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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

Autoimmune Disease, Chronic Disease, Health and Fitness, Nutrition, Obesity, Research

Study clarifies link between dieting, exercise and reduced inflammation

Study clarifies link between dieting, exercise and reduced inflammation

4503404991_13da58b6e6_bIf you’ve ever wondered how dieting and exercise reduce inflammation, read on. According to new research, a compound that our bodies crank out when energy supplies are low could be the link between diet and exercise, and reduced swelling in the body.

When diet, fasting and exercise starve the body for calories, the body increases production of a compound called beta hydroxybutyrate (BHB). This compound has long been known as an alternate source of energy; the new research suggests that BHB can also block the inflammatory response.

In their study, published this week in Nature Medicine online (subscription required), a team of scientists co-led by Yun-Hee Youm and Kim Yen Nguyen at the Yale School of Medicine, discovered that the compound BHB reduces swelling in the body by inactivating a group of proteins, called the inflammasome, that drive the inflammatory response.

The research team used human immune cells and mice to explore the effects of BHB in the body. They found that mice given BHB directly, and mice fed a low-carbohydrate diet (that prompted their bodies to synthesize their own BHB), both benefited from reduced inflammation.

These results are noteworthy because a better understanding of the mechanism that links diet, exercise and inflammation could help scientists develop more effective treatments for inflammatory disorders such as Type 2 diabetes, atherosclerosis and Alzheimer’s disease.

Previously: Newly identified type-2 diabetes gene’s odds of being a false finding equal one in 1 followed by 19 zeroesImproving your health using herbs and spices, Exercise may alleviate symptoms of arthritis regardless of weight loss, Study points to inflammation as cause of plaque buildup in heart vessels and Examining the role of exercise in managing and preventing diabetes
Via ScienceDaily
Photo by Dave Nakayama

Cardiovascular Medicine, Health and Fitness, Public Health, Research, Women's Health

Even moderate exercise appears to provide heart-health benefits to middle-aged women

Even moderate exercise appears to provide heart-health benefits to middle-aged women

woman on bike

It’s no secret that exercise offers a plethora of health benefits; tons of research has established that. But I was still heartened to read about a new study showing that physically active middle-aged women had lower risks of heart disease, stroke and blood clots than did their inactive counterparts. (I read about the work on my phone as I walked home from a barre class last night, which made me feel especially happy about having had just worked out.)

Researchers from University of Oxford looked at data from 1.1 million women in the United Kingdom, who were followed for an average of nine years. From an American Heart Association release:

In the study:

  • Women who performed strenuous physical activity— enough to cause sweating or a faster heart beat — two to three times per week were about 20 percent less likely to develop heart disease, strokes or blood clots compared to participants who reported little or no activity.
  • Among active women, there was little evidence of further risk reductions with more frequent activity.

Physical activities associated with reduced risk included walking, gardening, and cycling.

Lead author Miranda Armstrong, MPhil, PhD, commented that “inactive middle-aged women should try to do some activity regularly,” but then noted that the results suggest that “to prevent heart disease, stroke and blood clots, our results suggest that women don’t need to do very frequent activity.” That’s good news, ladies!

The study appears in the journal Circulation.

Previously: Lack of exercise shown to have largest impact on heart disease risk for women over 30, Exercise is valuable in preventing sedentary death, Study shows regular physical activity, even modest amounts, can add years to your life, CDC report shows exercise becoming a popular prescription among doctors and Brisk walking reduces stroke risk among women
Image by Thomas Hawk

Health and Fitness, Nutrition, Public Health

Why establishing a health baseline is a “critical starting point for achieving future health goals”

Why establishing a health baseline is a "critical starting point for achieving future health goals"

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Raise your hand if you want to be more successful at achieving health goals, such as losing weight or lowering your cholesterol levels, and maintaining a healthy lifestyle. Perhaps it’s time to consider creating a health baseline. “A health-care baseline is essentially where you are “at” on the broad, complex spectrum of physical, mental and emotional health,” explains Mary James, MD, an internal medicine physician at Stanford. “This can be a critical starting point for achieving future health goals.”

On Thursday, James will deliver an in-depth talk on the benefits of partnering with your primary care provider to establish a health baseline as part of the Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In anticipation of the event, I contacted James to learn more about why its important to have a basis for comparison, beyond the ever-fluctuating number on your bathroom scale or if you’re able to fit into your skinny jeans, to use in measuring progress in meeting your health goals. Below she discusses how assessing the state of your health now can pay off in a longer, more active life in the future.

