Is Sleep The New Sex? No, No, No, It’s Much More Important!

Some of us take sleep for granted, those who claim they fall asleep like a baby “as soon as their head hits the pillow”.  I remember my grandfather informing the rest of the family of how he only needed 3-4 hours of sleep and could function “just fine”. However, he was always the one napping on the couch or slumped in a chair snoozing during a family get together. Interestingly, to us as sleep specialists, falling asleep immediately as you lay down for the night, or dozing off inadvertently during the day may be a sign of sleep deprivation. In fact, the most common cause of daytime sleepiness it just not getting enough sleep at night.

Famous politicians have long boasted on how little sleep they needed. Most humans need 7.5-8 hours of sleep to awaken on their own feeling refreshed and alert. Only a very small percentage of the population is what we call “short sleepers” and can function well with 5 hours or less of sleep. If you looked up sleep in the dictionary you’d see it is defined as “a condition in which the eyes are usually closed and there is little or no consciousness”.  We now know the brain can be even more active in sleep than when awake. It uses more oxygen during the deepest stages of sleep than when you’re sitting at your desk working. Some mammals including dolphins and whales can sleep with only one side of the brain and be awake on the other side of the brain.  You’d think that would be nice if we could do it although if our bosses found out, they might just make us work a longer shift.

Sleep is to humans what gas is to a car, what water is to plants, it fuels the brain. During sleep we shuffle and sort out our memories and recharge the brain and its important functions. Sleep recharges our batteries. Sleep deprivation can have the same effect on brain function as driving when you’re drunk. It can slow down your reflexes, promote poor decision making, and increase the chances of reckless and unsafe decision making. Just ask a rat if sleep is important. Indeed, if you deprive a rat of sleep for a month or so, they will perish and die. Let’s give thanks we are not rats. However, you cannot underestimate the importance of sleep.

Oh, don’t get me wrong. Sex can be rejuvenating. But just talk to the young couple whose newborn has kept them up for weeks and months on end. What would they wish for on a vacation? Well, I can’t speak for others although a great night’s sleep might just be the new sex for them. So just lean your head back on that chair and ponder, “Is sleep the new sex, or nay I say it, even more important!”

-Timothy L. Grant, M.D. – Neurologist and Sleep Specialist

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What is low T? Does Manopause exist?

It seems you can’t go anywhere these days without seeing an advertisement on the TV, Radio, or billboard for Low T or Testosterone.
Testosterone is a hormone produced by the Testes and plays an important role in men’s health as it helps maintain:
1. Muscle mass
2. Bone formation
3. Red blood cell production
4. Normal libido
5. Sperm production
As we age testosterone levels tend to decrease. There are 3 blood tests to check Testosterone Levels. There is some controversy how to
interpret these tests.
1. Total Testosterone
2. Free testosterone
3. SHBG (Sex Hormone Binding Gobulin)
It is best to check levels in the morning as they tend to be highest at this time of the day. It may be useful to check other blood hormone levels including thyroid function, LH, FSH, and Prolactin levels as part of an evaluation. Occasionally obesity can decrease SHBG and cause a falsely low testosterone.
Testosterone Replacement is approved for individuals with low testosterone ( usually below 300ng/dl) associated with:
1. Decreased Libido
2. Erectile Dysfunction
3. Lack or decrease in energy
4. Osteoporosis or bone loss
5. Depression
6. Hair loss
7. Sleep disturbance
8. Decrease in strength
There are several types of FDA approved Testosterone replacement including creams, injections, pellets, and buccal. In addition many anti aging clinics use compound pharmacies to produce unique testosterone blends.

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Making Exercise Easy!

Whoa! Does the word “exercise” evoke thoughts or emotions reminding you of either elementary school gym class or something slow, long and torturous?  For a great many people, exercise is viewed as a chore versus an activity that one engages in. Yes it’s true that there are a million different ways to exercise and there are probably even more promises made about how exercise will get you the beach body that you have always wanted. Let’s take a closer look at simple, practical ways to burn extra calories throughout the day. Remember, our body weight is heavily affected by how man calories we take in versus how many calories we expend (burn). So if you are able to consistently engage in exercise, then weight balance and even weight loss can become easier.

Tips.

