December Newsletter
In This Issue
Eat To Live
Good For Your Heart
What Type of Drinker Are You?
A Better Model of Medical Care
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. It's hard to believe that 2017 is coming to an end. I would like to thank all of you for a great year, and wish you and your families nothing but joy and success in 2018!

As we head into the new year, many people make resolutions. I would venture to guess a fair amount of them involve improvements in diet and pledges to exercise more. In that vein I have chosen a couple of articles to help you make decisions and plans for success

The first article examines the relationship between dietary patterns and long-term survival. Your food is your medicine and this study backs up what I always relay to my patients, your nutrition will determine your health. Which diet is best? It depends, but this study looked at two specific types and found a diet that lowered mortality. Check out the article and links for complete information. 

Heart disease is  the leading cause of death for both men and women and prevention of heart disease is a major focus of my practice. The second article shows us a way to reduce this risk without drugs! If you need motivation for your "exercise more" resolution, you will find it here.

New Year's Eve is almost here. Many of us will raise a toast to the passing of 2017 and the start of 2018. What does your choice of drink tell us about your emotional state? Does your drink affect your emotions? Which country has the angriest drunks? The answers are in the third article. Happy New Year!  

Click on the links the the left to check out our redesigned  web site ...
Eat To Live
Dietary patterns and long-term survival
This study, from the Cooper Clinic in Dallas and published in The American Journal of Medicine, evaluated the impact of dietary patterns on mortality. Researchers followed 11,376 people over 18 years and found that risk of all-cause mortality was significantly lower for people who followed the DASH dietary pattern and risk was increased for those with added sugar and solid fat intake. Interestingly, they found no independent associations between the Mediterranean diet and all-cause or cardiovascular mortality. 
  • BACKGROUND: Dietary patterns are related to mortality in selected populations with comorbidities. We studied whether dietary patterns are associated with long-term survival in a middle-aged, healthy population.
  • METHODS: In this observational cohort study at the Cooper Clinic preventive medicine center (Dallas, Tex), a volunteer sample of 11,376 men and women with no history of myocardial infarction or stroke completed a baseline dietary assessment between 1987 and 1999 and were observed for an average of 18 years. Proportional hazard regressions, including a tree-augmented model, were used to assess the association of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, Mediterranean dietary pattern, and individual dietary components with mortality. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality.
  • RESULTS: Mean baseline age was 47 years. Each quintile increase in the DASH diet score was associated with a 6% lower adjusted risk for all-cause mortality (P < .02). The Mediterranean diet was not independently associated with all-cause or cardiovascular mortality. Solid fats and added sugars were the most predictive of mortality. Individuals who consumed >34% of their daily calories as solid fats had the highest risk for all-cause mortality.
  • CONCLUSIONS: The DASH dietary pattern was associated with significantly lower all-cause mortality over approximately 2 decades of follow-up in a middle-aged, generally healthy population. Added solid fat and added sugar intake were the most predictive of all-cause mortality. These results suggest that promotion of a healthy dietary pattern should begin in middle age, before the development of comorbid risk factors.


This large study followed people for almost two decades and found healthy diet patterns were associated with significantly lower risk of mortality. What you are eating today will have a significant effect on your lifespan. DASH stands for Dietary Approaches to Stop Hypertension. It was a diet developed to reduce blood pressure, however, it seems that it may be a healthful long-term diet plan as well. The DASH diet emphasizes vegetables, fruits, low-fat dairy, moderate fish, poultry, whole grains, and nuts. It also limits sodium intake and encourages foods high in potassium, magnesium and calcium. More information on the DASH diet.

I did find it interesting that the Mediterranean diet, which has been associated with lower mortality risk in multiple other studies, didn't show an association in this study. However, I still feel that this is a healthful diet and it has many components in common with the DASH diet.
Neither diet showed a decrease in cardiovascular risk which I found interesting. 

