Quick Tips for Keeping the Weight Off this Holiday Season!

1. drink a glass of water before every meal
2. eat your vegetables first at every meal
3. use appetizer plate for meals to keep meal portion size reasonable
4. take a walk around the block or take a 5 minute walk before each meal (exercise helps to curb cravings and will keep your meal intake amount to a reasonable amount)
5. before you decide to have a second helping, make it a rule to wait 5 minutes before you get it so you can decide if you’re full or not
6. aim to be about 70-80% full at every meal, don’t eat to the point where you are 100% full or stuffed, you’ll have eaten too much at that point

Quick Tips for Preparing for Your Next Trip!

1. bring melatonin with you if you are going to be changing time zones, 3-6mg at night when you get there will help with jet lag
2. check the weather of the location you are going to so that you can dress appropriately and avoid drastic temperature changes that may affect your health
3. get plenty of rest before your trip so that you have enough energy and your immune system is optimized to fight the germs you are expose to while traveling
4. bring music or aspects from home like candles to help you de-stress while on your trip, stress negatively affects your health and immune system
5. try to eat similarly to how you eat while you are home and avoid eating overly fatty or processed foods while on vacation. Prior to going on trip, try to eat as anti-inflammatory and as plant-based as possible for the few days before your trip to make sure your immune system and energy level is optimized for your trip.

Quick Tips for Sleep and Energy!

1. avoid work emails and work about an hour before bed so that you can unwind and drift off to sleep easier
2. magnesium and calcium at bedtime can help with sleep quality, but check with your doctor first so that you don’t take too much of these
3. turn down the lights and avoid watching stressful TV shows or reading stressful news articles prior to bed, these will keep you too riled up for sleep
4. take frequent short breaks throughout the day at work to help keep your energy level up and de-stress
5. take walks during the day to help boost energy level
6. caffeine may seem like a good idea but it’ll just lead to an energy crash later in the day so aim to get plenty of rest and take breaks and exercise to help with energy

Spring Cleaning Tips for Your Health!

1. clean out your food cupboards and get rid of all processed foods
2. stock up on charcoal water filter to make sure you get into habit of drinking plenty of water every day
3. instead of keeping processed snacks around, cut up fresh vegetables and fruits for snacking
4. keep nuts in the house for small handfuls of healthy fat and protein when you are hungry
5. keep frozen bananas or berries for snacks
6. throw out the old sponge because it’s likely harboring a lot of bacteria

How Pain Affects Our Behavior

When you are in pain, does it ever seem like nothing else matters except you and your pain? Well, you may not be alone in this feeling.

In my clinic, I have a large patient population of chronic pain patients, and it is common to have the chronic pain issues overwhelm these patients’ lives. When I ask most of these patients what is their biggest stressor in their life, they usually will answer that the pain is what demands most of their time and energy and affects them the most.

When people have overwhelming medical issues, it is usually all-encompassing and has a significant impact on overall functioning and may even dictate how their life changes in many very real ways. It can frequently impact family, social, financial and work life to a significant degree; and usually the impact is negative, because diseases can restrict our life such that what brought us pleasure before no longer can be achieved based on physical limitations.

So it would make logical sense to assume that major diseases affect not just our body, but the very core of our life and interactions with others. Now there are studies that actually establish such a correlation, because it seems that bodily states and diseases can affect higher order behavioral interactions, potentially at the level of neuronal networks.

Based on a study published in Plos One on Oct. 12, 2011 by researchers in Rome, Italy, it seems that people suffering from pain exhibited a greater self-centered perspective aimed at maximizing self-gain. What’s interesting about this study is that it suggests that physiological states may play a significant role in higher order interpersonal behavior and social interactions.

Within this study, their results showed that the “feeling of pain makes an individual less inclined to behave according to social norms that regulate most social and economic interactions.” This study is consistent with the findings of a previous study from the Iowa Gambling Task looking at chronic back pain patients, and there was an association of greater intensity of pain being associated with higher rate of egocentric bias and reduction of the capacity to react emphatically toward others.

