Thank you to our patients for entrusting your care to Weisz Concierge Medical in 2022.
Best wishes for a Happy and Healthy Holiday!
Question: I come from a large family, and we have a lot of holiday parties. I want to enjoy myself, but I also want to start the new year feeling healthy. My concern is about drinking alcohol. What’s the best way to handle that part of the holidays?
Answer: Even a short-term increase in alcohol use can have adverse health effects, including changes in blood sugar level and blood pressure. It can also lead to changes to mood and mental health, lowered resistance to risky behaviors, increased risk of trips or falls and dangerous driving. All of which is to say that your concerns about holiday drinking are well-founded.
Begin by crafting a plan. Set a drinking limit for yourself before each event — and stick to it. This can absolutely include the decision to not drink any alcohol at all. If you are going to partake, never do so on an empty stomach. Have a meal, or at least a snack, before heading into the festivities. Once inside, make the food table your first stop, and stick to the protein and vegetable side of things. Protein and fiber both help stabilize blood sugar and keep you feeling full.
Peer pressure is a real thing when it comes to drinking. Get your nonalcoholic drink served in a wine glass or a flute, and you can head off uncomfortable conversations. Set a time at which you will stop drinking and, again, stick to it. Offers of more alcohol may come your way, so it’s also a good idea to prepare a gracious or funny way to refuse.
Got a Question? Send it to drw@weiszconciergemedical.com and, if it is of general interest, Dr. Weisz will provide an answer in an upcoming issue of the Concierge Connection.
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Harvard Study Shows Vegetarian Diets Reduce Risk of Prostate Cancer
Are you a man who wants to eat a healthier diet? It’s been known that by becoming a vegetarian, the foods you eat will lower your odds of developing heart disease and diabetes. But research released this week has shown that your chances of contracting prostate cancer are also reduced if you stick to fruit and vegetables and avoid meat.
Earlier this year, researchers published results from a comprehensive review of the literature on plant-based diets and prostate cancer risk. They concluded that apart from having advantages for cardiovascular health and quality of life, plant-based diets have the potential to improve prostate cancer outcomes.
Anti-Cancer Compounds
Plants contain a number of anti-cancer compounds such as flavonoids, tannins, and resveratrol. Cooking meat, on the other hand (especially red and processed meats), generates two types of carcinogens . The researchers behind this new review assessed 32 studies evaluating possible links between plant-based diets and lower prostate cancer risk. In some, they enrolled subjects who were prostate cancer patients who had been followed over time to see if dietary changes, exercise, stress management, and other lifestyle interventions would lead to better outcomes.
In general, the studies indicated beneficial effects from consuming plant-based meals. Most of the studies found that plant-eaters developed prostate cancer at lower rates than meat-eaters. And 60% of the studies reported that prostate-specific antigen (PSA) levels increased more slowly in plant-eaters compared to meat-eaters. A rise in PSA suggests prostate cancer is worsening, or recurring in men who have already been treated for the disease.
More Study Needed
The review authors support a conclusion that vegetarian diets are protective. However, large-scale clinical trials are still needed to confirm the association, cautioned Dr. Stephen Freedland, a urologist and the director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Medical Center in Los Angeles.
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Source: Harvard Health Publishing / Harvard Medical School. By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases • December 16, 2022
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Vitamin D Deficiency Linked to Alzheimer Disease and Other Disorders
It has been known for decades that a link exists between vitamin D deficiency and neurologic disorders including multiple sclerosis (MS), Alzheimer dementia (AD), Parkinson disease (PD), and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease). But the role of vitamin D supplementation to prevent and manage these diseases has been unclear.
Vitamin D was discovered to be a steroid-like hormone in 1968 and later was isolated as the active hormonal form of vitamin D3. Vitamin D receptors are found on virtually every tissue in the human body including the brain and entire nervous system.
