Saturday, January 20, 2024

Journal Watch January 2024



 

COVID-19 

Monoclonal Antibodies: A New Treatment for Long COVID?: The study, published in the American Journal of Emergency Medicine, found three Florida patients with long COVID made complete — and sudden — recoveries after they were given the monoclonal antibody cocktail casirivimab/imdevimab (Regeneron).

 

Long COVID: New Info on Who Is Most Likely to Get It: People with a  history of asthma, eczema, or allergies; Signs of autonomic nervous system dysfunction; Preexisting immune system issues; Chronic infections; Diabetes; Being slightly overweight; A preexisting history of anxiety or depression Joint hypermobility (being "double-jointed" with pain and other symptoms); and women are among those who appear more vulnerable to developing long COVID, said doctors who specialize in treating the condition. While patients who become severely sick and require hospitalization have a higher risk of developing long COVID, this group size is small compared with the much larger number of people infected overall. As a result, despite the lower risk, those who only become mild to moderately sick make up the vast majority of patients in long COVID clinics. Medscape 

 

Fall 2023 vaccines are effective: Newest data on fall vaccines shows they are 70% effectiveness against hospitalization (preprint; Netherlands; among 60+ year-olds previously vaccinated). Another study found significant added protection for (at least) 30 days against emergency department use, outpatient use, and hospitalization. (Kaiser; among those over 18 years.)

 

Fall vaccines help protect against long Covid: A recent study showed that the more vaccines you get, the less likely you will get long covid. This is called a dose-response relationship: One dose of vaccine reduces risk by 21%, 2 doses reduce by 59%, and 3+ doses reduce by 73%.

 

Transmission Takes Hours: Transmission increased linearly by 1% chance per hour. Most transmission resulted from exposures lasting one hour to several days. Households accounted for 6% of contacts but 40% of transmissions.

 


PAIN

Two types of CBT are equally effective in the treatment of fibromyalgia: There does not appear to be any profound differences between so-called exposure-based CBT (cognitive behavioral therapy) and traditional CBT in the treatment of fibromyalgia. Both forms of treatment produced a significant reduction in symptoms in people affected by the disease. Pain 

 

Scientists use high-tech brain stimulation to make people more hypnotizable: In the new study in Nature Mental Health, the researchers found that less than two minutes of electrical stimulation targeting a precise area of the brain could boost participants' hypnotizability for about one hour. "We know hypnosis is an effective treatment for many different symptoms and disorders, in particular pain.” Nature Mental HealthTrusted Source

 

Early Menopause, Hormone Replacement Therapy May Raise Rheumatoid Arthritis Risk: A new study published in RMD Open reports that early menopause (before the age of 45), hormone replacement therapy (HRT), and having at least four children are among the risk factors associated with a greater risk for developing rheumatoid arthritis.

 

Pain-based weather forecasts could influence actions: For individuals who experience chronic pain, weather can be a significant factor in their day-to-day plans. In a recent study from the University of Georgia, about 70% of respondents said they would alter their behavior based on weather-based pain forecasts. The study surveyed more than 4,600 individuals, and among migraine sufferers, 89% identified weather as something that impacts their pain level, and 79% saw weather as a trigger for pain. Among individuals with other conditions, 64% said weather patterns could trigger pain and 94% identified weather as a factor that impacts pain.

 

Different pain types in multiple sclerosis can cause difficulty staying active: For patients with multiple sclerosis, a regular exercise routine is important for managing symptoms. Due to different causes of chronic pain though, physical exercise can be more difficult for some. Research published in the Journal of Pain  found that widespread pain with nociplastic features, also known as WPNF, can make engaging in physical activity a painful task for some patients with MS. “WPNF is a chronic and diffuse pain which can be challenging to localize or describe precisely.  In a person with MS, this type of pain arises from altered processing signals within the central nervous system. This is opposed to pain that arises from specific tissue damage, classified as nociceptive pain, or pain related to demyelination and axonal damage, classified as neuropathic pain.”

