Longevity Metrics

Lecture Summary
Keeping your brain healthy pays dividends. It can also help prevent dementia down the road. Join me on an interesting discussion regarding how to keep your brain working optimally for years and years.

Key Points
- exercise your brain, think and challenge yourself mentally constantly.
- exercise your body, this has been well studied and will help prevent dementia
- eat good food
- get adequate sleep
- avoid illicit and pharmaceutical medications that impair thinking. If used long term these will predispose you to dementia.
- have a purpose and give back
- engage with other people and society.
- protect your eyes, ears, and other senses

References
-       Cabral et al. Exercise for Brain Health: An Investigation into the Underlying Mechanisms Guided by Dose. Neurotherapeutics. 2019.

-       Erickson et al. Physical Activity, Brain Plasticity, and Alzheimer Disease. Archives of Medical Research. 2012.

-       Blackwell, L., Dweck, C., & Trzesniewski, K. (2002). Achievement across the adolescent transition: A longitudinal study and an intervention. Manuscript in preparation.

-       Dweck, C., & Leggett, E. (1988). A social-cognitive approach to motivation and personality. Psychological Review, 95,256-273.

-       Wikipedia. dementia, donepezil, memantine, blue zone.

-       Uptodate. Evaluation of Cognitive Impairment in Adults and Treatment of Dementia.

-       Montreal Cognitive Assessment. Available at (https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf)

-       Sirishinha Stitaya. The potential impact of gut microbiota on your health: Current status and future challenges. Asian Pac J Allergy Immunol. 2016.

-       Veerman et al. Television viewing time and reduced life expectancy: a life table analysis. BMJ. 2012.

-       Ray et al. Dementia and hearing loss: A narrative review. Maturitas. 2019.

Lecture Summary
Many new cancer drugs have marginal benefit or do not work at all. Their prices are obscenely high. Sadly, like the idiots we are, we pay for them. This podcast reviews the first chapter of Vinayak Prasad's book Malignant. The first chapter is a must read for any physician and the entire book is fantastic.

Key Points
- Fojo et al performed an analysis of 71 consecutive drugs from 2002 to 2014 used for solid tumors like breast and colon cancer. They found that the median improvement in survival was just 2.1 months.
- New cancer drugs in 2015 cost an average of 100,000$ per year of treatment.
- Drug companies are making obscene amounts of money on drugs that do not work.
- The price of cancer medications in no way reflects how well they work.
- American healthcare has completely lost its way!

References
- Prasad, VK. Malignant: How Bad Policy and Bad Evidence Harm People with Cancer. Johns Hopkins University Press. 2020.
- Fojo et al. Unintended consequences of expensive cancer therapeutics-the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity. JAMA Otolaryngologists. 2014.

Lecture Summary
This 2 part series will discuss what to eat for weight loss, wellness, as well as improving and sometimes even curing chronic medical conditions. The ideas around diet are simple! Staying on a diet long term is the difficult part.

Key Points
- Avoid eating or try to severly limit consumption of fast food, sugar, unhealthy fats, fried foods, and simple carbohydrates like white bread and white rice.
- Eat a diet rich in raw vegetables and fruits. Shoot for a rainbow of different colors. Add in nuts and seeds for additional nutrients. This should be the cornerstone of any healthy diet.
- Try and get most of your protein from plant based sources like beans, legumes, nuts, seeds, and soy.
- Limit meat intake. Shoot for 2 to 5 meals a week with meat or avoid entirely. Enjoy high fat steaks or processed meats like bacon, only on rare-special occasions.
- Very strict diets like the Ornish diet can improve and sometimes even cure chronic medical conditions like morbid obesity, type 2 diabetes, heart disease, depression, Alzheimers, and low grade prostate cancer.
- Lifestyle changes like those utilized in the Undo It program (Ornish.com) should be the cornerstone of chronic disease treatment. Pharmaceutical medications can be important, but should be discussed after or alongside lifestyle changes in most instances.

References
-       Tuso PJ. Nutritional Update for Physicians: Plant-Based Diets. Perm J. 2013

-       Ornish et al.  INTENSIVE LIFESTYLE CHANGES MAY AFFECT THE PROGRESSION OF PROSTATE CANCER.  J. of Urology. 2005

-       Ornish et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998

-       Frattaroli et al. Angina Pectoris and Atherosclerotic Risk Factors in the Multisite Cardiac Lifestyle Intervention Program. Am J of Cardiology. 2008

-       Silberman et al. The Effectiveness and Efficacy of an Intensive Cardiac Rehabilitation Program in 24 Sites. Am J of Cardiology. 2009

-       Pischke et al. Lifestyle Changes are Related to Reductions in Depression in Depression in Persons with Elevated Coronary Risk Factors. Psychology and Health. 2010.

Lecture Summary
This 2 part series will discuss what to eat for weight loss, wellness, as well as improving and sometimes even curing chronic medical conditions. The ideas around diet are simple! Staying on a diet long term is the difficult part.