What is a health baseline?

Your baseline has two basic components: existing illness and potential future illness. Your current baseline has been shaped by your medical, social and family history and is constantly being influenced by common factors in everyday life. Although some components of your healthcare baseline are more modifiable than others, it is important to have an accurate understanding of your current health status.

Why is it important to determine your personal health baseline?

You may be thinking, “I’m healthy – I take no medications and never go to the doctor. Why should I start now?” There are two fundamental components to good health. They are: appropriate treatment for current illness and appropriate preventative care to reduce health decline in the future. While most people actively seek care for the former, we often forget about the latter. Although the data is mixed on whether “routine check ups” are beneficial, there is strong evidence behind many of the preventative maneuvers that are typically discussed and ordered at these visits. Taking appropriate preventative health-care steps can help you avoid the need for prescription medications, hospitalizations and procedures and can help ensure a longer, healthier life.

How can establishing a health baseline help you be more successful in reaching personal wellness goals?

Many wellness goals start with changes in diet and exercise. Your primary care provider can help determine how to start making these changes in a safe, effective manner. Are there exercises you should avoid due to chronic back pain? Is it okay to start running if you have high blood pressure? Is it safe for you to start a vegan diet? What is a safe amount of weight to lose?

Wellness also includes mental and emotional health. Your primary provider can help determine what treatment is most appropriate for common conditions such as depression and anxiety. Maybe you’ve been feeling “down” lately – is this true depression that warrants medical treatment, or is it safe try a new yoga or meditation class first? These are just a few of the many things that can be assessed and addressed as part of your health baseline. Together, you and your primary care provider can prioritize health problems and determine effective interventions.

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Behavioral Science, Health and Fitness, Medical Apps, Public Health, Technology

What needs to happen for wearable devices to improve people’s health?

What needs to happen for wearable devices to improve people's health?

15353072639_f3a79557df_z“Wearable devices” are pieces of technology that are worn in clothes or accessories, and they often have biometric functionality – they can measure and record heart rates, steps taken, temperature, or sleep habits. Numerous tech companies have begun manufacturing and marketing such devices, which are part of a larger movement often referred to as the “quantified self” – where data about one’s life is meticulously gathered and recorded. Only 1% to 2% of Americans have used a wearable device, but annual sales are projected to increase to more than $50 billion by 2018.

Health and fitness apps are also proliferating, from software that maps where you run or provides a digital workout community, to programs that count calories or suggest how to improve your sleep. But what’s the real impact for people’s health?

Earlier this month, a report from the Journal of the American Medical Association called into question the idea that wearable devices will effect population-scale changes in health. There is a big gap, the authors claim, between recording health information and changing health behavior, and little evidence suggests that this gap is being bridged. Wearable devices might be seen as facilitating change, but not driving it. Mitesh Patel, MD, MBA, from University of Pennsylvania, and colleagues wrote:

Ultimately, it is the engagement strategies—the combinations of individual encouragement, social competition and collaboration, and effective feedback loops—that connect with human behavior.

The difficulty of population health is that changes have to be sustained to have meaningful effects, and that is quite difficult. The authors identify four steps that must be taken to bridge this gap towards sustained change.

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Health and Fitness, Patient Care, SMS Unplugged, Technology

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

fitness trackerIt was 11:47 PM. That meant that I had 13 minutes to reach my pre-set goal of  “activity” that the fitness tracker on my wrist had been registering throughout the day. If I met the goal I would get a “trophy” on the accompanying app. I probably looked pretty funny bouncing around my living room doing a squat here and a sit-up there, punching a pretend opponent, and running in place. But I made it minutes before midnight. If I hadn’t – well, then I would have just blamed the piece of technology on my arm for not working.

The tracker was a gift from my cousin Steve. Steve is impressively fit; he runs marathons, tackles obstacle courses, and races road bikes. A few years back at Christmas dinner, Steve challenged me to a pull-up contest – I was super hyped and ready for it until, well, I lost. Every holiday season since then, I’ve spent the weeks prior to heading home logging extra push-ups, pull-ups, and bicep curls just in case a re-match comes up. Without knowing it, Steve inspired me to get active. Now, with blinking lights and status reminders, the fitness tracker he gave me does so more frequently, more annoyingly, but in a way, more enjoyably and effectively.

The fitness band on my wrist doesn’t tell me to go to the gym or go for a run. The periodic updates on how far I am from my pre-set goal, however, “nudge” me to get up during a commercial and do a set of push-ups, to get out for a walk, or to take the stairs. I’ve even turned to running in place or a set of body squats whenever I find myself yawning to make sure I get enough points.