 

Early nerve intervention reduces pain and complications after amputation: Patients undergoing amputation are at risk of certain types of chronic pain problems. They may experience phantom limb pain, a sensation of pain in the missing limb; or residual limb pain, felt in the remaining portion (stump) of the amputated limb. For patients who suffer from one or both types of post-amputation pain, the effects on their quality of life are significant. Targeted muscle reinnervation decreases phantom and residual limb pain. Plastic and Reconstructive Surgery®

 

For people with migraine, feelings of stigma may impact disability, quality of life: Study finds that nearly one-third of people with migraine experienced related stigma. Neurology®

 

New study reveals significant reduction in lumbar spine reoperation with chiropractic spinal manipulation: A new study conducted by researchers at University Hospitals (UH) Connor Whole Health sheds light on the potential benefits of chiropractic spinal manipulation (CSM) for adults experiencing ongoing sciatica following low back surgery. The study revealed that patients who received chiropractic spinal manipulation experienced a substantial 45% reduction in the likelihood of undergoing additional lumbar surgery compared to those who received usual medical care. Specifically, the proportion of patients undergoing lumbar spine reoperation was 7% in the chiropractic spinal manipulation group, significantly lower than the 13% in the usual medical care group. BMC Musculoskelet Disord.

 

 


COMPLEMENTARY AND ALTERNATIVE MEDICINE

Psilocybin May Help Reduce Depression Symptoms in People with Cancer: People with cancer who underwent psilocybin-assisted therapy in a group setting saw reductions in symptoms of depression, a small clinical trial found. In the study, 30 people with cancer received a single 25-milligram dose of the psychedelic psilocybin. After 8 weeks, researchers reported, their depression severity scores dropped by an average of 19 points. In addition, half of study participants showed full remission of depression symptoms after 1 week, an effect that was sustained throughout the 8-week phase 2, open-label trial. Overall, 80% of participants experienced a sustained response. Adverse effects related to the treatment, such as nausea and headache, were “generally mild and expected,” the researchers wrote in their paperTrusted Source published in the journal Cancer. In addition, there was no indication of suicidal thoughts or behavior.

 

Psychedelic Ibogaine May Help PTSD and Depression After Traumatic Brain Injury: Veterans with traumatic brain injury who were treated with the psychedelic ibogaine saw improvements in daily functioning and mental health symptoms. Ibogaine was given alongside intravenous magnesium to protect participants’ heart from a potential side effect of the psychedelic. Additional studies are needed, including U.S.-based clinical trials, before ibogaine can be recommended as a treatment. Nature MedicineTrusted Source.

 

Mind and Body Approaches for Stress and Anxiety: Several mind and body approaches, including relaxation techniques, yoga, tai chi, hypnotherapy, and meditation may be useful for managing symptoms of stress in your patients. For some stress-related conditions, mind and body approaches are used as an adjunct to other forms of treatment. This issue of the digest provides a summary of current research on some of these approaches for stress, anxiety, and stress-related conditions. NCCIH Clinical Digest 

 

Afib Risk May Increase for People Who Use Cannabis to Treat Chronic Pain: People who use medical cannabis for chronic pain are more likely to experience atrial fibrillation and other forms of heart arrhythmia compared to non-users.  European Heart Journal

 

Cannabis has no clear effect on treatment of opioid addiction, US study finds: Experts, publishing their results in The American Journal of Drug and Alcohol Abuse, have found that cannabis is having no significant effect on peoples’ use of opioids, taken outside of medical guidance. 

 


FDA ACTION

• Cleared NM-101 (Terran Biosciences), a cloud-based software platform to analyze neuromelanin-sensitive MRI scans, which could aid in the diagnosis of neurodegenerative diseases. 

• Approved an updated low-density lipoprotein (LDL)-cholesterol lowering indication for bempedoic acid (Nexletol) and the single-pill combination of bempedoic acid plus ezetimibe (Nexlizet).

• Approved Casgevy, a cell-based gene therapy, for the treatment of patients 12 years of age and older with transfusion-dependent beta-thalassemia, an inherited disorder.

• Authorized for marketing the DermaSensor Inc. DermaSensor device. It is a prescription device, indicated for the evaluation of skin lesions 

• Approved pembrolizumab (Keytruda, Merck) with chemoradiotherapy (CRT) for patients with FIGO 2014 Stage III-IVA cervical cancer. 

