NOVEMBER 23-24, 2019 SLEEP

Do you sleep 6 - 8 hours a day ? In addition to physical activity ( exercise) and a good dietary lifestyle, sleeping 6 - 8 hours per night is an important component of a healthy lifestyle. Longer sleep is considered a healthy habit. I was used to only getting 5 hours or less night sleep from my medical school years and less when in residency training. Today I try to be in bed by 10:30 and sleep till 5:30 a.m. The Academy of Sleep Medicine recommends that the optimal duration of sleep for adults is 7 hours per night.

It is not known whether excessive sleep duration or daytime napping expose individuals to a greater risk of death and cardiovascular disease

There are many complaints I hear in the office which are related. Daytime sleepiness and nocturia ( increased urination at night) are the most common complaints. There are studies that sleep greater than 10 hours had a relatively higher prevalence of CV risk factors and higher among those day time nappers. This only proves that we really don’t know the exact amount of hours one should sleep. These studies give us a better idea on the risk of CV mortality and morbidity.

From what I read I interpret this: ‘ Many sleep patterns may predispose to increased CV risk by different mechanisms that we fully do not understand at this point.’

Until tomorrow…

NOVEMBER 22, 2019 SLEEP APNEA

Obstructive sleep apnea with excessive daytime sleepiness was associated with a three fold greater likelihood of having a diagnosis of heart failure and a doubled likelihood of suffering a cardiovascular event.

So if you snore or know someone who snores( possibly your partner) you better get a doctor to write a prescription for a sleep study. At Fratellone Medical in NYC or Connecticut Integrative in Fairfield CT we are diligent about recommending a sleep study to our patients after the initial consultation for patients that snore or have sleep disturbances.

This was studied at great length at the University of Pennsylvania Perelman School of Medicine in Philadelphia. This study found different sub types of obstructive sleep apnea. These sub types were studied in particular to the long term consequences with respect to cardiovascular heart disease. Clinical subtypes were associated with different risks in the more than 1,207 patients studied.

It was found compared to those without obstructive sleep apnea, that the overall cardiovascular risk was driven by the sub type of obstructive sleep apnea. This was similar to another sleep apnea global study in Iceland.

There are more studies to validate these results.

Until tomorrow…

NOVEMBER 21, 2019 CHOCOLATE

Would you rather eat dark chocolate or a drink a cup of black tea ? Or would you rather eat dark chocolate or have a tomato salad with buffalo mozzarella ?

We do know that dark chocolate is better for you than milk chocolate. Studies have already proven this. Good milk chocolate might taste better and less bitter but milk cancels the good effects of the antioxidants. Studies have shown that dark chocolate boosts blood antioxidant levels by almost 20 percent.

Dr Joe Vinson at the University of Scranton found that the polyphenols in milk chocolate to be higher than in red wines or black and green tea. Yes, milk chocolate polyphenols NOT dark chocolate. We know of course that the polyphenols n dark would be better than red wine. I never thought that those in milk chocolate would be higher. He even found this to be true when comparing polyphenols of milk chocolate against tomatoes.

So do you eat milk chocolate or eat a tomato?

Until tomorrow…

NOVEMBER 20, 2019 TOMATOES AND STROKE

Tomatoes can reduce your risk of stroke. Who doesn’t love a tomatoe. It may be acidic, but grilled with olive oil it is very health conscious.

Tomatoes are ripe with the antioxidant lycopene.

A recent studied published in Neurology found that people with the highest levels of lycopene in their blood were 55 % were less likely to have a stroke than those with lower amounts. This adds to what is already known that more fruits and vegetables , lower our risk to have strokes.

Until tomorrow…

NOVEMBER 19, 2019 SAFFRON

Saffron is a spice derived from the flower of Crocus sativus, commonly known as the "saffron crocus". The vivid crimson stigma and styles, called threads, are collected and dried to be used mainly as a seasoning and coloring agent in food

This expensive spice appears to be as effective as the stimulant methylphenidate (MPH) used to treat children with ADHD ( attention deficit hyperactivity disorder). This was published data from a small randomized trial at Tehran University of Medical Sciences in Iran. This group found there was no effective difference in the saffron vs MPH group.