Several medical societies have issued recommended minimum serum concentrations of Vitamin D. These were set at a recommended range of 20 to 50 ng/mL These were based on an increase in fractures as well as increases in pancreatic and prostate cancers at higher than recommended doses. A vitamin D level of 30 ng/mL is the average that most societies recommend. However, guidance on vitamin D supplementation in patients with neurologic conditions is still lacking.
Vitamin D deficiency is more prevalent among people living in areas of reduced sunlight, among those with higher levels of melanin (dark-skinned), and who are 65 years and older.
Sunlight provides approximately 80% to 90% of recommended vitamin D dose per day, far surpassing the amount derived from a well-balanced diet.
Alzheimer Disease and Vitamin D
Alzheimer dementia presents as a progressive cognitive decline with behavioral changes. Studies on vitamin D and AD date back to 1992 with reporting of a decreased vitamin D receptor in the hippocampus of AD patients. It was learned that Vitamin D deficiency is important in aging and age-related cognitive decline and may be associated with increased risk of developing AD and dementia.
Findings from a large-scale observational study involving prospective data from the UK Biobank on more than 294,500 people suggest that participants with low vitamin D levels had a 54% greater chance of developing dementia than those with normal levels.
In a 6-month pilot study involving 43 people newly diagnosed with Alzheimer disease, use of vitamin D supplementation was superior at halting cognitive decline compared with use of intervention alone. A randomized, placebo-controlled trial involving 210 patients with Alzheimer disease showed that 12 months of supplementation with vitamin D was significantly associated with improvements in cognitive test scores(MMSE). A significant increase in full-scale IQ score was also found.
Researchers have also investigated the potential effects of vitamin D on orientation, memory, cognitive decline, and executive functions in older adults without Alzheimer disease. In a study of 1058 older adults who underwent serum vitamin D tests between 1997 and 1999 and follow-up cognitive testing 3 times over the next 12 years, vitamin D deficiency was associated with poorer performance on the MMSE test.
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Source: Clinical Advisor. By Dana S. Miles, MS, PA-C, CAQ-EM • December 15, 2022
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Diagnosing Disease by the Sound of Your Voice with Artificial Intelligence
Most of us have two voice changes in our lifetime: first during puberty. Then a second time as aging causes structural changes that may weaken the voice.
But for some of us, there’s another voice shift, when a disease begins or when our mental health declines. This is why more doctors are looking into voice as an indicator that tells them that a disease is present.
Vital signs like blood pressure or heart rate can give a general idea of how sick we are. But they’re not specific to certain diseases says the co-principal investigator for the National Institutes of Health’s Voice as a Biomarker of Health project.
Speaking is complicated, involving everything from the lungs and voice box to the mouth and brain. “A breakdown in any of those parts can affect the voice,” says an assistant professor of otolaryngology (the study of diseases of the ear and throat) at Vanderbilt University in Nashville, who is working on the NIH project.
You or those around you may not notice the changes. But researchers say voice analysis as a standard part of patient care – along with blood pressure checks or cholesterol tests – could help identify those who need medical attention earlier.
Often, all it takes is a smartphone. You can provide voice data in your pajamas, on your couch according to a computer scientist for the NIH project. Plus, multiple samples can be collected over time, giving a more accurate picture of health than a single snapshot from, say, a cognitive test.
Over the next 4 years, the Voice as a Biomarker team will gather a massive amount of voice data. The goal is 20,000 to 30,000 samples, along with health data about each person being studied. The result will be a sprawling database scientists can use to develop algorithms linking health conditions to the way we speak.
The researchers plan to employ advance voice screening apps, which could prove especially valuable in remote communities that lack access to specialists or as a tool for telemedicine. Down the line, wearable devices with voice analysis could alert people with chronic conditions when they need to see a doctor.
Imagine your watch, your phone, or Alexa telling you: “I’ve analyzed your breathing and coughing, and today, you’re really not doing well. You should go to the hospital.”
