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Behavioral Science, Health and Fitness, Obesity, Public Health, Sleep

How insufficient sleep can lead to weight gain

How insufficient sleep can lead to weight gain


I don’t think I’ve ever met a person who hates sleep and can’t wait to get less of it. Yet, even though most people want more sleep and know it’s important for their health, few people get as much shut-eye as they need. If you’re one of the many who needs a bit more motivation to get to bed earlier, a recent BeWell@Stanford article on how sleep can affect your weight may do the trick.

In the Q&A, sleep expert Emmanuel Mignot, MD, PhD, director of the Stanford Center for Sleep Sciences and Medicine, explains why and how insufficient sleep can increase your risk of weight gain:

It is very clear that if you’re not sleeping enough, you’re putting yourself at risk for increasing your weight.  If you sleep less than six hours a night, you’re likely to have a higher BMI (body mass index). Longitudinal data — and the evidence is quite strong — shows that if you sleep more over time, you’ll lower your BMI, which correlates with weight reduction.

In the first centuries of human life on earth, if humans weren’t sleeping they were probably looking for food or fleeing a predator. Not sleeping enough was a sign that we were in danger or that we were under stress. When we are sleep deprived, we feel hungry. Data indicates that if you sleep less, you eat more, and it disrupts your hormones. This problem is magnified in today’s world because food is too available!

Mignot also discusses the top reasons why people sleep so little, the importance of naps, and how being sleep-deprived skews our perception of doing and performing well. “[W]e have to make sure we don’t burn the candle at both ends, Mignot said. “Sleeping brings creativity, productivity and the ability to perform at a higher level.”

The piece is a quick, and informative, read.

Previously: Exploring the history and study of sleep with Stanford’s William Dement“Father of Sleep Medicine” talks with CNN about what happens when we don’t sleep wellStanford doc gives teens a crash course on the dangers of sleep deprivation, Narcoleptic Chihuahua joins Stanford sleep researcher’s family and More evidence linking sleep deprivation and obesity
Photo by Goodiez

Medical Education, Medical Schools, Mental Health, Stanford News

A call to action to improve balance and reduce stress in the lives of resident physicians

A call to action to improve balance and reduce stress in the lives of resident physicians

4086639111_a7e7a56912_zIn November of 2010, those in Stanford’s general surgery training program experienced an indescribable loss when a recently graduated surgical resident, Greg Feldman, MD, committed suicide. His death wound up being a call to action that brought about the Balance in Life program at Stanford, according to program founder Ralph S. Greco, MD.

With the Balance in Life program now in its fourth year, Greco; chief surgical resident Arghavan Salles, MD, PhD; and general surgery resident Cara A. Liebert, MD, have learned much about the daily stresses that resident physicians face. In a recent published JAMA Surgery opinion piece they wrote:

As physicians, we spend a significant amount of time counseling our patients on how to live healthier lives. Ironically, as trainees and practicing physicians, we often do not prioritize our own physical and psychological health.

A recent national survey found that 40% of surgeons were burnt out and that 30% had symptoms of depression. Another study reported that 6% of surgeons experienced suicidal ideation in the preceding 12 months. Perhaps most startling, there are roughly 300 to 400 physicians who die by suicide per year—the equivalent of 3 medical school graduating classes.

Greco, Salles and Liebert explain that the Balance in Life program is specifically designed to help resident physicians cope with these stresses by addressing the well-being of their professional, physical, psychological and social lives. To accomplish this goal, the program offers mentorship and leadership training activities; dining and health-care options that are tailored to the residents’ busy schedules and needs; confidential meetings with an expert psychologist; and social events and outdoor activities that foster support among residents.

The authors concede that the program may not fix every stressful problem that their residents face, but it does let the residents know that their well-being is important and valued. “This may be the most profound, albeit intangible, contribution of Balance in Life,” the authors write.

Although the program (and the JAMA article) is geared for people in the medical field, it’s not much of a stretch to see how its core principles can apply to any work setting. Learning how to manage stress and reach out to colleagues for support is a valuable skill and, as the authors write, to provide expert care for others you must first take good care of yourself.