However interesting these findings are, it is not to suggest that all pain-sufferers tend to be egocentric or self-centered. The important point that this study and the Iowa Gambling Task study showed is that there is an association between physiological bodily states and our social and economic higher order behavioral states.

When we take this important point to heart, it helps us both as sufferers of pain and as loved ones of sufferers of pain to more thoroughly understand why people with various diseases may behave one way or another. In hopes of creating understanding and patience with loved ones with various disease states, these studies help us all to understand that there are indeed neurological implications to diseases that, at first glance, may not seem to have a direct impact on the brain.

In prior studies, there appears to be evidence that fairness-directed conducts, such as mutual cooperation with partners or altruistic behavior, are related to neuronal activation of the mesolimbic dopaminergic system. But, how this is specifically affected by chronic pain and acute pain requires further studies to determine whether various bodily states such as acute and chronic pain alter these areas of neuronal functioning in regards to correlates of induced social preferences and behavior.

My caution for readers who are now aware of these study findings is not for you to just assume people with chronic pain or other diseases will behave a certain way and to judge them based on that. But rather, it is to have an openness of mind to understand and accept that there is indeed a neuronal association between diseases and our brain such that their behavior may be significantly altered.

With such understanding, it may be easier for us to accept our loved ones and ourselves as they or we are, but to also work within that framework to ensure that interpersonal relationships remain strong. There may even come a time where it is necessary to utilize unbiased third-parties to help maintain strong interpersonal relationships as we all deal with various diseases and its impact not just on our body, but to our relationships as well.

Various therapeutic methods may be especially helpful, such as cognitive behavioral therapy, to help patients and their loved ones to adjust to a new dynamic so as to regain and then maintain strong healthy relationships and interactions.

As I see many patients go through various stages in their life, both with and without active disease, I also see a level of pliability in how these patients maintain relationships in their life that are important to them. So, regardless of the finding of this study, even if there is a level of increased tendency toward egocentric bias or self-centered gains, what I have noticed most in my patients with chronic pain and other diseases is perseverance toward maintaining the integrity of relationships and situations that are important to them.

When it comes down to it, living with pain or any active disease state requires inner strength and courage, and most of my patients have those qualities in abundance. And if the bodily state of the disease alters their neuronal status toward some behavioral changes, most of what I see is that they continue to protect the relationships that are important to them.

So, take the findings of this study as a forewarning that diseases may alter your own behavior or that of your loved one afflicted with pain or disease… but that the relationships you cherish do not have to suffer when you are aware of what you are dealing with and are willing to fight for what is important to you.

Do We Have a Potential Cure for HIV?

When HIV was first discovered in 1983 to be the cause of AIDS, patients and doctors alike felt the full brunt of the fear associated with a newly discovered lethal contagion. Today, almost two and a half to three decades later, we seemed to be at the brink of having found a functional cure for HIV. To this potential triumph, we must be proud of what our minds and technologies are capable of. However, the battle has just begun and much still needs to be elucidated before we can do our well-deserved victory dance.

At the initial forefront of confronting and tackling the AIDS epidemic, doctors traditionally focused on prevention of HIV by finding ways to protect people not yet exposed to it via education, potential vaccines, and using treatments to suppress viral activity to prolong life expectancy. With recent stem cell research, there seems that a “functional cure” to HIV may very well be in the horizon for us all.

The case of a patient treated in 2007 and 2008 with bone marrow stem cell transplants with anti-inflammatory post-transplant treatment regimen, where HIV in his body has been suppressed to the level where it has been undetectable for 3 years, has prompted renewed hope for a “functional cure” for HIV from this new angle. This gives researchers, physicians, and patients alike a renewed hope for a possibility of a “cure.” This comes after many years of persistence towards other treatment “cures” with many significant strides forward; but also, unfortunately, some haltering strides as well. Nevertheless, in order to procure eventual success in this fight against the AIDS epidemic, we must learn from our mistakes and glean what we can from our successes until a “cure” is obtained.