• Approved belzutifan (Welireg, Merck & Co., Inc.) for patients with advanced renal cell carcinoma (RCC)

 

PREVENTION


Exercise

How much should you exercise for a longer, healthier life? Study offers clues: A new studyTrusted Source from researchers at the University of Jyväskylä in Finland that is currently being peer-reviewed has found that while exercise is important to living a long life, following other healthy lifestyle habits may have an even greater impact. According to the study, the researchers believe the beneficial association of long-term exercise with reduced death risk was largely accounted for not only by exercise but also by other health-related factors. One healthy habit does not counteract unhealthy lifestyle. “Significant improvements in health have been found worldwide through five simple measures: avoiding obesity, keeping blood pressure normal, not smoking, controlling diabetes, and treating high cholesterol,” he added. “Regular exercise might add to those benefits, but it won’t offset the detrimental effects of ignoring those proven beneficial pursuits.”

 

Benefits of running in the cold outweigh warm weather running: Experts say running in cold weather provides boosts over warm weather running due to a number of factors, including exertion, metabolic strain, and calorie-burning brown fat. They note that exercising during the winter is also a way to combat seasonal affective disorder.

Experts recommend proper layering for cold weather, along with more grippy footwear if conditions are slippery. They add that new runners should consult with their doctor, then slowly build toward their goals. Medical News Today 

 

Walking Fast May Help Prevent Type 2 Diabetes:  Several clinical trials have shown that walking regularly is associated with a lower risk for cardiovascular events and all-cause mortality, and having a higher daily step count is linked to a decreased risk for premature death.

 

Study shows weed makes workouts more fun, but it's no performance enhancer: A bit of weed before a workout can boost motivation and make exercise more enjoyable. But if performance is the goal, it may be best to skip that joint. That’s the takeaway of the first ever study to examine how legal, commercially available cannabis shapes how exercise feels. The study was of 42 runners,  Sports Medicine

 

Dancing Can Help You Lose Weight and Develop Lean Muscle: Dancing doesn’t just feel good. New research shows it can help you lose weight, too. The systemic reviewTrusted Source, published today in the scientific journal PLOS One, reviewed 10 studies on the effects of dance interventions on body composition in people living with overweight or obesity. Compared to average lifestyles, dance was found to contribute to meaningful improvements in body mass, BMI, waist circumference, fat percentage, and fat mass. The researchers concluded that “For its high efficiency and greater sense of enjoyment, dance can be a beneficial exercise intervention for fat loss.”

 

Physical exercise boosts motor learning – and remembering what one has learned: Violinists, surgeons and gamers can benefit from physical exercise both before and after practicing their new skills. The same holds true for anyone seeking to improve their fine motor skills: Indeed, being physically active and elevating one’s heart rate has the wonderful side effect of improving our ability to learn by increasing the brain's ability to remember. In a new study, researchers from the Department of Nutrition, Exercise and Sports have shown that this effect also applies to the formation of motor memory, enabling us to recall and perform tasks such as riding a bike, drive a car and lace up our shoes, almost automatically.

 

A single session of aerobic exercise improves blood pressure in rheumatoid arthritis patients: A study involving 20 women with rheumatoid arthritis and high blood pressure demonstrates the benefits of walking at moderate speed for 30 minutes even after tests that simulate stressful situations and tend to raise blood pressure. published in the Journal of Human Hypertension

 

Being Active for Just 15 Minutes May Offset Full Day of Sitting at Work: A study of a half-million people found substantial increased risk of death in individuals who sit most of the day at work. The risk was even greater for cardiovascular disease. Individuals who were active at work or intermittently sitting did not have an increased risk. hose findings come from a large retrospective study in TaiwanTrusted Source, published in the journal JAMA Network Open.

 

 


Diet/Nutrition

How an Intermittent Energy Restriction Diet May Help with Weight Loss: New research is reporting that losing weight via a diet known as intermittent energy restriction(IER) significantly alters gut microbiome and improves brain activity. In turn, that may also help people’s weight loss efforts. It may also help with attention, motor inhibition, emotion, learning, and willpower. However, experts say IER isn’t for everyone, particularly people with type 1 and 2 diabetes or a history of disordered eating.