Previously: After work, a Stanford surgeon brings stones to lifeSurgeon offers his perspective on balancing life and workProgram for residents reflects “massive change” in surgeon mentality, New surgeons take time out for mental health and Helping those in academic medicine to both “work and live well”
Photo by Gabriel S. Delgado C.

Scope Announcements

A Memorial Day break

A Memorial Day break


We’re off today in honor of Memorial Day. Scope will resume publication tomorrow.

Photo by Vjeran Pavic

Humor, Medical Education, Medicine and Society

University of Glasgow medical student makes learning anatomy a feast for the senses

Areo Oli_Mike McCormick_560

If you’ve ever heard the phrase “you are what you eat” and playfully wondered which part of you is composed of coffee and sweets, take a peek at the gallery of artwork called CandyAnatomy. These candy creations are the work of Mike McCormick, a medical student at the University of Glasgow. Recently, I reached out to McCormick to learn more about his inventive works of art and how they came to be. Here’s what he had to say.

How did CandyAnatomy begin?

CandyAnatomy was born out of the realization that I could be as nerdy as I wanted and the only repercussion was that it might make me a better doctor. [While getting] my previous degree, Physiology (Hons) at the University of Edinburgh, I’m pretty sure I would be laughed out of town for being so embarrassing, but medicine rewards absorbing as much information as you can. I would draw muscles, nerves and blood supply with a sharpie on my arm; convert anything I could to mimic a biological system; and candy was just so full of possibilities that would also make tasty snacks!

Do your creations help you learn the material you study in medical school, or does the art serve another purpose?

Yes, the creations do make it easier for me to learn the subject. I take time to consider what sweets most resemble the cells or structures in question; this helps me remember. Good examples might be the Aero Bubbles, whose high surface area resembles alveoli, or using a jelly snake to remind me about serpentine receptors.

Why did you choose to use candy in your artwork? Do you have a sweet tooth?

Ha, ha – honestly I’m a child of two dentists, so candy is probably forbidden! But… I’m showing candy can be used for something other than eating, so perhaps that’s setting a better example from a dental perspective! I actually just use the candy because the colors make for a very vibrant image, people want to eat them, and because I don’t actually eat them they will last longer before they go out of date. I’ve used a little SavouryAnatomy, but it doesn’t last very long!

What inspired the artwork (featured above) “Aero-Oli”?

I had been searching for an idea to detail the site of gaseous exchange. We had been doing a few weeks of respiratory anatomy and pathology, and I didn’t just want to produce two lungs out of candy, as it’s not very eye-catching. When shopping, I spotted the Aero Bubbles and I just had to [use them]. I like this image because it explores the structure [at different magnifications, much] like switching the power of a microscope. It shows the smooth muscle around the bronchioles that play an important role in asthma, and it also details the capillary network (surrounding the alveoli) that oxygenates the blood and removes waste products.

Thinking about your future, what area of medicine are you planning to pursue?

In the future I’m considering becoming a surgeon because I like working with my hands, dissecting and learning anatomy. However, pediatrics might be another alternative as clearly CandyAnatomy would be a good way to explain medical situations to children.

Previously: Image of the Week: A playful take on the human respiratory systemImage of the Week: VeggieanatomyImage of the Week: Quilled anatomyKitchen anatomy: Brain carved from a watermelon and Virtual dissection table helps teach human anatomy
Via Laughing Squid
Artwork courtesy of Mike McCormick

Chronic Disease, Global Health, Medical Apps, Stanford News

Reporting and treating cholera: Soon, there could be an app for that

Reporting and treating cholera: Soon, there could be an app for that

8424972981_35858721c7_zIn the aftermath of the 7.0 magnitude earthquake that shook Haiti in January 2010, clean water for drinking and hygiene was scarce. This set the stage for the largest cholera outbreak in recent history, killing an estimated 6,631 people. Now that a devastating 7.8 magnitude earthquake has hit Nepal, a similar situation may be in the works. Eric Jorge Nelson, MD, PhD, a pediatrician and cholera expert, is working to change this scenario with a smartphone app that he and his team are developing for use in places at high-risk for cholera outbreaks.