Key Points
- Combine dietary changes with exercise, stress reduction, and social support for the best chance of long term success. Love yourself and let the good food you put in your body be a manifestation of that love.
- The best diet for any person is the diet they can stick to.
- Reducing the total number of calories consumed over long periods of time will lead to weight loss.
- GMOs are not intrinsically harmful. However, what companies have actually done with GMOs is. This is why I try and eat mostly organic foods when avaialable.
- Processed foods are often high in sugars, salt, fat, and calories. They are designed to keep us wanting more. Say no to cheap, high-calorie, low-nutrient, processed foods.

References
-       Tuso PJ. Nutritional Update for Physicians: Plant-Based Diets. Perm J. 2013

-       Ornish et al.  INTENSIVE LIFESTYLE CHANGES MAY AFFECT THE PROGRESSION OF PROSTATE CANCER.  J. of Urology. 2005

-       Ornish et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998

-       Frattaroli et al. Angina Pectoris and Atherosclerotic Risk Factors in the Multisite Cardiac Lifestyle Intervention Program. Am J of Cardiology. 2008

-       Silberman et al. The Effectiveness and Efficacy of an Intensive Cardiac Rehabilitation Program in 24 Sites. Am J of Cardiology. 2009

-       Pischke et al. Lifestyle Changes are Related to Reductions in Depression in Depression in Persons with Elevated Coronary Risk Factors. Psychology and Health. 2010.

Lecture Summary
This podcasts reviews all of prenatal care and recommendations for how pregnant woman can stay safe during pregnancy. Much of this episode is based on my own personal practice. So much of pregnancy care is based on the current standard of care, expert opinion, and "what we have always done". More clinical trials are needed to find out what parts of prenatal care are important and what parts may be causing harm.

Topics/Key Points
- Pre-pregnancy
- Getting pregnant
- Finding out babies due date
- 1st prenatal visit
- Ongoing screenings throughout pregnancy
- Pregnancy medical visits
- Genetic testing
- Vaccines during pregnancy
- Later screenings
- RhD negative moms
- When to go to the hospital to have a baby
- Diet during pregnancy
- Foods to avoid in pregnancy
- Exercise
- Sexual intercourse
- Activities to Avoid

References
- Pope et al. Sugar substitutes during pregnancy. Can Fam Physician. 2014.
- Heuser C. Seafood, Spas, & Sandwiches presentation. University of Utah, Maternal Fetal Medicine. Available online.
- Weihe and Grandjean. Cohort studies of Faroese children concerning potential health effects after the mothers' exposure to marine contaminants during pregnancy. Acta Vet Scand. 2012.
- Golding et al. ALSPAC--the Avon longitudinal study of parents and children. I. Study methodology. Paediatr Perinat Epidemiol. 2001.
- CDC. About teen pregnancy. Available online: https://www.cdc.gov/teenpregnancy/about/index.htm
- CDC. Pregnancy rates for US women continue to drop. Available online: cdc.gov/nchs/products/databriefs/db136.htm.
- Association for Safe International Road Travel. Road safety facts. Available online: https://www.asirt.org/safe-travel/road-safety-facts/#:~:text=Annual%20United%20States%20Road%20Crash,enough%20to%20require%20medical%20attention.
- wikipedia.org, postpartum depression
- wikipedia.org, mercury in fish
- Keulen et al. Induction of labour at 41 weeks versus expectant management until 42 weeks (INDEX): multicentre, randomized non-inferiority trial. BMJ. 2019.
- uptodate.com, nutrition in pregnancy
- Jackson et al. Listeriosis outbreaks associated with soft cheeses, United States, 1998-2014. Emerg Inf Dis. 2018.
- Drevets et al. Listeria monocytogenies: epidemiology, human disease, and mechanics of brain invasion. FEMs Immunology and Medical Microbiology. 2008.
- JanakiramanV. Listeriosis in pregnancy: diagnosis, treatment, and prevention. Rev Obstet Gynecol. 2008.

We hear a lot about why healthcare providers are so burned out. Most of the discussion is centered around the horrible systems we work in, medical insurance frustration, loss of provider autonomy, increasing complexity, and long hours. However, another important factor related to provider burnout is our increasingly unhealthy patients who do not take any responsibility for their own health and seam to ask the world of us. In practice, we complain about these people all the time. We cringe when we see them on our schedules. Alarmingly, this group of people appears to be growing, both in size and number! I believe that these patients and the lack of personal responsibility in healthcare is a huge problem. This podcast discusses these issues. It is all based on my opinion and personal experience. I think it will resonate with many of the listeners....assuming anyone is actually listening that is.

Lecture Summary
Listeria is a gram positive rod that can cause rare but devastating infections in humans. The young, old, pregnant, and immunocompromised are at highest risk for listeriosis, the disease caused by this ubiquitous environmental bacteria. This podcast will review the basic bacteriology, epidemiology, diagnosis, treatment, and prevention of listeriosis.