In a prior case, another patient was given bone marrow stem cell transplant from a baboon, a species naturally resistant to HIV, but that patient passed away from complications of AIDS after transient improvement of symptoms. Similarly, with the advent of highly-active antiretroviral therapy (HAART) medication regimens, patients were able to achieve significantly suppressed viral levels. But we soon realized that the virus can remain dormant in many cells only to reactivate later on, therefore realizing that HAART was not a “cure.” In the interim, other treatment ideas have been entertained in hopes of achieving this elusive “cure.”

The concept of shock and awe also has been tossed around as a way to drive dormant HIV virus in cells outward to be treated and destroyed by HAART regimen. But, many questions still remain regarding this concept because we are still unclear as to where all of the viral population might remain dormant and whether activation of the dormant virus might precipitate decline and activation of disease symptoms in patients beyond what is desirable. With so many questions still remaining, the key concept to focus on is that with each new hypothesis of potential “cure” options, we are finely sifting through the information we need to take the necessary steps toward finding the solution for eradication of this far-reaching global disease epidemic.

And after all those prior attempts and various perspectives, it has led us to the most recent strides toward the ideology of finding a “functional cure” for HIV. The terminology of “functional cure” indicates the potential eradication of viral activity from all tissues in body whereby the virus is suppressed enough by our own enhanced immune system such that the virus stays permanently in check. If we are able to achieve this, the concept of temporizing medication therapy may be dispensable altogether.

For the patient who received the stem cell transplant in 2007 and 2008, his case is being intricately evaluated to see what factors in his history may be replicable in other patients and what key steps within the process ensured his “functional cure.” This patient was transplanted with the stem cells from a donor who was resistant to HIV because the CCR5 surface co-receptor protein is missing in these cells; thus, leaving the HIV virus unable to enter cells. Although HIV also could use another receptor CXCR4 to enter cells, it is still unclear why it did not occur in this patient.

There is some suggestion that perhaps the anti-inflammatory medications given to this patient after transplantation may have helped the process because the cellular damage of HIV infection also rests heavily on a chronic inflammatory process. So, it remains to be seen as to whether a strong anti-inflammatory treatment regimen in combination with such a stem cell transplant may be the way to go for a more universally successful “functional cure.”

Whichever way a potential treatment and “cure” regimen might be, we should still be fully cognizant that prevention should always be an important concept to practice in medicine. The concept of prevention should always remain at the forefront of our thoughts because with most viral infections, we should always be weary of viral mutation, which could potentially thwart our attempts at “functional cures.”

The exact necessary comprehensive regimen to be able to consistently achieve a “functional cure” for all HIV patients still remains to be clarified. The final conclusion of a universally successful “functional cure” may indeed be a combination of prior regimens with that of a stem cell transplant plus a potent anti-inflammatory regimen.

With recent advances and successes, we are all optimistic about what the future may hold for us all in this fight against the AIDS epidemic, but we are also far from the final successful chapter of our battle with HIV. Therefore, however hesitant and haltering our strides may be at times, the key is to make sure that those strides continue to confidently move forward for the benefit of future generations to come.

Impact of Diabetes on Alzheimer’s Disease: Concerns Extend Beyond American Health

We all know sugar, especially at higher levels of intake, are bad for our health. We know that it worsens aging of skin, suppresses immune functioning, puts us at higher risk for diabetes and cardiovascular diseases, and worsens inflammation in the body.

But, increasingly, we are seeing that the impact of chronic elevated sugar intake and sugar levels in our blood stream may also lead to neurodegenerative issues to a significant degree. With glucose intolerance and insulin insensitivity, there seems to be a correlation with Alzheimer’s as seen in diabetic patients. Studies are suggesting that those with diabetes mellitus tend to get Alzheimer’s disease more frequently and possibly even at an earlier age as compared to the general public.