In the past, I’ve been good about working out, even doing stretches of two-a-day gym trips. But this doesn’t last very long as I use the busy “medical school” schedule as an excuse. After getting the fitness tracker, it’s been a string of random, spontaneous, and unstructured “work outs” throughout the day. While I may not have achieved Mr. America status, I’ve felt good about meeting my daily goal and racking up “trophies.” It’s even become a bit of a game to see how high I can actually make my numbers go. I’m competing against myself. This may sound weird, but at least I know my opponent and understand what I’m up against, right?

Wearing the fitness band reminded me of the concept of nudges. Nudges, as discussed by Richard Thaler, PhD, and Cass Sunstein, JD, describe how a person can be steered toward making a particular decision without hard instruction. An individual encounters small pushes towards doing something that is desired of them, unaware that they’re being led in that direction. Commercial companies have mastered this in form of advertising, making us feel as if we “need” their product. This fitness band has me thinking that I’m playing a game; the soreness in my legs and looser fitting clothes would indicate that I’m working out.

My experience with the fitness tracker has reminded me of the importance in framing conversations with patients. We often resort to telling patients, “You should work out and eat healthy – if you don’t you’ll get this or that disease.” It’s easy to frame things in the negative and use scare tactics. But rather than give constant reminders of what they aren’t doing, conversations with patients should contain nudges of encouragement. Nudges such as aligning goals with patient priorities, setting check-in time-points, and incorporating social networks for accountability. If we could do for chronic-disease management what the fitness band tries to do for working out, our patients might have an easier time.

Moises Gallegos is a fourth-year medical student. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Photo by Vernon Chan

Health and Fitness, Parenting, Pediatrics, Pregnancy, Public Health

Exercising during pregnancy may reduce children’s risk of hypertension

Exercising during pregnancy may reduce children's risk of hypertension

7619293834_c18e2bee15_zRegular physical activity during pregnancy has been shown to benefit both mom and baby: Past studies found that exercise can help expectant mothers manage weight gain, sleep better, improve circulation and reduce swelling or leg cramps and increase their endurance in preparation for childbirth. A growing body of evidence also suggests that maternal exercise can boost babies’ brain development and influence a child’s health into adulthood.

Now findings (subscription required) published in the Journal of Sports Medicine and Physical Fitness show that by exercising, moms may reduce their children’s risk of developing high blood pressure, or hypertension. The Michigan State University researchers say their findings are significant because earlier studies have shown babies with low birth weight are more likely to have poor cardiovascular health and an increased risk of hypertension. PsychCentral reports:

[Researchers] initially evaluated 51 women over a five-year period based on physical activity such as running or walking throughout pregnancy and post-pregnancy.

In a follow up to the study, they found that regular exercise in a subset of these women, particularly during the third trimester, was associated with lower blood pressure in their children.

“This told us that exercise during critical developmental periods may have more of a direct effect on the baby,” [said lead author James Pivarnik, PhD].

The finding was evident when his research team also discovered that the children whose mothers exercised at recommended or higher levels of activity displayed significantly lower systolic blood pressures at eight to 10 years old.

“This is a good thing as it suggests that the regular exercise habits of the mother are good for heart health later in a child’s life,” Pivarnik said.

Previously: Extreme pregnancy: A look at exercise and expectant moms, Could exercise before and during early pregnancy lower risk of pre-eclampsia?, Are women getting the message about the benefits of exercising during pregnancy? and Pregnant and on the move: The importance of exercise for moms-to-be
Photo by Nathan Rupert

Ask Stanford Med, Health and Fitness, Nutrition, Obesity

How to keep New Year’s resolutions to eat healthy

How to keep New Year's resolutions to eat healthy

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New Year’s Day always offers the opportunity to hit pause, reflect on our lives and set goals to improve our health and well-being. For many of us, this year also involved making promises to eat healthier and lose weight. To help you achieve your nutrition goals, I reached out to Stanford health educator Jae Berman. Below she shares how to select New Year’s resolutions that you’ll actually keep (perhaps you’ll have to tweak the ones you made last week!), offers strategies for eating healthy even when you’re pressed for time, and explains why cooking for yourself is a key factor in changing nutritional habits.

What are some examples of smaller, more manageable, goals that could help someone make better food choices?