1. If you can take the stairs in a building to get to you destination, do so. Taking an elevator or escalator up just one or a few flights or levels is losing out on an opportunity to walk a little, exercise your leg muscles and burn a few extra calories.
2. When parking in a lot or even a parking garage, try to park further away from the entrance or where you need to go versus parking close by. This way you have to walk just a little extra bit, and for health and weight balance, every little bit helps.
3. Find or remind yourself of a physical activity that you used to do and enjoy and rekindle that joy. If you like dancing, dance! Many centers offer all sorts of dancing classes, from the classic Fred Astaire Dance Studios to dance classes that are now part of the “aerobics” classes offered by so many gyms, the opportunity for “dancerise” is there. No matter what physical activity gives you joy or at least makes you smile, embrace it and do it consistently so you can enjoy all of the health benefits of physical activity.
4. If you are new to exercise and interested in gaining strength, then you have the perfect opportunity to utilize the tutelage of a certified personal trainer. The trainer can take you through exercises, demonstrate form and teach you just how to do resistance training in order to gain the strength and improved body composition that you may want.
5. One thing that can be done now is to use a pedometer to track how many steps you take per day. Physicians and scientists believe that we all need to take at least 10,000 steps per day for overall health. This is not as much as you may thing. Wearing a pedometer makes it easy just to see how many steps you take per day and where as well as when you can increase step taking. Pedometers these days come in many forms (clip to the waist of the pants, wearable on the wrist and so forth). The trick is to just wear one and view it daily with the goal of 10,000 steps in mind.

 

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Thank you.

-Douglas Kalman PhD, RD

Understanding Menopause and Hot Flashes

Flickr/Ryk Neethling

Menopause is defined as one year without a period. However, menopausal symptoms can begin to develop 5 to 15 years before the onset of menopause. This is called perimenopause. During this time your estrogen levels begin to decrease. This lack of estrogen creates a constellation of signs and symptoms including hot flashes, vaginal dryness, mood swings, libido changes, sleep disturbances and more.

One of the most troubling symptoms of menopause or perimenopause is hot flashes. Hot flashes are a sudden sensation of intense heat, which causes the face, neck, or upper body to become flushed and sweaty. A hot flash can last 30 seconds to 5 minutes. A hot flash during the night often requires that you change your night clothes as they are all wet.

How do we treat these debilitating symptoms? There are 3 options: Do nothing and live with them, treat them with prescription medications, or treat them with herbal preparations.

Pharmacologic or prescription medicine for the management of hot flashes consists of hormonal and non-hormonal options. The hormonal option is estrogen and it can be taken as a pill, a patch or a cream. This is successful in relieving 99% of hot flashes. It is the most effective treatment. Its major disadvantage is that it may cause blood clots, or increase your risk of certain cancers, including breast cancer. It is generally a safe option for the first 5 years following menopause.

The most common non-hormonal treatment for control of hot flashes is antidepressants. These medications can decrease the number of hot flashes by approximately 80% and they are well tolerated. Their major side effect is loss of libido. These are other prescription medications such as blood pressure pills, migraine medications, and antihistamines, which have small success rates.

For patients who prefer a natural alternative, there are multiple herbal preparations, which can decrease hot flashes. The Chinese herbs like Black Cohosh and Dong Quai have been studied the most. While the data is conflicting, there still is a large body of evidence, which suggest that these herbs may improve hot flashes. Isoflavones and soy are plant-derived substances called phytoestrogens. These herbs appear to “mimic” estrogen and appear to reduce hot flashes. There are multiple studies showing improvement of hot flashes and other menopausal symptoms while taking soy isoflavones. Other herbal products, which seem to help include yams and red clover.

The ultimate decision on the correct treatment varies from woman to woman. It is important that you discuss the side effects, the risks and the benefits of each class of treatment and decide the best treatment for you. There are many health professionals and knowledgeable people who can help guide you through this process.

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-Dr. Robert Feldman M.D. – Obstetrics and Gynecology

The Truth About Gluten

Flickr/Slacker Mark

It seems that the most popular thing these days is something called gluten allergy. It is the hottest thing on the lips of everyone from health gurus to nutritionists to fitness junkies, but what does that actually mean? And is it really worth all the hype? Celiac disease, or its more scientific name – Gluten intolerance – is in reality a very uncommon disease that stems from gastrointestinal inflammation and inability to digest gluten – a common nutrient in most breads, pastries, pasta and anything made from wheat. Unfortunately humanity has perfected its skills at whipping up amazingly delectable goodies in all forms and shapes that involve ground wheat grains and a bit of sugar and yeast… Hence, it is everywhere!

