Are You Getting Too Little Sleep?

A lot has been said recently about the adverse effects of not getting enough sleep. These range from accidents, big and small, to heart attacks, depression, forgetfulness, weight gain, and....(the list goes on). But individuals vary in their need for sleep. For some, the "classic" 8 hours sleep is just right. For others, 7 or 9 hours is the right number. And the need may change with age and other circumstances.
So how do you know if you're getting enough sleep? If you're inappropriately sleepy during the day, you may not be getting enough sleep.

The simple questionnaire shown below (known as the Epworth Sleepiness Questionnaire) was developed to assess your daytime sleepiness.For each of the 8 questions, circle the most appropriate level. Don't skip any question.

0 -  there is no chance you would doze or sleep

1 -  there is a slight chance of dozing or sleeping
2 - there is a moderate chance of dozing or sleeping
3 - there is a high chance of dozing or sleeping

Situation Chance of Dozing or Sleeping    Sitting and reading    Watching TV 0     1       2     3 0     1       2     3    Sitting inactive in a public place 0     1       2     3    A passenger in a car for an hour or more 0     1       2     3    Lying down in the afternoon 0     1       2     3    Sitting and talking to someone 0     1       2     3    Sitting quietly after lunch (no alcohol) 0     1       2     3    Stopped for a few minutes in traffic       while driving 0     1       2     3 Total score (add up all circled numbers) __________

A score of 10 or higher may indicate that you are not getting enough sleep. It just doesn't tell you the reason.

A score of 18 or above is considered "very sleepy." Further evaluation may be needed to look for the cause, which may include the high risk condition of sleep apnea.

If you are concerned, seek advice. We're here to help.

Vitamin D - For Me?

Vitamin D deficiency in the US is wide spread, affecting more than 40% of the people. Vitamin D is also known as the "sunshine vitamin," and the deficiency is much more prevalent in the northern states and in dark-skinned people. It is also more common in the elderly and the obese. Interestingly, vitamin D is synthesized in the skin from HDL cholesterol (the "good cholesterol"), and people with a very low HDL cholesterol also tend to be more prone to vitamin D deficiency.

In our practice, we check blood vitamin levels routinely, and found that, of those not previously tested, more than 50% were vitamin D deficient.

But why check the vitamin D level?

1. In women, Vitamin D plus calcium supplementation helps reduce dangerous hip and vertebral fractures (I'm sure it also happens in men, albeit to a lesser extent). It's an important factor in the prevention of bone thinning in general, especially with advancing age, and in the prevention of the bone pain often associated with bone thinning (osteoporosis and osteopenia).


2. Women who took vitamin D supplements for an average of 7 years, in an extensive study, had a 13% lower incidence of breast cancer.


3. People with low vitamin D levels have a significantly higher risk of fatal heart attacks, about 27% higher, a frightening statistic (fatal heart attacks account for more than 400,000 deaths a year in the US).


4. It has been strongly suggested, although not fully scientifically proven, that Vitamin D helps keep Diabetes type II (the common type) under better control.


5. Some cancers may be reduced in people who take vitamin D supplements, or who normally have higher (but still normal) vitamin D levels: Colorectal, breast, prostate and pancreatic.


6. There is a marked increase in uterine fibroids in women who have low vitamin D levels.

Except for the effect on bone, where the picture is quite clear, it is not fully understood why all this happens. Is it because people with a naturally normal D level, or those who take supplements simply benefit from having a more acceptable D level? Or is it because these people have other beneficial lifestyles that bring their D levels to normal and at the same time reduce their risk for associated diseases?

I don't know the answer, but I don't recommend taking a chance.

Some of the best, and desirable, food sources for vitamin D include the oily fish salmon, mackerel and tuna, and fortified milk (skimmed or low fat, of course). Others include cod liver oil, beef or calf liver, and egg yolks (do you really want to do that? It will do wonders to your cholesterol).

Vitamin D levels may fluctuate with time, especially with the change of seasons and more so in the north. So you have to check the level periodically.

Does this give you enough reason to have your vitamin D level checked? If it doesn't, talk to me!

This article, as well as some of my other articles, was also published at: http://ezinearticles.com/?Vitamin-D,-To-Take-or-Not-To-Take?&id=8228492

You Call This Exercise?

I saw joggers outdoors through my window. I'll stay indoors, but I'll pedal...

Holiday Weight Gain

We used to believe that the average American adult gained 5 or more pounds during the holiday season, between Thanksgiving and New Year. But a study published in the New England Journal of Medicine (NEJM) in 2000 changed all that. It concluded that the average Holiday Season weight gain was "only" 1 pound.

But this just didn't sound right. As many of you know, my practice had a weight management division for over 25 years, known as Health Extenders, where we followed a large number of patients for their weight and behavior over long periods of time, including the holiday period. We never believed the 1 pound weight gain, and I still believe it's much higher than that.

Revisiting the NEJM article recently, the study was relatively small, including only 200 people. In reality, the study showed that perhaps 3 pounds were gained during the actual holiday season, and that one of these three pounds was still "retained" during the following 6-9 months. In addition, the study did suggest that, the heavier you are, the more you are likely to gain weight during the holiday season. The statistical variability between individuals was, in my opinion, too wide to render a scientifically valid opinion.

