzymes called sirtuins, which are largely credited with the beneficial effects of calorie restriction. It's involved in a host of metabolic actions throughout the body, but it tends to decline with age.Nature Communications

n-3 Fatty Acids Don't Seem to Be of Any Benefit in Dry Eye Disease: Supplementation with n-3 fatty acids is not associated with significant benefit in dry eye disease, according to a study published online April 13 in the New England Journal of Medicine

Consuming more than five drinks a week could shorten your life: Even moderate alcohol drinking linked to heart and circulatory diseases, study finds. drinking more alcohol is associated with a higher risk of stroke, fatal aneurysm, heart failure and death. The study compared the health and drinking habits of over 600,000 people in 19 countries worldwide and controlled for age, smoking, history of diabetes, level of education and occupation. Findings challenge the widely held belief that moderate drinking is beneficial to cardiovascular health, and support the UK's recently lowered guidelines. The Lancet

Links between eating red meat and distal colon cancer in women: A new study suggests that a diet free from red meat significantly reduces the risk of a type of colon cancer in women living in the United Kingdom. When comparing the effects of certain diets to cancer development in specific subsites of the colon, scientists found that those regularly eating red meat compared to a red meat-free diet had higher rates of distal colon cancer -- cancer found on the descending section of the colon, where feces is stored.  International Journal of Cancer 

People with Type 2 diabetes who eat breakfast later, more likely to have a higher BMI: Being an "evening person" is linked to higher body mass indices among people with Type 2 diabetes, and having breakfast later in the day seems to be what drives this association, according to a new article. Science Daily

High omega-6 levels can protect against premature death: Could omega-6 fatty acids protect you against premature death? The answer is yes, according to a new study. While protecting against death, omega-6 fatty acids also keep cardiovascular diseases at bay. “Linoleic acid is the most common polyunsaturated omega-6 fatty acid. We discovered that the higher the blood linoleic acid level, the smaller the risk of premature death,” says one of the researchers. The American Journal of Clinical Nutrition

Raw fruit and vegetables provide better mental health outcomes: Researchers have discovered raw fruit and vegetables may be better for your mental health than cooked, canned and processed fruit and vegetables. Frontiers in Psychology

Nut Consumption Associated with Reduced Risk of A-Fib: Nut consumption is associated with reduced risk of atrial fibrillation, according to a study published online April 16 in Heart.

Eating Pecans May Cut Risk of Cardiovascular Disease, Diabetes: Benefits seen in markers of cardiometabolic disease, including insulin sensitivity Nutrients 

Coffee Consumption Cuts Coronary Artery Calcification: Odds of coronary calcification significantly lower for never smokers drinking more than 3 cups/day. Journal of the American Heart Association

TREATMENT

Antiepileptic Drugs Increase Risk ofAlzheimer’s Disease, Dementia: The use of antiepileptic drugs is associated with an increased risk of Alzheimer’s disease and dementia, according to a study published in the Journal of the American Geriatrics Society. Continuous use of antiepileptic drugs for a period exceeding 1 year was associated with a 15% increased risk of Alzheimer’s disease and with a 30% increased risk of dementia.

Blue-Light Therapy May Reduce Anxiety, Sleep Difficulties After Mild Traumatic Brain Injury: Morning use of blue-light therapy may increase cortical volume and help reduce trait anxiety and sleep difficulties in people with mild traumatic brain injury, according to preliminary findings of a prospective study presented at the 38th Annual Meeting of the Anxiety and Depression Association of America (ADAA).