 

What is a fasting-mimicking diet, and how does it benefit cardiovascular health? The fasting-mimicking diet is a 5-day vegan diet with a composition such that the human body responds as it does to water-only fasting. For the rest of the month, the patients [return] to their normal diet. Researchers at the University of Southern California have now found that the fasting-mimicking diet provides some unique heart-healthy effects when compared to the Mediterranean diet. Npj Metabolic Health and DiseaseTrusted Source

 

Always Using Salt at Mealtimes May Increase Your Kidney Disease Risk by 29%: A recent study published in JAMA in December Trusted Sourcefound that people who use more salt at mealtimes are at greater risk for developing kidney disease.

 

Why binge drinking is more dangerous for your liver than daily alcohol consumption: Researchers say binge drinking combined with genetic risk can dramatically raise the risk of developing alcohol-related cirrhosis. They add that having type 2 diabetes puts people who binge drink at even greater risk. Their findings were detailed in a studyTrusted Source published in the journal Nature Communications.

 

Delayed Meals Tied to Increased CVD Risk: Beyond the nutritional quality of a diet, the timing of meals is important, with later first and last meals of the day associated with increased risks for cardiovascular diseases (CVDs), especially in women, results of a large prospective study suggested. Each additional hour delaying the time of the first meal of the day was associated with a higher risk for overall CVD, with the association stronger in women than in men. Each additional hour in delaying the time of the last meal was associated with an increased risk for cerebrovascular disease; here, a last meal after 9 pm was associated with a 28% higher risk than a meal before 8 pm. Nature Communications.

 

Your Disposable Water Bottle May Contain 240,000 Plastic Nanoparticles: A new study estimated that, on average, one liter of bottled water contains 240,000 detectable plastic fragments. These are known as nanoplastics, which are a cause for concern because they are difficult to detect and can pass through intestinal, tissue, and blood-brain barriers, which can result in serious health implications. To make sure your water is safe to drink, you can place water filters on the faucets and/or use them prior to drinking the water to get rid of some of the unwanted particles. Proceedings of the National Academy of Sciences

 

Getting More Plant Protein May Help Women Avoid Cancer, Diabetes and Other Conditions: Plant protein, compared to other animal-based protein sources like dairy and meat, could be essential to healthy aging in women. Those who eat more plant protein are more likely to be free from chronic disease, physical and mental impairment, and have better mental health as they age, suggests a new study published in The American Journal of Clinical NutritionResearchers found that every 3% of total dietary calorie from plant protein was associated with a 38% increase in the likelihood of healthy aging in women.

 


Sleep

Will Blue Light From Your Phone Disrupt Your Sleep?: A new studyTrusted Source released in the journal Nature suggests that so-called blue light — the type of light emitted from these devices — may not be as disruptive as previously understood. Researchers found that between the blue, yellow and white light there was no conclusive evidence that blue was worse than other forms of light.

 

Transcranial Electrical Stimulation Effective for Insomnia: Transcranial alternating current stimulation (tACS), a noninvasive technique that uses low-intensity electrical currents to modulate brain activity, is an effective intervention for treating chronic insomnia, especially in older people, results of a relatively large study suggested. Journal of Psychiatric Research.

 

Winding down the window, drinking tea and coffee, turning the radio up and singing while driving could be signs of a dangerous snoring condition: Frequently using more than three strategies to stay alert while driving could be a sign of excessive sleepiness due to obstructive sleep apnoea (OSA), according to a study published in ERJ Open Research. 

 

Streamlining cognitive behavioral therapy for chronic insomnia: A combination of cognitive and behavioral strategies, ideally delivered in person by a therapist, maximizes the benefits of cognitive behavioral therapy for insomnia (CBT-I), according to new research. CBT-I is a form of talk therapy, which can be delivered in person or through self-help guides. By analyzing 241 studies, involving over 30,000 adults, researchers identified the most beneficial components of CBT-I. These included: cognitive restructuring, third-wave components, sleep restriction, stimulus control and in-person delivery. Self-help with human encouragement could also be beneficial, while waiting for active treatment and enforcing relaxation procedures appeared to be potentially harmful. Understanding which components of CBT-I can offer the most benefit will hopefully help practitioners help their patients get a better night’s sleep. JAMA Psychiatry 

 

 


Vitamins/Supplements

Form of vitamin B3 may help manage Parkinson’s disease: Now, a phase 1 clinical trial has found that a high dose supplementation of nicotinamide ribosideTrusted Source (NR) — a source of vitamin B3 and precursor to NAD+ — increased whole blood NAD+ levels and expanded the NAD+ metabolomeTrusted Source in people with Parkinson’s disease, and may be associated with clinical symptomatic improvement for those with the condition. Nature CommunicationsTrusted Source.