Artificial intelligence may be better than a brain at pinpointing the right disease. For example, slurred speech could indicate Parkinson’s, a stroke, or ALS, among other things.
Will such technology eliminate the need for doctors and clinicians? Possibly. In a recent study of patients with cancer of the larynx, an automated voice analysis tool more accurately flagged the disease than laryngologists did.
Which health conditions show the most promise for voice analysis?
1. Voice Disorders (Cancers of the larynx, vocal fold paralysis, benign lesions on the larynx)
The patient speaks into a smartphone app. An algorithm compares the vocal sample with the voices of laryngeal cancer patients. The app spits out the estimated odds of laryngeal cancer, helping providers decide whether to offer the patient specialist care.
2. Mood and Psychiatric Disorders(Depression, schizophrenia, bipolar disorders)
No established biomarkers exist for diagnosing depression. Yet if you’re feeling down, there’s a good chance your friends can tell – even over the phone. We carry a lot of our mood in our voice. Bipolar disorder can also alter voice, making it louder and faster during manic periods, then slower and quieter during depressive bouts. The catatonic stage of schizophrenia often comes with a very monotone, robotic voice.These are all something an algorithm can measure.
3. Neurological Disorders (Alzheimer’s, Parkinson’s, stroke, ALS)
For Alzheimer’s and Parkinson’s, one of the first changes that’s notable is voice, usually appearing before a formal diagnosis, says another member of the NIH project. Parkinson’s may soften the voice or make it sound monotone, while Alzheimer’s disease may change the content of speech, leading to an uptick in “umm’s” and a preference for pronouns over nouns.
4. Respiratory Disorders (Pneumonia, COPD)
Beyond talking, respiratory sounds like gasping or coughing may point to specific conditions. Emphysema cough is different, COPD cough is different. Researchers are trying to find out if COVID-19 has a distinct cough. Breathing sounds can also serve as signposts. There are different sounds when we can’t breathe. One is called stridor, a high-pitched wheezing often resulting from a blocked airway. AI analysis of these sounds could help doctors more quickly identify respiratory disorders.
5. Pediatric Voice and Speech Disorders (Speech and language delays, autism)
Babies who later have autism cry differently as early as 6 months of age, which means an app could help flag children for early intervention. Autism is linked to several other diagnoses, such as epilepsy and sleep disorders. So analyzing an infant’s cry could prompt pediatricians to screen for a range of conditions.
And That’s Only the Beginning…
Eventually, AI technology may pick up disease-related voice changes that we can’t even hear. In a new Mayo Clinic study, certain vocal features detectable by AI – but not by the human ear – were linked to a three-fold increase in the likelihood of having plaque buildup in the arteries.
“Voice is a huge spectrum of vibrations,” explains study author Amir Lerman, MD. “We hear a very narrow range.”
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Source: Medscape Family Medicine. By Laura Tedesco. December 8, 2022.
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Skipping Meals or Not Waiting Long Enough Between Meals Could Be Risky
A shorter time interval of 4.5 hours or less between meals has been associated with an increased risk of premature death according to a large, new and controversial study that looked at frequency of meals in US adults 40 years of age and older.
The study also indicated that eating one meal per day — compared with three — is associated with shorter lifespans.
The findings may raise questions about the health benefits of limiting both the number of and interval between meals across the day, said the lead author.
“At a time when intermittent fasting is widely touted as a solution for weight loss, metabolic health, and disease prevention, our study is important for the large segment of American adults who eat fewer than three meals each day. Our research revealed that individuals eating only one meal a day are more likely to die early than those who had more daily meals.”
Participants who skip breakfast are more likely to develop fatal cardiovascular diseases, while those who skip lunch or dinner increase their risk of death from all causes compared with those who eat three meals a day, the study showed. Based on these findings, they researchers recommend eating at least two to three meals spread throughout the day.