Although disasters and cholera often go hand in hand, the disease is also a perennial problem in places like Bangladesh and Nepal, where monsoons routinely overflow sewers and contaminate water supplies, Nelson explained. In areas such as these, about 2.8 million cases of cholera occur each year.

Time is of the essence when reporting and treating cholera. “The time it takes from when a person ingests the bacterium [Vibrio cholerae], becomes sick with diarrhea, and dies can be less than 24 hours,” Nelson told me during a recent conversation. If untreated, as many as half of the people with cholera can die, but the mortality rate drops to less than one percent if treated in time.

Therein lies the rub, Nelson explained. Many cholera-stricken areas have limited access to electricity and the tools that disease experts and doctors need to rapidly report and respond to a cholera outbreak. “The reporting mechanisms are often six-weeks delayed,” Nelson said. “We need a way to help hospitals; they need an ongoing system to provide real-time data.”

To address this problem, Nelson and his colleagues are creating a smartphone app with the aid of a $1.25-million Early Independence Award from the National Institutes of Health. Their first goal is to develop and deliver the app to doctors working in hospitals in Bangladesh, where cholera is common.

The app is a series of four pages that prompt the doctor to collect data that helps them report, diagnose and treat patients with cholera. It also contains a checklist of “danger signs” that doctors may fail to notice; this list reminds him or her to look for other illnesses that could mask or mimic cholera.

Perhaps the best feature of the app is that it’s fast. “If English is your first language, you can get through the app in roughly 60 seconds. If English is your second language, it takes about two minutes,” Nelson told me.

Continue Reading »

Cardiovascular Medicine, Medical Education, Research, Stanford News

Stanford med student/HHMI fellow testing new way to deliver treatment to heart

Stanford med student/HHMI fellow testing new way to deliver treatment to heart

Jensen and Woo 560

The human heart has fascinated second-year medical student Christopher Jensen ever since he first flipped through anatomy books as a child. Now, the Howard Hughes Medical Institute (HHMI) has given Jensen a special opportunity to pursue his passion.

Jensen is one of 68 medical students from across the U.S. chosen to take part in the HHMI Medical Research Fellows Program. This program gives medical students a chance to try their hand at research by offering them funding, mentorship and a full year to explore the medical research project of their choice.

Recently, I spoke with Jensen about his interest in the heart and his HHMI project. “I was homeschooled,” Jensen told me. “My parents bought me books on biology and I thought that anatomy – the heart in particular – was fascinating.”

Later, when Jensen studied biology at school, his interest grew: “The more I learned about the heart, the more I wanted to understand it better. I was in awe and wonder of how this one organ could supply blood for the whole body.”

Jensen’s curiosity about the heart led him to Stanford where he met his HHMI mentor, Y. Joseph Woo, MD, chair of Stanford’s Department of Cardiothoracic Surgery. “When I saw Woo’s work I was enthralled,” Jensen said.

Jensen’s one-year research project with Woo will focus on a growth factor, called Neuregulin-1ß, that plays an essential role in the development of heart, skin and brain cells. “We’ve already demonstrated neuregulin’s ability to rescue and regenerate heart muscle immediately after a heart attack,” Jensen told me.

In these studies, Neuregulin-1ß is given during surgery as an injection to the heart. This delivery method prevents neuregulin from acting on the entire body (which could have negative side effects) but it limits this treatment to surgical procedures. Jensen’s goal is to develop a non-surgical way to target heart cells with the neuregulin treatment so it can quickly be given to a patient after they have a heart attack.

Over the next year, Jensen and Woo will test a special hydrogel that could provide a way to transport neuregulin through the veins to targeted tissues in the heart. The hydrogel, Jensen explained, forms a gummy, slow-dissolving solid when it reaches the heart. This therapy could help cardiac surgeons target heart cells with Neuregulin-1ß for long periods of time whenever the treatment is needed. “This would be a phenomenal advancement and could pave the way for minimally invasive therapies in the hospital,” Jensen said.

“I’m excited about this research,” Jensen told me. “It could lead to other work in the field or a career in cardiac surgery and research.” It also possible that, one day, it could lead to a therapy to treat patients suffering from heart failure.