 

Can This Common Herb Help Grow Hair? Rosemary oil is good at regrowing hair in people with androgenetic alopecia, which is a common form of hair loss. The herb might also protect hair from the sun, pollution, and other environmental elements, according to an article in Insider. The Cleveland Clinic also reports that rosemary oil might also help against dandruff and premature graying. Khetarpal suggests massaging rosemary oil into the scalp, letting it soak overnight, and then washing it out. Try to do this two or three times a week. 

 

Train your brain to overcome tinnitus: An international research team has shown that the debilitating impact of tinnitus can be effectively reduced in just weeks by a training course and sound therapy delivered via a smartphone app. The app, MindEar, is available for individuals to trial for themselves on a smartphone. “MindEar uses a combination of cognitive behavioural therapy, mindfulness and relaxation exercises as well as sound therapy to help you train your brain’s reaction so that we can tune out tinnitus. The sound you perceive fades in the background and is much less bothersome,”   Frontiers in Audiology and Otology

 

Taking a Daily Multivitamin May Help Slow Cognitive Aging and Boost Memory: The new study published online on January 18, 2024, in The American Journal of Clinical Nutrition, reports that daily multivitamin supplementation was beneficial for both global cognition and episodic memory. The study is the third in a series of studies that are part of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS). The study authors estimated that daily supplementation had delayed cognitive aging by about two years in comparison to those who had received a placebo rather than a multivitamin.

 


Other

2024 Adult Vaccine Schedule Changes: This year's schedule includes more vaccines with new recommendations. The newest vaccine additions to the schedule include respiratory syncytial virus (RSV) vaccines, the mpox vaccine (Jynneos), a new MenACWY-MenB combo vaccine (Penbraya), and the new 2023-2024 formulation of the updated COVID vaccine (both mRNA and protein-based adjuvanted versions).  2024 Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule

 

Poor Oral Health Tied to Worse Brain Health: Proper care of teeth and gums may offer benefits beyond oral health, including improving brain health, new research suggests.

In a large observational study of middle-aged adults without stroke or dementia, poor oral health was strongly associated with multiple neuroimaging markers of white matter injury. "Because the neuroimaging markers evaluated in this study precede and are established risk factors of stroke and dementia, our results suggest that oral health, an easily modifiable process, may be a promising target for very early interventions focused on improving brain health.” The study was published online in Neurology.

 


TREATMENT

Statins May Help Slow Cognitive Decline in People with Alzheimer's: According to a new studyTrusted Source, people with dementia experienced cognitive decline at a slower rate if they were also given a lipid-lowering statin. However, it’s important to note this is an observational study so researchers say they are hesitant to recommend statin therapy for people with Alzheimer’s or other forms of dementia at this time.

 

New Stroke Prevention: Clopidogrel-Aspirin Within 72 Hours: Dual antiplatelet therapy (DAPT) with clopidogrel-aspirin given within 72 hours of a mild ischemic stroke or a high-risk transient ischemic attack (TIA) shows a greater risk reduction for new stroke than aspirin alone, although with a higher bleeding risk. This study was published online New England Journal of Medicine.

 

Bariatric surgery may slow cognitive decline for people with obesity

Cognition scores remained stable, while secondary executive function tests showed improvement Journal of Nutrition, Health & Aging 

 

Shingles Vaccine Offers 4 Years of Protection: Findings from the prospective cohort study showed that people who received two doses of the vaccine, regardless of when they received their second dose, experienced 79% vaccine effectiveness (VE) during the first year, with effectiveness decreasing to 73% by year 4. By contrast, the rate of effectiveness during the first year was 70% for people who received a single dose, falling to 52% effectiveness by year 4. Annals of Internal Medicine.

 

Common Diabetes Pills Also Protect Kidneys: Medication people with type 2 diabetes use to manage their blood sugar also appear to protect their hearts and kidneys, according to a new study in JAMA Network Open.  These pills, known as sodium-glucose cotransport protein 2 (SGLT2) inhibitors, reduce the amount of blood sugar in a kidney by causing more glucose to be excreted in urine.