Key Points
-       Listeria is ubiquitous in nature and the gastrointestinal tracts of many animals including humans are often colonized. Most infections are from Listeria monocytogenes, but other listeria can also cause infection.

-       Invasive infections are rare but carry a high mortality. 

-       Most infections come from food.

-       Infections in pregnancy are often more mild but can cross the placenta causing fetal demise and neonatal sepsis.

-       Queso Fresco and other Latin soft cheeses account for the majority of soft cheese related infections and have occurred in both pasteurized and unpasteurized cheeses. Hispanic pregnant woman are disproportionately affected by listeria, likely for this reason.

-       Listeria should be cultured from sterile body sources like blood, CSF, or placental tissue to confirm infection.

-       Ampicillin or Penicillin are the first line treatments. Trimethoprim Sulfamethoxazole, meropenum, and even Vancomycin have also gotten the job done.

References

Listeriosis. WHO. Available at https://www.who.int/news-room/fact-sheets/detail/listeriosis

FoodNet 2015 Report. CDC. Available at https://www.cdc.gov/foodnet/pdfs/FoodNet-Annual-Report-2015-508c.pdf

Listeriosis – wikipidia.org

Listeria – uptodate.com

Jackson et al. Listeriosis outbreaks associated with soft cheeses, United States, 1998-2014. Emerg Inf Dis. 2018.

Drevets et al. Listeria monocytogenies: epidemiology, human disease, and mechanics of brain invasion. FEMs Immunology and Medical Microbiology. 2008.

JanakiramanV. Listeriosis in pregnancy: diagnosis, treatment, and prevention. Rev Obstet Gynecol. 2008.

Lecture Summary
In this podcast I talk about my experiences with adverse drug reactions working as a Hospitalist. I then provide a brief summary of the 2019 American Geriatric Society Beers Criteria. "Beers List" reviews medications which are potentially inappropriate to use in elderly patients.

Key Points
- At least 10% of the patients I admit to the hospital are the direct result of the medications they have been prescribed.
- Bleeding, falls, altered mentation, kidney and electrolyte problems, and overdose are the most common adverse reactions I see in my practice
- The American Geriatric Society publishes a Beers Criteria, every 3 years, to highlight medications that are potentially harmful in elderly patients (> 65 years)
- Avoid mixing multiple medications with strong anticholinergic properties.
- Read this paper if you treat elderly patients!
- I often break these guidelines in my practice, but I try to be aware of potential problems so I can identify adverse reactions quickly and remove culprit medications.

References
Beers Criteria/List. American Geriatric Society. 2019 addition

Lecture Summary
This podcasts talks about an epidemic in the United States called polypharmacy. This is when a person takes multiple medications and it is becoming an increasing problem in the elderly. 

Key Points
- The opioid epidemic is still happening
- Polypharmacy occurs when an individual takes 5 or more medications
- Many people are being harmed by the drugs which are meant to help them
- Polypharmacy is one of the biggest ways that healthcare harms people and why iatrogenesis is thought to be the third leading cause of death in the United States.

References
Charlesworth et al. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988-2010. J Gerontol A Biol Sci Med Sci. 2015.

Morin et al. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018.

Rawle et al. Assocations Between Polypharmacy and Cognitive and Physical Capabilities. J Am Geriatr Soc. 2018.

Fried et al. Health outcomes associated with polypharmcy in community-dwelling older aduls: a systematic reveiew.. J Am Geriatr Soc. 2014.

Wimmer et al. Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review. J Am Geriatr Soc. 2017.

Beers Criteria/List. American Geriatrical Society. 2019 addition

Lecture Summary
This podcasts reviews obesity epidemiology and comorbidities. It then goes on to discuss obesity under the paradigm of addiction.

Key Points
- Obesity is the great pandemic of our time, it is on the rise, and it is disproportionately effecting children.
- Most all of our common and serious health problems are linked in some way to obesity
- The behavior of the obese, sick patients only makes sense to me when viewed through the lens of addiction.
- Healthcare providers, policymakers, and the greater society need to take aggressive action against obesity.
- Loosing weight presents an opportunity to potentially cure serious health issues. We have very few cures in chronic medicine today! This is such a golden opportunity. Providers should never omit discussions regarding obesity, as it is so often the root cause of disease.

References

Adult Obesity Facts. CDC. Available at https://www.cdc.gov/obesity/data/adult.html

Obesity and Overweight. WHO. Available at https://www.who.int/news-room/fact-sheets/detail/obesity-andoverweight#:~:text=Worldwide%20obesity%20has%20nearly%20tripled,years%20and%20older%2C%20were%20overweight.&text=39%25%20of%20adults%20aged%2018,kills%20more%20people%20than%20underweight.

Numerous papers on Pubmed debate the idea of overeating being an addiction. Just type in “food and addiction” on pubmed.com. 

Apovian AM. Obesity: definitions, comorbidities, causes, and burden. Am J Managed Care. 2016.

 So many papers exist to support the statements in this blog it was hard to pick just a few.