Previously: A new era for stem cells in cardiac medicine? A simple, effective way to generate patient-specific heart muscle cells
Photo courtesy of Christopher Jensen

Behavioral Science, Mental Health, Research

Type of verbal therapy could reduce PTSD risk among trauma victims

Type of verbal therapy could reduce PTSD risk among trauma victims

217849066_f011b26437_zTurning on the bedroom light can knock the teeth out of all kinds of terrors. This same concept – seeing things as they are, not as we fear them to be – also forms the basis for many therapies used to treat the estimated 5.2 million people living in the U.S. with post-traumatic stress disorder (PTSD). Now, research shows that treating a victim of trauma with a certain type of therapy within six hours of the event – when most memories are formed – can reduce his or her risk of developing PTSD.

In the study, researchers from King’s College London and the University of Oxford investigated the effect of two treatments: “updating” therapy, where the patient talks about traumatic memories to update them with more factual information, and “exposure” therapy where the patient revisits the source of fear to decrease its emotional effect. These two techniques were applied to 115 participants after they watched six film clips containing real-life footage of humans and animals in distress.

The researchers found giving the participants “information about the fate of the films’ protagonists” (i.e., using the updating technique) significantly reduced the occurrence of fearful feelings, and it reduced these intrusive thoughts better than the exposure treatment and no treatment at all.

As psychologist and lead author Victoria Pile, PhD, explains in a press release, this study is important because there are currently no established therapies to help victims of trauma fend off PTSD. And, she said, “this research implies that finding out what actually happened as soon as possible after the trauma might change the way the memory is stored and so limit the devastating effects of PTSD.”

The researchers note that these findings could be especially helpful for people who are routinely exposed to traumatic situations, such as emergency service workers, military personnel and people working in conflict zones.

Previously: Study shows benefits of breathing meditation among veterans with PTSDExamining the scientific evidence behind experimental treatments for PTSDUsing mindfulness therapies to treat veterans’ PTSD and In animal study, sleep deprivation after traumatic events lowers risk of PTSD symptoms
Image by Capture Queen

Health and Fitness, In the News, Sleep, Videos

“Father of Sleep Medicine” talks with CNN about what happens when we don’t sleep well

"Father of Sleep Medicine" talks with CNN about what happens when we don't sleep well

Dement - smallA good night’s sleep is often the first thing to go when we have an important work deadline or health issue. I know this from firsthand (and recent!) experience: I let a foot injury kept me up until 4 a.m. today even though I know that cheating sleep – or getting a poor night of sleep – is bad for my health.

But is skimping out on sleep now and again really that bad? As Chief Medical Correspondent Sanjay Gupta, MD, and Stanford sleep expert William Dement, MD, PhD, explain in a recent CNN feature: yes. When we rest, our bodies go to work, Gupta explains: “When your head hits the pillow, your body doesn’t shut down. It uses that time to heal tissue, strengthen memory, even grow.”

Dement, who founded the Stanford Center for Sleep Sciences and Medicine in the 1970s and has devoted his career to understanding sleep, has lots of experience with patients who miss out on these benefits because they don’t sleep well – due to obstructive sleep apnea. (The disorder, he says, affects 24 percent of adult males in the U.S.) In the piece, he and Gupta discuss the risk factors, such as excess weight and large tonsils, linked to sleep apnea and what can be done to alleviate the problem.

If you have a few minutes, this video is worth a watch. Dement makes his first appearance at the 2.5-minute mark.

Previously: Stanford doc gives teens a crash course on the dangers of sleep deprivationWilliam Dement: Stanford Medicine’s “Sandman”Stanford docs discuss all things sleep, Why untreated sleep apnea may cause more harm to your health than feeling fatigued and What are the consequences of sleep deprivation?
Photo, which originally appeared in Stanford Medicine, by Lenny Gonzalez

In the News, Media, Science

Science enthusiasts flock to #IAmAScientistBecause and #BeyondMarieCurie on Twitter

Science enthusiasts flock to #IAmAScientistBecause and #BeyondMarieCurie on Twitter

iamascientistbecause tweet - smallRecently, a friend of mine commented that scientists “don’t use Twitter much.” The statement may have been true in the past, but as evidenced by #IAmAScientistBecause and #BeyondMarieCurie, scientists and science enthusiasts are now driving some trending topics on Twitter.