 

New Vaccine May Help Stop Recurrence of Certain Pancreatic, Colorectal Cancers: Researchers are investigating a potential vaccine that could help prevent certain cancers from returning. The vaccine, labeled the ELI-002 vaccine, appeared to reduce the risk of relapse in some people with pancreatic and colorectal cancers. All of the patients had a specific tumor mutation called mKRAS mutation, which is one of the more common gene mutations linked to cancer. The vaccine appeared to reduce the risk of relapse in people with pancreatic and colorectal cancers who’d previously had surgery and chemotherapy, according to the studyTrusted Source, which was published in Nature Medicine.

 

Eli Lilly Offers Obesity Drug Directly to Consumers: Eli Lilly, maker of the anti-obesity drug Zepbound, announced this week the launch of LillyDirect, a direct-to-patient portal, allowing some patients to obtain its drug for as little as $25 a month.

 

Trazadone and CBT no more effective than placebo for improving insomnia among long-term dialysis patients: A clinical trial of more than 120 persons undergoing hemodialysis found that cognitive behavioral therapy for insomnia (CBT-I) or trazodone were no more effective than placebo for improving mild to moderate chronic insomnia. These findings are important given the prevalence of insomnia among long-term dialysis patients. The study is published in Annals of Internal Medicine. 

 

 Gabapentinoids associated with severe exacerbation of COPD: A population-based cohort study of more than 10,000 persons using gabapentinoids found that their use was associated with an increased risk of chronic obstructive pulmonary disease (COPD) exacerbation. This study supports the warnings from regulatory agencies and highlights the importance of considering this potential risk when prescribing gabapentin and pregabalin to patients with COPD. The study is published in Annals of Internal Medicine.   

 

Erectile dysfunction medications may increase risk of death when combined with common chest pain medication: Phosphodiesterase type 5 inhibitors (PDE5i)—an erectile dysfunction drug sold under the names Viagra, Levitra, Cialis, and others—are a common medical treatment for erectile dysfunction (ED) in men with cardiovascular disease (CVD). However, a new Swedish study published in the Journal of the American College of Cardiology suggests that patients are at higher risk for morbidity and mortality over time when PDE5is and nitrate medication are both prescribed. 

 

Therapy vs. Antidepressants: Which Is Best for People with Heart Disease?: A new study shows behavioral activation therapy improved depression symptoms as effectively as medication in people with heart failure. JAMA Network OpenTrusted Source.

 

OTHER

Being overly optimistic may be linked to poor decision-making: Positive thinking and optimism are often associated with success in life. However, a new study from the University of Bath in the U.K. suggests that they are signifiers of low cognition, since they frequently lead to poor decision-making, specifically in the realm of finance.The study finds that people with the highest cognitive ability are 22% more likely to be realistic (pessimistic) in financial planning, with a 34.8% reduction in optimism compared to people of low cognitive ability. The study suggests that optimism bias leads people to anticipate more positive outcomes than they should reasonably expect in business planning, investing, and other fiscal activities. The result is loss of funds, debt, and business failures. Personality and Social Psychology Bulletin.

 

Hearing Aids and Dementia Risk Study Retracted: A study published last spring suggesting that hearing aids may help reduce dementia risk has been retracted due to a coding error identified by the authors.  The study was published April 13 in The Lancet Public Health and reported by Medscape Medical News at that time. It was retracted by the journal on December 12. Despite the retraction, other studies have suggested a link between hearing and dementia.  One study of US Medicare beneficiaries found a 61% higher dementia prevalence in those with moderate to severe hearing loss compared to those with normal hearing. As reported by Medscape Medical News, in this research, even mild hearing loss was associated with increased dementia risk, although it was not statistically significant, and use of hearing aids was tied to a 32% decrease in dementia prevalence.  In addition, a large meta-analysis showed that hearing aids significantly reduce the risk for cognitive decline and dementia and even improve short-term cognitive function in individuals with hearing loss.