Adjuvant Pembrolizumab Beneficial in Stage III Melanoma:

Pembrolizumab is associated with significantly longer recurrence-free survival than placebo as adjuvant therapy for high-risk stage III melanoma, according to a study published online April 15 in the New England Journal of Medicine. Fecal microbiota transplantation produces sustained improvements in cognitive and clinical outcomes: A single treatment using an optimized, targeted form of fecal microbiota transplantation (FMT) produces sustained clinical and cognitive improvements, according to the results of a long-term follow-up of patients with liver cirrhosis and hepatic encephalopathy (HE) who had participated in a short-term study. The original, randomized, open label study, which enrolled 20 outpatient men with cirrhosis and recurrent HE receiving standard-of-care (SOC) treatment, had previously reported that a single FMT enema after antibiotic pretreatment improved cognitive function at Day 20 and reduced HE episodes and hospitalizations over the following 5 months compared with SOC.1 The long-term outcomes of this study, which were presented today at The International Liver Congress™ 2018 in Paris, France, demonstrated sustained and statistically significant reductions in the number of HE episodes and hospitalizations as well as improvements in cognitive function over 1 year in the men who received FMT compared with the control group.

Neuromodulation Therapy Gives Relief FromHand Tremor: Non-invasive neuromodulation therapy using a custom stimulation pattern provides symptomatic relief from hand tremor in essential tremor, according to a study presented at the annual meeting of the American Academy of Neurology

Triple Therapy Tied to Reduced Rate of COPD Exacerbations: Benefits seen for triple therapy with fluticasone furoate, umeclidinium, and vilanterol. NEJM 

Calcium Channel Blockers May up Cancer Risk in Women: Use of short-acting calcium channel blockers (CCBs) is associated with increased risk of pancreatic cancer in postmenopausal women, according to a study presented at the annual meeting of the American Association for Cancer Research.

OTHER

Physicians devise emergency and trauma care referral map for US: In response to repeated calls for an integrated emergency care system in the US, physicians rose to the challenge and divided the nation into hundreds of referral regions that describe how patients access advanced care, in a way that respects geopolitical borders. Annals of Emergency Medicine 

Three-Quarters of COPD Cases Are Linked to Childhood Risk Factors That Are Exacerbated in Adulthood: Three-quarters of chronic obstructive pulmonary disease (COPD) cases have their origins in poor lung function pathways beginning in childhood. These pathways are associated with exposures in childhood, and amplified by factors in adulthood, according to a study published in The Lancet Respiratory Medicine. While smoking remains the biggest risk factor for COPD, the study demonstrates that childhood illnesses (such as asthma, bronchitis, pneumonia, allergic rhinitis, eczema) and exposures to parental smoking are also linked to the disease. A second study in the journal also suggests that there could be a window of opportunity during childhood to reduce the risk of poor lung function in later life. Both studies identified pathways of how lung function changes over life, which are associated with different risk factors and disease risk in later life. The authors said that these insights are important for lung disease prediction, prevention, and treatment. 

Most Doctors' Offices Don't Offer Flexibility for Uninsured:Most uninsured patients can make primary care appointment but only if can pay full cash amount. Health Affairs 

Age affects how we predict and respond to stress at home: A recent study finds that older adults are better than younger adults at anticipating stressful events at home -- but older adults are not as good at using those predictions to reduce the adverse impacts of the stress. The Journals of Gerontology

Take a Break: Try Morris Dancing

It’s so un spring in Vermont, with snow, sleet, freezing rain and driving wind. Yuck! May Day is just two weeks away, so I’m trying to think warm, sunny thoughts.

Have a number of friends that are/were Morris dancers, which is a May Day tradition in certain parts of the world. When I lived near D.C. it was great fun to go out and follow the local Morris team through Georgetown stopping at various bars along the way. Now living in Vermont, there is the Marlboro Morris Ale.

The earliest reference of Morris dancing comes from about 1448. By the early 16^th century Morris dancing was already a fixture at Church festivals. In medieval and Renaissance England, the churches brewed and sold ales, including wassail. These ales were sold for many occasions, both seasonal and sacramental - there were christening ales, bride's ales, clerk, wake and Whitsun ales - and were an important means of fund-raising for churches. Hence the reason the big Morris dancing gathering in Vermont is called the Marlboro Ale. Learn more about the history of Morris dancing.

As you’ll see from the videos below there are lots of ways to perform Morris dancing. Flying ribbons, jangling bells, flashing hankies, banging sticks, swords, clogs and rapper all make up different styles of Morris dancing. They are generally accompanied by live musicians playing drums, pipes accordion and sometimes fiddles.