When breaking down components of the diet, sugar intake was the most predictive of mortality. Interestingly, the lowest sugar intake group didn't have the lowest mortality rate, it was the second lowest. It isn't clear why this is the case but it is thought that perhaps this group had been in higher sugar intake groups and instructed to decrease sugar due to health issues. I highly doubt there is a "healthful" amount of sugar intake.

Most of you know that I consider diet the cornerstone to health. What type of diet should you eat? What I can tell you for sure is that the SAD (standard American diet) is not the way to go. This diet contains tons of processed foods, sugar, saturated fats (dangerous with sugar and processed foods), and is low in fiber. In contrast the DASH, Mediterranean, Wheat Belly, various forms of keto, Paleo and others I recommend depending on individual needs are all high in vegetables, fiber, low in sugar, contain minimal to no processed foods, are moderate to high in nuts, seeds, healthful oils and fats, and moderate in fruit and meat intake. The most important thing initially is to make a positive change. Choose one that sounds doable for you. What you will find is that after eliminating sugar and processed foods for about a week you will no longer crave them. You can lose weight and improve health parameters with all of the diet plans above. The important thing is to make a change!

Good For Your Heart
More evidence physical activity reduces cardiovascular disease risk

Activity is good. We know this. We also know that with in our current society activity is harder to get on a daily basis. Many of us have sedentary jobs and many people tend to be sedentary during their leisure time as well. This study, from JAMA Cardiology, followed a group of over 487,000 adults in China without cardiovascular disease over 7.5 years and found that those individuals with higher levels of activity had significantly lower risk of cardiovascular disease. 


  • Importance: In China, the patterns and levels of physical activity differed from those in high-income countries. Substantial uncertainty remains about the relevance, both qualitatively and quantitatively, of domain-specific physical activity for cardiovascular disease (CVD) subtypes in Chinese adults.
  • Objective: To assess the shape and strength of the associations of total, occupational, and nonoccupational physical activity with CVD subtypes in Chinese men and women.
  • Design, Setting, and Participants: This population-based prospective cohort study in 10 (5 urban, 5 rural) areas across China included 487,334 adults who were aged 30 to 79 (mean 51) years with no prior CVD history when enrolled from June 2004 to July 2008.
  • Exposures: Self-reported total, occupational, and nonoccupational physical activity, quantified as metabolic equivalent of task hours per day (MET-h/d) based on the type, frequency, and duration of specific activities.
  • Main Outcomes and Measures: Major vascular events (n = 36,184) and their components, including major coronary events (n = 5082), ischemic stroke (n = 25,647), intracerebral hemorrhage (n = 5252), and CVD death (n = 8437), Cox regression yielded adjusted hazard ratios for each disease that was associated with physical activity.
  • Results: Of the 487,334 study participants, 287,527 (59%) were women and the mean (SD) age was 51 (10.5) years. The overall mean (SD) total physical activity was 21.5 (12.8) MET-h/d, mainly from occupational activity, especially among men (75% vs 50% in women). Total physical activity was inversely associated with the risk of major vascular events, with the adjusted hazard ratio that compared the top vs bottom quintiles of physical activity being 0.77 (95% CI, 0.74-0.80). Throughout the range of total physical activity studied, the association with CVD with each 4 MET-h/d higher usual total physical activity (approximately 1 hour of brisk walking per day) associated with a 6% (95% CI, 5%-7%) lower risk of major vascular events, and a 9%, 5%, 6%, and 12% lower risk of major coronary events, ischemic stroke, intracerebral hemorrhage, and CVD death, respectively. The strength of the associations was similar and independent of each other for occupational and nonoccupational physical activity. However, for occupational physical activity, the associations with CVD subtypes were greatly attenuated above 20 MET-h/d, especially for intracerebral hemorrhage. The associations of total physical activity with major vascular events were similar among men and women and across different levels of sedentary leisure time but were much weaker among individuals with high blood pressure.
  • Conclusions and Relevance  Among Chinese adults, higher occupational or nonoccupational physical activity was associated with significantly lower risks of major CVD.
How much activity is needed for health? Good question. This study gives some guidelines. The researchers found that each hour of 4 metabolic equivalents (METs) of activity daily (occupational and nonoccupational) lowered the risk of cardiovascular disease by 5-12%. A MET is defined as the energy it takes to sit quietly. So 4 METs is equivalent to brisk walking or similar activities. This amount of activity can be accumulated throughout the day either with work or recreational activities. Any activity is better than none so try to move more at work, walk briskly when you can, and accumulate activity throughout the day. Here is a guide to the metabolic equivalents of different activities.   
What Type of Drinker Are You?
Do different types of alcohol trigger specific emotions?
Can your choice of alcoholic drink trigger specific emotional triggers? This international self-reported online study included data on 29,836 respondents aged 18-34 years. Results noted that emotions differed substantially between demographic groups. While spirits such as vodka, gin, and whisky were more likely to elicit the most positive emotions  (energized, sexy, confident), they were also more likely to make respondents feel ill. Almost 30% reported drinking spirits was associated with aggression. Red wine was most likely to make people feel relaxed (and tired). Heavier drinkers reported negative emotions (tired, aggressive, ill, restless, and tearful) more often. Women and younger drinkers reported more emotions associated with drinking overall. South Americans tended to feel more energized, relaxed, and sexy, while Norwegians tended to be more aggressive. The French became restless. 