People often jump in too hard, too fast when creating New Year’s resolutions. This perfectionist and “all or nothing” attitude tends to result in grand, lofty goals that we quit if we have a setback or don’t see immediate results. When considering health and weight loss-related goals make sure they are realistic and sustainable.

Instead, closely examine your routine and note one thing you can improve. This behavior may be something obvious, such as you drinking soda every day and wanting to stop. Or, it could be an aspiration to make healthy habits more sustainable, for example, bringing your lunch to work so you can lose weight and save money. Those who already eat well and exercise regularly may want to adopt a goal on a larger scope and learn to cook or try a new form of exercise.

Pick one thing (just one!) and make sure it is SMART – specific, measurable, achievable, results-focused and time-bound. Pick a resolution that is within reach, yet a bit of a stretch so that it’s a challenge. Additionally, goals should lead towards creating a sustainable habit. Some ideas include: Bring your lunch to work Monday-Thursday for the entire month of January; eat five fist-sized servings of vegetables every day; drink coffee only at breakfast; go to sleep at at the same time every night and wake up at the same time every morning for the month of January; or do 30 minutes of weight training three times a week.

In an effort to slim down in the New Year, some individuals may go on the Atkins diet and other popular weight-loss plans, or decide to do a juice fast, like the Master Cleanse. What’s your advice for those considering these approaches?

It’s very difficult to change someone’s mind when they decide to try these types of weight loss plans. So I usually say, “Go for it!” After a few days, the person often feels miserable and wants to create a long-term plan for managing their weight. I will say the one benefit of these quick fixes and fad diets, which I do not endorse, is that they teach a person what it feels like to be hungry. This may sound strange, but this awareness is an important lesson.

Many people overeat and are used to eating to avoid being hungry. We also tend to mindlessly eat out of boredom, or simply because food is in front of us. Going on a restrictive diet results in some feeling hungry for the first time in long time and, as a result they learn their hunger cues. When you experience a hunger cue, which is right when you think “I could eat,” then you should eat just enough food to get through the next three to four hours. You don’t need a huge meal to feel stuffed and small; unsatisfying snacks aren’t helpful either. Understanding what it feels like to be satiated is very important for long-term success.

Ongoing research at the Stanford Prevention Research Center shows that “one diet really does not fit all.”  So I can’t tell you exactly what to eat, but I can tell you that creating a long-term sustainable plan is key.

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Health and Fitness, Orthopedics, Videos

Director of Stanford Runner’s Injury Clinic discusses advances in treating six common running injuries

Director of Stanford Runner's Injury Clinic discusses advances in treating six common running injuries

Running, as many athletes and fitness fanatics are well aware of, can often lead to foot, knee and hip injuries as a result of repetitive overload. But many of the aches and pains that nag runners can be easily avoided and remedied.

In the above Stanford Health Care video, Michael Fredericson, MD, director of the Stanford Runner’s Injury Clinic and head team physician with the Stanford Sports Medicine Program since 1992, provides an overview of prevention and treatment strategies for six of the most common running injuries. He also describes advancements in non-surgical treatment options for patients who don’t respond to standard therapies.

Previously: Director of Stanford Runner’s Injury Clinic discusses treating and preventing common injuries, Watching your phone or tablet while working out may diminish form, Stanford physician discusses prevalence of overuse injuries among college athletes and A closer look at how stretching may benefit the body

Chronic Disease, Health and Fitness, Videos

The importance of regular exercise in delaying and treating diabetes

The importance of regular exercise in delaying and treating diabetes

Looking for motivation to exercise regularly? Consider this statistic: People who engage in physical activity for seven hours a week have a 40 percent lower risk of dying early than those who are active for 30 minutes or less a week. Among the many health benefits bestowed is helping prevent and manage diabetes.

In this Stanford Health Care video, Baldeep Singh, MD, a clinical professor at Stanford who focuses on chronic disease management, explains how exercise can lower blood sugar during your workout and afterwards and help insulin work better. He says in the talk:

[Exercise] is one of the most important things that you can do as you get older because it really has all plus and no minuses … One of the keys is consistency. You want to be consistent in your regiment – even the same time of day … It’s much better to make small incremental changes and be consistent with them, than to make a huge change and than do nothing the rest of the year.

This video is the second lecture in a three-part series addressing important questions related to diabetes and lifestyle choices.

Previously: Examining the role of exercise in managing and preventing diabetesWithout exercise, Americans are growing more obese, according to Stanford researchers, Preventing pre-diabetes from turning into diabetes and Fighting a fatalistic attitude toward diabetes 

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