Well watch this video to not only learn the history but also to learn the basic steps:

Not interested in today’s activities, try the Take a Break Pinterest Board.

Take a Break: Make May Baskets

May 1^st is several weeks a way so there is time to work on this.

May Day is an ancient traditional spring holiday in many cultures, celebrated with singing, dancing, May poles, Morris dancing, special foods, bonfires and yes, May Baskets. These are small baskets, filled with flowers and/or treats, that are hung on the door of someone’s house, or apartment, and the giver rings the bell and runs away.

Making a paper cone basket

•  Download a paper cone pattern and use as a template to cut out cones from card stock

• Because the card stock can be stiff, staple the top and then glue the seam.

• Staple ribbon for the handles.

• Glue buttons, ribbons, paper scraps or whatever appeals to you to cover the staples and to create a nice rim around the cone

• Put a few treats in the bottom to plug the hole-Hershey Kisses work well-and then add flowers, balloons or whatever you like. Make your own flowers from tissue paper or card stock. While real flowers are the prettiest, if using them, wrap the stems in a moist towel and then plastic wrap.

For real flowers

• Clean a tin can (soup, coffee, vegetable)

• Decorate the can if you choose

• Punch holes in the sides for the ribbon handle

• Add flowers and water

Not interested in today’s activities, try the Take a Break Pinterest Board.

National Save Money on Your Meds Week!

Consumer Reports has named April 7-14 as National Save Money on Your Meds Week. Check the following articles to learn how to do this.

"Gag Clauses" Stop you from Getting the Lowest Rx Prices from Consumer Reports

 Life with chronic Conditions: I can’t afford my Meds

Life With Chronic Conditions: Pampering is a good thing

For those affected by chronic conditions, anxiety and stress are commonplace. One of the ways to relieve it is to pamper your self-indulge in kindness and care. And no, it doesn’t have to require spending money or getting in the car to drive somewhere. Keep in mind though it doesn’t include doing something that isn’t healthy for you-e.g. only eating cake for lunch when you are on a restricted diet. I should also note that pampering isn’t the domain of females. Everyone deserves and needs it.

• Linger over a cup of tea, coffee, or another beverage you would enjoy. Sit where it’s comfortable and restful, savoring the experience.

• Call a friend to talk and catch up. Better yet have tea with a friend

• Soak in a bath or hot tub. Depending on your preference, pair it with a good book, candles, and/or aromatherapy

• Give yourself a manicure and/or pedicure. If you can afford to have this done, all the better. Lots of guys get these done and I know musicians that rely on regular manicures to keep their hands in good shape.

• Try restorative yoga, deep breathing and/or meditation

• Get a massage. Look for deals as many spas run them during off hours. Not comfortable with a full body massage, just get one for your feet or shoulders.

• While it could be fun to book yourself into a fancy hotel, order room service, watch a movie and enjoy a spa bath, you can do all these things at home. You can order take out or just pick up simple items from the made to order section of your grocery store

• Buy a special plant or flowers and put them somewhere they can be enjoyed.

• Take a workshop to learn something new, e.g calligraphy. Depending on what it is, you can try on-line tutorials but you’ll need to set up uninterrupted time to work on it

• Try Five Ways to Relax

Take a Break: Try a New Recipe

When was the last time you made something completely new to eat? Chances are it’s been a while as it’s easy to get into a rut. With spring produce just starting to show up in stores, now is the time to look at new recipes. While you can certainly revisit favorite cookbooks, consider some of these websites:

•Smitten Kitchen: This is my favorite and recommend joining her facebook page.

• Blue Zones Recipes: If you want to try something that people eat to live to be 100, this is a good place to start. Recipes are very tasty from the ones I’ve tried.

• Food Network: If you like to watch chefs making food, this is a good place to start.

• Giadzy : Easy Italian

• 2017 Saveur Best Blogs Award: This includes food, drink as well as travel

Not interested in today’s activities, try the Take a Break Pinterest Board.