Luckily, as I stated before – real gluten intolerance is truly rare. Symptoms range from bloating, to headaches, weight loss and nausea/diarrhea, skin rash is commonly seen, joint pain and swelling may occur, and patients generally feel sick. The only way to truly diagnose this condition is by upper endoscopy and mucosal biopsy, but there are a few blood test that may be helpful in the diagnosis. Treatment of the condition involves complete avoidance of all gluten intake – a real challenge as it is in everything we consume. The kicker here however, is the evolution of a concept known as gluten sensitivity (not intolerance as in true celiac disease). It is a condition that is marked by milder symptoms than in true celiac disease, and is typically more challenging to diagnose due to frequent absence of positive blood results and uncertain results on mucosal biopsy of the intestinal tract. Never the less – patients feel uncomfortable and it effects their quality of life. Some report general discomfort after consuming high gluten foods (here comes the pastry reference again), while others may suffer from headaches and skin lesions. Some child psychologists even feel that it may contribute to ADHD… It is still very much an evolving concept and we are not quite sure of the full ramifications of this condition. So if you feel that breads, pastas, baked good are making you feel sick or bloated it may be worth your time to avoid all wheat products for a month to see if you feel any better – just don’t expect it to be easy!

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-Dr. Olga Kromo M.D – Rheumatologist

The Health Benefits of Black Pepper

Flickr/Brandon Grasley

One of the most popular spices, black pepper, has often been misunderstood as the pauper of the spice world.  An equal opportunity culinary player, paper packaged for fast food consumption and freshly grounded in haute cuisine, as it turns out it not only spices but also heals.

Is it possible to consider a spice as medicine? Different cultures have used their native plants for their botanical pharmacological healing properties for millennia. Ancient Indian Ayurvedic tradition has used Piper nigrum for centuries particularly to help with upper respiratory infections, improve breathing, help with cardiac health, gastrointestinal issues and diabetes.

Modern medical research findings seems to align with these findings, as some research has shown that a water extract of black pepper has potential immune-modulating and anti-tumor activities in vitro and other studies showed that an oil extract of black pepper had strong antioxidant effects.

Include pepper in your next culinary adventure and it will not only invigorate your taste buds but possibly benefit your health!

-Dr. Jackie Miodownik-Aisenberg M.D. PhD – Internist

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What is the Human Microbiome Project?

Image/Data Analysis and Coordination Center (DACC) for the National Institutes of Health (NIH)

The NIH has spent over 100 million dollars on The Microbiome Project which is a study to evaluate how healthy and unhealthy humans interact with micro-bacteria. The 5 anatomical areas that interact both positively and negatively with bacteria include the skin, gastrointestinal tract, mouth, vagina, and respiratory tract. The project will study the genetic make up of the bacteria that make up the Microbiome.

The ultimate goal will be to determine how the interaction between the bacteria and host  can effect an individual’s health. Many scientist believe that bacteria can have both a positive and negative effect on an individual’s health. We have always thought bacteria cause illness but we have learned with Probiotics that some bacteria can treat or prevent disease. Who knows what other application bacteria may have to treat diseases in the future.

 

-Dr. Howard Schwartz M.D. – Gastroenterologist

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Mindful Eating: Easy Tips to Get You Started

Flickr/Arya Zai

There is something to be said for behavioral influences on our food choices as well as mood states. Mindless eating includes how food psychology and environment influences what and how much we eat. The probable foremost authority on Mindless Eating is Dr. Brian Wansink of Cornell University Food and Brand Lab. His 2006 book, “Mindless Eating; why we eat more than we think” is still considered a classic and an important read of behavior. This column today will cover Dr. Wansink’s latest research and how the results may be helpful on an individual level.

The latest research finding is that if you think about your future before you make daily food choices, the better food choices one will make. What is also realized now, is there is more to stress eating than simply emotion (many more things influence food decisions than just mood alone). More often than not, those in a bad mood will choose to eat junk food while those in a good mood, chose healthier food choices. Scientifically, we can measure affective regulation and temporal construct. Simply said, this research is measurements in how people react to their moods/emotions and perspective of time.

In a study using Parent Teacher Associates (PTAs) (211 of them) determined that those in a positive mood compared to controls, did better and earlier evaluations of foods to select, thus picked healthier foods. The researchers strongly noted that ability to think about the future was strongest in relationship to making healthy food choices. In a follow up study of 315 collegiate students, the same result occurred. Those in a positive mood made more nutritious choices.

The take home from this research to me is simple. Make your food choices when you are in good spirits, therefore keep a log or use the proper app to do your priority lists and food choices review.

In addition, Dr. Wansink shared from his lab the following tips for dealing with Mindless Eating:

• Keep counters clear of all foods but the healthy ones
• Never eat directly from a package – always portion food out onto a dish
• Eat something hot for breakfast within the first hour of waking up
• Avoid going more than 3-4 hours without having something small to eat
• Put down your utensils between bites to slow down your eating

If you can start with the productive healthy mindset, and follow the tips shared, not only better control of your nutrition can be a result, perhaps a healthier longer future is also in your future.