 

Modifiable Risk Factors for Young-Onset Dementia Flagged: In addition to better known risk factors such as diabetes, stroke, heart disease, and depression, findings of a large study suggested vitamin D deficiency, elevated C-reactive protein (CRP) levels, and social isolation increase the risk for young-onset dementia (YOD). Hearing impairment also increased risk. Some alcohol use seemed to be protective (moderate or heavy alcohol use had a lower association with YOD than alcohol abstinence, possibly due to the "healthy drinker effect" where people who drink are healthier than abstainers who may have illnesses preventing them from drinking, said the authors). JAMA Neurology.

 

What's the Disease Burden From Plastic Exposure?: Exposure to endocrine-disrupting chemicals (EDCs) via daily use of plastics is a major contributor to the overall disease burden in the United States and the associated costs to society amount to more than 1% of the gross domestic product, revealed a large-scale analysis. The research, published in the Journal of the Endocrine Society on January 11, indicated that taken together, the disease burden attributable to EDCs used in the manufacture of plastics added up to almost $250 billion in 2018 alone. Plastics may contain any one of a number of EDCs, such as polybrominated diphenylethers in flame retardant additives, phthalates in food packaging, bisphenols in can linings, and perfluoroalkyl and polyfluoroalkyl substances (PFAS) in nonstick cooking utensils. These chemicals have been shown to leach and disturb the body's hormone systems, increasing the risk for cancer, diabetes, reproductive disorders, neurological impairments in developing fetuses and children, and even death.

 

Research aims to harness technology for improved heart and brain health: Research teams share findings and progress on projects aimed at harnessing digital solutions — including text messaging, smartphone apps, wearable devices and artificial intelligence — to improve health, reduce health care disparities, empower people to better manage their health and wellness and enhance patient/clinician connectivity in a special issue of the Journal of the American Heart Association.

 

People Who Go Into Type 2 Diabetes Remission See 40% Drop in Heart Disease Risk: The study, published in the journal Diabetologia , is one of the first to highlight the impact diabetes remission can have on cardiovascular outcomes. The trial showed that type 2 diabetes remission is possible through lifestyle interventions —such as exercising and eating healthy — that lead to significant weight loss. That said, the risk reduction is largely dependent on how long people are able to maintain remission, which can be difficult with diabetes.  It can be difficult to maintain diabetes remission through lifestyle changes alone, but if long-term remission is achieved, the effects on heart and kidney health can be substantial. 

 

 

Saturday, January 6, 2024

Life with Chronic Conditions: Napping/Segmented sleeping


It’s the beginning of the new year and so lots of articles on ways to improve your health from the perfect diet, exercise, stress relievers and of course sleep. 

As I’ve been reading some of the sleep articles, I thought of my musician friend and middle school teacher Ray. He would come home from school and immediately go to bed. That way, he was ready to hit the clubs by 9 pm. Turning in for the night around 1 or 2 am and getting up at 6:30, he’d got about 5 hours of sleep at night and another 2 or so from his afternoon/early evening nap. Thus he racked up 7-8 hours of sleep in a 24 hour period. 

 Basically he operated on a “segmented sleep” or “Biphasic sleep” schedule. This approach was ideal for him and he was quite happy, only complaining if someone called during his napping time. 

 

Before the industrial age and artificial lighting, it was normal for people to get up in the middle of the night and do things-basically having “two sleeps.” There are lots of references throughout history about “two sleeps.” 

 

The industrial age brought with it high productivity during day light hours, with people sleeping for 6-9 hours, rather than intermittently for 10-12 hours. Artificial light extended the productivity time. This affected our circadian rhythms, leading to what we now consider to be the norm: 6 to 9 hours of sleep that occur overnight. 

 

Watch Roger Ekirch’s, the author of “At Day’s Close: Night in Times Past” discuss how segmented sleep was the norm.   


 

We obsess about getting too little or too much sleep. While getting all your sleep in one time is promoted, history and research don’t necessarily support that one long bout of sleep is for everybody. In fact, many people I ask about their sleep patterns seem to have some form of biphasic sleep. My friend Gloria, who died at 100 on New Year’s Day,  kept needle work by her bed, so she could sew when she woke during the night. Other friends tell me they listen to podcasts, meditate, do crossword puzzles (my husband’s preference), enjoy the solitude etc. 

 

So if you think you have insomnia, but follow a segmented regular sleep pattern, this could be just how you are wired.