So what's the lesson? Weight gain during the holiday season is still a real problem, which, if it goes unchecked, can lead to ongoing weight gain. Taken cumulatively over several years, this can indeed become a real health hazard.

Especially during this holiday season, please be selective in your choice of foods. Politely reject the fatty cuts of beef, the skin on the chicken, the fried food, and, yes, the white wheat products and sugar. Choose the leaner cuts of meat (even lean pork is OK today), chicken, turkey and fish. Don't forget whole wheat bread and pasta, and use Stevia instead of sugar to sweeten your drinks. Exercise, not only to help maintain a lower body weight, but also as a relaxation method.

Above all, enjoy the holiday season, your friends and family, and drive responsibly.

Statins – To Take or Not to Take?

And the controversy rages on. If you followed the article Experts Reshape Treatment Guide for Cholesterol and the editorial Don’t Give More Patients Statins in the New York Times in the last two days, you’d see the breadth of the issue.

The problem is that, while heart disease is the number one cause of death in the US, most heart disease is not necessarily caused by an elevated cholesterol or abnormal cholesterol pattern. The number one cause of premature heart attacks (and overall mortality) is smoking!

It is quite clear that people who have already had a heart attack are at a high risk for a subsequent heart attack, and those with type 2 diabetes carry a similar risk. These people should be treated with statins, if possible. Most experts agree.

But...
What is one to do with the healthy person who has a high LDL (“bad cholesterol”), a family history of heart attacks, and faulty lifestyles such as eating the wrong foods and not exercising? Some people simply get away with it – without statins. According to the new guidelines, these people should still get statins, even if in retrospect they should not have had them. So how do you know who will “get away with it?” You don’t know for sure, but you try to better assess their risks.

Besides the usual physical examination and lab results, additional testing may be in order. This may include more sophisticated blood tests, such as those done by Berkeley Heart Lab or Boston Heart Diagnostics, and a variety cardiac stress testing (simple, radionuclear, or ECHO).

When there’s still a question, a non-invasive CT scan of the coronary arteries can be performed. This test determines the amount of calcium in the major coronary arteries. The higher the “calcium Score” the greater the risk of a future heart attack.

In my practice, I’ve had a fairly large number of patients with very high total cholesterol  and “bad cholesterol” levels who lived, or still living, with no statins and no heart attacks to a ripe old age.

So, my take is that statins are not for everyone, and a reasonable attempt should be made to identify those who are at an increased risk for a heart attack. And then treat.

Low Glycemic Index Foods – Why Bother?

After a meal blood sugar levels usually rise. To keep the blood sugar in check, insulin levels rise, and then return to normal, in order to bring blood sugar levels back to normal.. There are many reasons to keep both blood sugar and insulin levels within acceptable limits, but most important are the control of diabetes, cholesterol, and weight.

Keeping you sugar under control helps curb appetite- that’s how it helps you lose weight.

The foods that raise your blood sugar the most, the culprits, are “simple carbohydrates” (or simple carb’s): Sugar, high fructose corn syrup, and highly processed wheat products (mainly white flour).

The “good carbohydrates” are complex carbohydrates such as whole wheat products and a host of vegetables, legumes and some fruits (don’t forget the grapefruit, the season is approaching…).

The Glycemic Index (GI)is a measure of the blood sugar rise after a test amount of a given food is ingested. The Glycemic Load (GL) is a measure of the sugar level rise after a regular portion size amount of the same food is ingested.  The lower the numbers, the better the food.

You can find many GI and GL tables on the internet. A reliable source is the one by Berkeley Labs. Use it.

Any question? You know where I am.

Curb Your Sweets

I need not tell you the dangers of dietary sweets/sugars, especially if you have, or are at risk for, diabetes. Here are some hints for curbing your sweet-craving:

• Start the day with a balanced meal of protein, vegetables (yes, vegetables for breakfast) and complex carbohydrates. This will allow your blood sugar to rise slowly and gradually, as it should, and avoid a “sugar rush.”
• Avoid eating “light bread” made of wheat flour, which is made of simple carbohydrates. Have whole wheat bread instead of light bread, sweetened crackers, white rice, or potatoes.
• Incorporate into your meals complex carbohydrates: whole wheat products, corn, beans, peas, lentils, whole grain rice.
• Try to eat something as frequently as every three hours, in order to not deplete your energy stores, and to avoid sugar craving. A piece of fruit or whole wheat cracker may do.
• Get enough sleep. Tired bodies demand immediate energy in the form of simple carb’s.
• Have some sun exposure. Avoid staying in dark environments most day (as you may do in the office). Lack of sun exposure causes a decrease in serum serotonin, which causes relative depression and an increase in sugar craving. A little bit of Chocolate (70% cocoa, please) will increase serotonin level, and may elevate the mood.
• A boring lifestyle, associated with low serotonin, drives sweet craving. So keep busy. Exercise, yoga, or spending  quality time with someone will help a lot.
• You don’t have to totally abstain from sweets. Have a measured amount of your favorite candy periodically – every day, two days, or a week. Don’t eat it all at once, leave some for tomorrow.

Have a great day, without the sweets...