The study also showed that among those people who do eat three meals per day, an average interval between any two meals of 4.5 hours or less was associated with a higher risk of premature death.
Not When We Eat but What We Eat
Some nutritional researchers have questioned the results of the study.
One critic pointed out that the devil is in the details, noting the researchers did not consider the number of calories consumed, and most importantly, the medical conditions of the participants in the study.
“They had these great results that basically indicate that skipping a meal is bad for you no matter how you parse it,” one critic said, but added that “unfortunately, when they removed everyone who had cancer or heart disease to start with, almost nothing is statistically significant anymore.” This research suggests association not causation, the critics pointed out.
They pointed to earlier studies that showeda difference in weight loss favoring participants who skipped breakfast. The quality of what we eat rather than its timing is far more important, especially the avoidance of ‘junk foods’ they added. Sugar in the diet was likely to account for the largest part of the relationship between junk foods and early death.
How Was the Study Conducted?
According to a 2009-2010 US Government study, 40% of Americans skip meals and at least one in five skip breakfast or lunch. “We already know that skipping your breakfast is not a good idea for heart health, but we wondered about other meals of the day, like lunch and dinner. Also, we wanted to know whether the intervals between meals were associated with premature death,” said one of the current researchers.
A total of 24,011 adults aged 40 years or older participated. The findings, said the research leader, may be directly translated to the general population.
Eating behaviors, including surveys of 24-hour recall of foods and beverages and times of eating, were collected between 1999-2014, and using mortality data any potential associations between eating behaviors and mortality, including those specific to cardiovascular death, were calculated.
Reduced Intervals Between Two Meals Show Worse Outcomes
Results were calculated about the associations between premature death and 1) meal frequency 2) intervals between two meals, and 3) skipping meals.
When the frequencies of meals across the day were linked to death due to cardiac issues results showed that the fewer the number of meals, the greater the mortality.
However, when participants with diagnosed CVD and cancer were excluded from the analysis, the results related to meal frequency were no longer significant.
Regarding the relative effect of skipping any meals, compared with skipping none, researchers found that missing breakfast had a no connection with all-cause mortality but a significant connection for cardio-vascular-related deaths.
Skipping lunch was associated with a significant increase in all-cause mortality, but a nonsignificant increase for cardio-vascular-related mortality. Similarly, skipping dinner was significant for all-cause but not for cardiovascular-related death.
Mixed Results
And when researchers looked at the intervals between meals, they found mixed results. Eating at intervals of 4.5 hours or less or more than 5.5 hours was significantly associated with all-cause mortality but not associated with heart-disease mortality.
Food Insecurity Blamed as Primary Cause
The authors of the study point out several possible reasons why skipping meals is a probable risk factor for disease and mortality. Firstly, they point to food insecurity, which has been shown to be associated with higher heart disease risk.
Food insecurity is defined as the limited or unknown availability of nutritional and safe foods for everyone in a household to meet their basic needs. During the pandemic, food insecurity rose among Black and Hispanic households, single-parent households, and households with children. More people also enrolled in government programs combating food insecurity compared to pre-pandemic years.
Despite the current administration’s recent pledge to end food insecurity in America by 2029 through an expansive government effort, year over year food prices have risen in 2022 at their greatest level in forty years.
Skipping meals is hazardous
Also skipping breakfast, in particular, might be a behavioral marker for unhealthy dietary and lifestyle habits, according to the researchers. They also highlight that skipping meals usually means eating meals with a larger energy load, which could aggravate the burden of glucose metabolism regulation, leading to metabolic deterioration.
This could also explain the association between a shorter meal interval; for example,4.5 hours, and mortality, as a shorter waiting time in between meals also means a larger energy load in a given period of time.
More Study Needed
Noting the mixed and somewhat confusing results, the researchers concluded that these findings need replication and assessment in other populations.
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Source: Medscape Family Medicine. By Becky McCall. December 1, 2022
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A Dose of Holiday Humor