 

Your Brain on Sleep: Sleep is important to a number of brain functions, including how nerve cells (neurons) communicate with each other. In fact, your brain and body stay remarkably active while you sleep. Recent findings suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake…. Sleep affects almost every type of tissue and system in the body – from the brain, heart, and lungs to metabolism, immune function, mood, and disease resistance. Research shows that a chronic lack of sleep, or getting poor quality sleep, increases the risk of disorders including high blood pressure, cardiovascular disease, diabetes, depression, and obesity. Brain Basics Understanding Sleep 

 

How much sleep do people need?   Most adults need 7-9 hours of sleep a night, but after age 60, nighttime sleep tends to be shorter, lighter, and interrupted by multiple awakenings.  Older people are also more likely to take medications that interfere with sleep. The National Sleep Foundation posted a study  in December that concludes, Consistency of sleep onset and offset timing is important for health, safety, and performance. Nonetheless, when insufficient sleep is obtained during the week/work days, weekend/non-work day catch-up sleep may be beneficial.

 

People that work shifts, where one week they’re on nights and the next on days, definitely suffer from this type of scheduling as it precludes consistency and may not offer sufficient stretches of sleep for the brain to recharge as it needs to. 

 

Does it make a difference if you sleep all at once or break it up? Individuals vary in their need for sleep to begin with and include other factors such as age, health, working the night shift, parenting a young child, season, weather and so forth. For example, a “siesta” is a common practice in hotter climates. Farmers start early in the morning and work later into the evening. By taking a siesta (nap) mid-day they are able to get their 7-9 hours of sleep in, while avoiding the hottest part of the day. 

 

No matter how you slice it, the brain needs to recharge and waking yourself by an alarm to shorten your sleep cycle isn’t helpful. 

 

How to tell if you aren’t getting enough sleep: The following are some indicators that you may be dealing with a sleep issue: difficulty focusing; short tempered; taking unusual risks; feeling extremely sleepy; yawning a lot and/or falling asleep at the wrong time, such as while driving. 


Try taking a sleep quiz to get a better indicator-the questions vary from quiz to quiz. These are just two examples:

Health Central’s Quiz   

Short sleep deprivation quiz 

 

Keep in mind that not getting enough sleep doesn’t just make us tired, according to a recent study, it can increase anxiety, degrade mood and altogether undermine our emotional functioning. Psychological BulletinEven staying up an hour later can cause us to be “off” the next day. 

 

What about napping?: Studies indicate that a short nap can increase creativity, boost brain, and lower blood pressure   However, there is a sweet spot, where if you sleep too deeply or too long, it can have a negative effect.

 

Who benefits most from a nap? The benefits of napping are strongest for people who have sleep debt, meaning their nighttime sleep falls short  Shift workers, new parents and older people with fragmented nighttime sleep all seem to get a boost from a nap.

 

Nap Length: According to the National Sleep Foundation Researchers a 20 minute nap is the best length. A short nap like this allows your mind and body to rest without entering the deeper stages of sleep. If you have time and a need for a longer nap, napping for 60 to 90 minutes is enough time to have deep, slow-wave sleep, but end up in the lighter stages of sleep so you feel alert when you awake. Medium-length naps of around 45 minutes can be problematic because you will likely wake up during slow-wave sleep, the deepest stage, which can leave you with that groggy feeling—called sleep inertia—when you wake up.

 

But a short nap still has benefits! Scientists have found that when people napped around 30 minutes, they had better memory recall and superior overall cognition than both non-nappers and those who napped longer. You may be familiar with the term “power nap.” How long is a power nap? Power naps taken in the early afternoon usually last 15 to 20 minutes and can restore and refresh you when experiencing a natural decline in energy and wakefulness. NASA tested the effects of power napping on astronauts and found it had an effective boost to performance and alertness.

 

Bottom Line: Humans vary in sleep patterns but need about 7-9 hours sleep in a 24 hour period. Certain chronic conditions may dictate different sleep lengths and patterns.  Further, sleep needs to be sufficient in length to allow the brain to recharge. Talk to your medical provider about your sleeping if it’s a concern to you. Note that there is now a category on sleep in the monthly Journal Watch (3rd Saturday of the month) as there is considerable research being done in this field and what is known today could be different in the months and years ahead.