-Douglas Kalman PhD, RD

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References:

1. http://en.wikipedia.org/wiki/Mindless_Eating
2. www.foodnavigator.com/content/view/print/883545 Accessed February 19, 2014
3. http://foodpsychology.cornell.edu/outreach/mec.html Accessed February 23, 2014

Do I Have ADHD?

Flickr/wintercool612

Over the past several years, we have seen an increase in adults coming into our practice wondering whether or not they have attention-deficit/hyperactivity disorder (ADHD).  This is not surprising, given the amount of stress that people are under, as well as all the “attention” that ADHD has received recently.  However, many things besides ADHD can produce poor attention, so it may be helpful to review some chief characteristics that are required in order to determine whether an adult meets the criteria for ADHD.

Attention is a complex cognitive process that is regulated by various brain regions and neurotransmitter systems.  Effective attention can be thought of as a two-step process:  We must be able to focus our attention on a primary source of interest (e.g., reading a book), while at the same time blocking or tuning out meaningless distractions.  Many things can cause poor attention, the most common ones being fatigue, stress, depression, and even certain medical conditions (e.g., hypothyroidism, fibromyalgia).

ADHD is thought to represent a certain degree of inefficiency in the frontal lobes, the brain region that is responsible for controlling attention and behavior.  Not only do people with ADHD have difficulty with focus and attention (e.g., distractibility, forgetfulness, procrastination, poor time and task management), they can also have problems with hyperactivity (e.g., restlessness, feeling fidgety, always “on the go”) or impulsivity (e.g., lose temper easily, interrupt others, impatient, difficulty awaiting their turn).  A critical element to make the diagnosis of ADHD in adults is that several of these behaviors must have been present during childhood (before the age of 12) and had to have caused some level of difficulty at home and at school.  It is estimated that 30% to 50% of children with ADHD will continue to manifest symptoms into adulthood, so it certainly is possible that adults presenting with attention and focusing problems have ADHD, but again, there must have been ADHD behaviors present during childhood.

If you present any of these symptoms, it is important to seek a consultation with a qualified health care practitioner.

Dr. Rafael Rivas-Vasquez PsyD – Psychologist

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Better Sleep: Insomnia

Insomnia as a condition characterized by any combination of difficulty falling asleep, staying asleep, or awakening too early in the morning and feeling unrefreshed.  According to the National Sleep Foundation, almost half of adult Americans reports they experienced difficulty falling asleep at one point in their lives.  Insomnia is the most common sleep disorder, affecting about 12% of the population at any given time, or about 32 million people.  More women than men are affected.  Older adults become less efficient with her sleep and can experience more frequent insomnia.  Transient, or short-term insomnia, can often be treated quite easily or may resolve spontaneously on its own.  Chronic, or long-lasting insomnia, is often more difficult to resolve.  It is often associated with many other medical and psychological illnesses, including depression.  It can also occur in patients with other sleep disorders such as restless leg syndrome, sleep apnea, (difficulty breathing during sleep with associated snoring), and narcolepsy (an illness associated with excessive daytime sleepiness).

Symptoms of insomnia may include anxiety, fatigue, difficulty concentrating, drowsiness, forgetfulness, irritability, headache, low energy, weight gain and increased blood pressure. Often, treatment entails simply embracing better sleep hygiene, or better sleep habits.  Often, only a brief course of over-the-counter or prescription medication is necessary.  For chronic insomnia, the best treatment is often a combination of medications and cognitive behavioral therapy (relaxation techniques and reinforcement of better sleep habits).  A sleep specialist can advise what is best for your individual case, including the risks and rationale of various medications and supplementations.

In order to ensure good sleep, it is important to have good sleep habits.  Often simple changes in your daily routine can improve your sleep.

Here are a few simple tips:

•           Avoid caffeine within 10 hours of bedtime.  Avoid alcohol and smoking, especially one or 2 hours before bedtime.

•           Exercise regularly.  Strenuous exercise should be avoided 3 hours before bedtime.

•           Don’t take naps, or limit them to 30 min.

•           Establish pre-sleep rituals, like a warm bath or reading.

•           Go to sleep only when you are sleepy and use your bed for sleep only, not as an office or place to watch television.

•           Get up about the same time every day, regardless of when you fall asleep.

•           If you can’t sleep, don’t stay in bed fretting.  After 10-15 min., go to another room and read until you feel sleepy.

Contact your physician if you:

•           Remain unable to fall asleep.

•           Can’t stay asleep.

•           Sleep at night but consistently feel sleepy during the day. You may have a separate medical problem that is preventing normal sleep patterns.

-Dr. Tim Grant M.D. – Neurologist and Sleep Specialist

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