  • Objectives: To examine the emotions associated with drinking different types of alcohol, explore whether these emotions differ by sociodemographics and alcohol dependency and whether the emotions associated with different drink types influence people's choice of drinks in different settings.
  • Design: International cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media from November 2015 to January 2016.
  • Study population:  Individuals aged 18-34 years who reported consumption of beer, spirits, red and white wine in the previous 12 months and were resident in countries with more than 200 respondents (n=21 countries; 29,836 respondents).
  • Main outcome measures:  Positive and negative emotions associated with consumption of different alcoholic beverages (energised, relaxed, sexy, confident, tired, aggressive, ill, restless and tearful) over the past 12 months in different settings.
  • Results:  Alcoholic beverages vary in the types of emotions individuals report they elicit, with spirits more frequently eliciting emotional changes of all types. Overall 29.8% of respondents reported feeling aggressive when drinking spirits, compared with only 7.1% when drinking red wine (p<0.001). Women more frequently reported feeling all emotions when drinking alcohol, apart from feelings of aggression. Respondents' level of alcohol dependency was strongly associated with feeling all emotions, with the likelihood of aggression being significantly higher in possible dependent versus low risk drinkers (adjusted OR 6.4; 95% CI 5.79 to 7.09; p<0.001). The odds of feeling the majority of positive and negative emotions also remained highest among dependent drinkers irrespective of setting.
  • Conclusion Understanding emotions associated with alcohol consumption is imperative to addressing alcohol misuse, providing insight into what emotions influence drink choice between different groups in the population. The differences identified between sociodemographic groups and influences on drink choice within different settings will aid future public health practice to further comprehend individuals' drinking patterns and influence behaviour change.

OK , I know this isn't the strongest article I've cited for a newsletter by a long shot, but hey, it's my last newsletter of the year and I thought it would get your attention. Do tequila drinkers have more fun? Or are they more aggressive? Seems like the correct answer is it depends. Young women drinking fruity cocktails are probably feeling more energized and sexy than a 50 yo guy having a beer. I know a glass of red wine at the end of a busy day makes me feel relaxed (and tired). Your mood and environment before drinking is probably influencing your emotions while drinking. 
My take on all this is that people should enjoy what they like (in moderation).  Just stay away from those 

Do emotions related to alcohol consumption differ by alcohol type? An international cross-sectional survey of emotions associated with alcohol consumption and influence on drink choice in different settings BMJ Open 2017;7:e016089. doi: 10.1136/bmjopen-2017-016089 .
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. 


As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email , phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.