Yesterday, a story on explained how these two popular hashtags have encouraged scientists to speak out. The first was created by the NatureCareers team in summer 2014, and the hashtag’s popularity suddenly increased earlier this week after Jon Tennant (@Protohedgehog), a graduate student studying paleontology at Imperial College London, shared the hashtag with his 6,000 some followers on Twitter. By Tuesday, the hashtag was trending on Twitter.

The resulting flood of tweets rallied scientists like epidemiologist Chelsea Polis, PhD, (@cbpolis) who told she spent a day following the IAmAScientistBecause Twitter campaign online. “Despite all of the negatives, there’s so much that’s beautiful about science,” Polis said.

Meanwhile, a separate empowering conversation began when science editor Melissa Vaught (@biochembelle) tweeted about Rachel Swaby’s (@rachelswaby) story on scientific achievements made by women. In her story, Swaby states that one woman tends to dominate conversations of female scientists and that we need to open our eyes to the many contributions other female scientists have made, and are making, to science:

Today if you ask someone to name a woman scientist, the first and only name they’ll offer is Marie Curie. It’s one of the biggest obstacles to better representation of women in science and technology, and it’s time to cut it out. Stop talking about Marie Curie; she wouldn’t have wanted things this way.

Vaught told that she created #BeyondMarieCurie as a response to Swaby’s article because “we need diverse stories of women in science.”

As I scrolled through the hundreds of Tweets aggregated by the two hashtags one post in particular stood out. As shown above, chemist Carina Jensen, PhD, (@Chem_Monkey) tweeted, “IAmAScientistBecause a professor said women don’t do well in Chemistry. I proved him wrong.” For me, this unites the sentiments of the two hashtags beautifully.

Previously: The power of social media: How one man uses it to help amputees get prostheticsA day in the lab: Stanford scientists share their stories, what fuels their workChipping away at stereotypes about older women and science, one story at a timeWhat’s holding women in the sciences back? and Women in science: A rare breed

Patient Care, Research, Stanford News

Patients who have a good emotional fit with their doctors are more likely to follow their advice

Patients who have a good emotional fit with their doctors are more likely to follow their advice

15633607804_fb1e60c03c_zGetting patients to trust – and take – their doctor’s advice isn’t always easy. In the United States alone, an estimated 40 percent of patients in certain disease groups struggle to follow their doctor’s recommendations.

A recent Stanford News story highlighted the importance of feeling emotionally aligned with your doctor. Patients are more likely to listen to, and approve of, doctors that convey the emotions and states they’d like to have.

In the study (subscription required, pdf here), psychologist Jeanne Tsai, PhD, and postdoctoral fellow Tamara Sims, PhD, recruited 101 adults from the San Francisco Bay Area to answer a series of questions about their health and emotional state.

Each participant received recommendations, such as “do muscle strengthening” or “rest,” from a virtual physician that focused on either “high arousal” or “low arousal positive states.” Participants that received advice from the “high arousal” virtual doctor were told to do activities that would increase their energy levels, while participants that got advice from the “low arousal” doctor were advised to take steps to help them relax.

For the next five days, participants reported how well they adhered to their virtual doctor’s advice, how calm or energized they felt, and how relaxed or energetic they wanted to feel. At the end of the five-day period, each participant ranked their virtual doctor’s competence, knowledge, and trustworthiness.

The researchers found that participants who wanted to feel more energized were more likely to prefer and listen to the advice of the high-energy doctor. Participants who wanted to feel more relaxed were more likely to favor and adhere to advice from the low-energy doctor.

As Tsai explains in the story, the importance of this study is that doctors may be able to encourage their patients to trust and take their advice more often if they make it a priority to identify their patient’s health goals first and then tailor their treatments accordingly.

Previously: Study explores how cultural differences can shape the way we respond to sufferingA call for extended bedside-manner trainingAbraham Verghese discusses reconnecting to the patient at the bedside and Hands on: Abraham Verghese teaches bedside skills
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