According to Dr. Schubert, a neurobiologist at Salk Institute in La Jolla, California, people with type 2 diabetes mellitus are at a 50-100% higher risk of developing Alzheimer’s disease than non-diabetics. These are astonishing numbers when you think about the number of people in the U.S. who have type 2 diabetes mellitus.

The potential economical, health, and social implications of what’s to come for the large numbers of Americans who have type 2 diabetes, who are looking at potentially developing Alzheimer’s disease, are staggering. According to the Alzheimer’s Association, about 5 million Americans already have Alzheimer’s disease. And according to the Centers for Disease Control and Prevention, about 8% of the entire U.S. population have diabetes; whereas 23% of people older than 60 have it. With similarly concerning figures, the National Institute of Diabetes & Digestive & Kidney Diseases reports that about 90-95% of those with diabetes have type 2 diabetes mellitus; and that we are increasingly seeing it occur in younger people.

These numbers are very concerning because we are essentially looking at longer periods of exposure to insulin insensitivity and glucose intolerance because onset is increasingly occurring in younger people. With the hypotheses that insulin plays a strong role in growth and survival of neurons and that elevated blood glucose levels cause damage by forming advanced glycation end products, the overall impact on neuronal and cognitive functioning is dramatically significant.

So, if Americans are developing diabetes at younger ages, we may, in fact, develop Alzheimer’s at earlier stages in our life, where we would otherwise still have been working and leading active functional lives.  With the increasingly earlier onset of diabetes and its potential lead towards earlier onset of Alzheimer’s disease, we are essentially looking at a potential significant negative impact on overall American health, economical productivity, and social climate.

So, even though the medical community has been vigilantly monitoring those with diabetes to make sure that diabetic patients have well-controlled sugar levels, the greater movement should be towards implementation of diabetes prevention programs. Way too often, I am seeing patients who have already developed pre-diabetes or diabetes before they are made to be concerned. Whereas, the patients who have had years of increasingly elevated trends of fasting sugars are being ignored, as long as the number is below 100.

My recommendation is that we move towards more stringent guidelines, where even the fasting blood glucose levels that are creeping into the mid- to upper-90’s should be addressed. Patients who used to have fasting sugars in the 80s, who are now consistently coming up with fasting sugars in the 90’s, should have nutritional counseling. Physicians should be urging these patients to make significant changes in their lifestyle, weight, and diet such that glucose intolerance stays at bay.

My personal belief is that, even though we know sugar is not good for our health and glucose intolerance is concerning, we are not yet taking the necessary important steps towards being more stringent with our patients at earlier stages of disease development, in regards to their fasting sugar levels that are trending up.

In general, we are waiting for the fasting sugar to hit 100 before we make moves to lower the blood sugar level; and even then, not all of the patients or physicians become too concerned with pre-diabetes. I see this happening way too often in my clinic and that concerns me as a physician who practices medicine with the philosophy that I want to “fix the leaky faucet before it overflows” into being a full-blown disease state.

These studies and scientific suggestions of the far-reaching implications of glucose intolerance and insulin insensitivity should hopefully spur us all to put more emphasis on changing our diet and lifestyle; way before we reach that “pre-diabetes” classification so that we may all keep ourselves and our loved ones as healthy and productive for as long as we can. In doing so, we can hopefully stave off the negative tides of the impact of Alzheimer’s disease in increasingly younger and larger population of Americans.

References:

• Burns JM, et al. Neurology. 2007, 69, 1094.
• Craft S, et al. Neurology. 2008, 70, 440.
• Klein WL, et al. Proc. Natl. Acad. Sci. USA 2009, 106, 1971.
• Schubert DR, et al. Neurobiol. Aging. DOI: 10.1016/j.neurobiolaging.2008.02.010.