Saffron and its active constituents appear to increase the reuptake inhibition of dopamine and norepinephrine . Saffron is also a GABA alpha agonist. This needs to be studied more

Saffron has been traditionally used for its antispasmodic, antiseptic and anticancer and its anticonvulsant effects.

It makes sense that this study was done in Iran as Saffron is a Persian herb

Until tomorrow…

NOVEMBER 18, 2019 INACTIVE INGREDIENTS IN ORAL MEDICATIONS

I recently read a disturbing study about inactive ingredients found in oral medications. As a prescriber, I was outraged. As physicians, we have lost our rights- medicine is controlled by the pharmaceutical industry as well as the health insurance companies. Yes we have a medical license, a DEA certificate and a prescription pad, but we do not always get to prescribe the medications we want or the test we need to perform on our patients.

Overall 92.8 percent of oral solid medications contain at least one ( if not more) potential allergens. This dats was published in the March 13 2019 issue of the journal, Science Translational Medicine. Data from the Brigham and Women’s Hospital in Boston revealed that an average tablet or capsule of 42,052 orals studied had 8.8 inactive ingredients. How is this possible ? Only 12 % of active pharmaceutical ingredients are free of inactive ingredients. This means that 88% of pharmaceutical ingredients have inactive ingredients that are allergens. These allergens cause problems or disease.

This is scary. Does this mean we are getting poisoned by taking prescription medications. Perhaps this is why so many Americans have turned to natural medicines as supplements and herbs. I would rather turn to an herb or plant as a treatment

Until tomorrow…

NOVEMBER 16-17, 2019 LEVOTHYOXINE

Hypothyroidism has a high prevalence in the United States. I am not an endocrinologist but see at least 10 patients per week with either hypothyroidism or Hashimoto’s thyroiditis( autoimmune thyroiditis) Levothyroxine is one of the most frequently prescribed medication in the United States. In 2016 there were 123 million prescriptions for levothyroxine . I prefer to use the name brands Synthroid and Tirosint instead of levothyroxine as I have seen individuals do better with the name brands. This is because there are no additives and no gluten in the name brands. Some FDA laws in 2007 required that synthetic T4 content in pills be within 5% of stated dose.

To tell you the truth , T4 which is levothyroxine is not enough for most patients. I do utilize T3 , synthetic as cytomel or liothyronine or natural as armour thyroid. For women or child bearing age I usually go with Synthroid or tirosint but have bene known to use T3 ( although not as effective ) for hypothyroidism or hashimoto’s

It is not unreasonable to try T3 in some patients. I have success with rotating thyroid , both T3 and T4 in most patients. I also recommend compounded thyroid in some patients. I have a special affinity for thyroid disease as for myself I have very controlled Hashimoto’s with TPO antibodies less than 25 ( from 1000) with using low dose naltrexone, selenium and a gluten free dietary lifestyle. I have used different thyroid medications throughout my life, now with no thyroid supplementation of any kind.

Until tomorrow…

NOVEMBER 15, 2019 BACK PAIN AND DIABETES

Did you know that individuals with diabetes have a greater likelihood of developing back pain ? It has been shown that diabetics have an increased likelihood of developing back pain or spinal pain compared with those that do not have diabetes.

There were five studies involving 131,431 ( not a small study) which showed an increased likelihood of reporting back pain among people with diabetes compared to those without diabetes. I am sure that this has to do with obesity among type II diabetic patients. There was one study indicating 30% of people with obesity developed chronic back pain over 10 years.

Since obesity is associated with less physical activity—this could be the reason . The abnormal sugar and lipid levels also play a role . These abnormalities reduce muscle blood flow and increase cartilage inflammation this making physical activity impossible. There are many causes why diabetics exercise less. We have to change this . As a physician it is my obligation to encourage my patients to exercise.

Until tomorrow…