February Newsletter
February, 2021
Welcome to the February newsletter. This newsletter aims to provide information and analysis of timely topics from recent articles published in the medical literature. I hope you find this information useful and helpful in your health journey. If you have comments or questions, please let us know!
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I spend a lot of time discussing healthy lifestyles with people but I often think that we physicians are not specific enough with our recommendations. This month all three articles have very specific changes we can make in our lifestyles to improve health and longevity. The first article looks at specific nutritional changes and has a calculator we can use to assess how many years of life we could gain with various changes in our nutrition. The second article shows us how even a few minutes of physical activity may add years to our lives. Finally, the third article tells us specifically when to stop eating before bedtime as well as potential problems with eating late and a common supplement many people take for sleep. I hope you enjoy these articles!

On the COVID front, we continue to make headway. Hospitalizations in Wisconsin are now the lowest they have been since early August. It is estimated that over 73% of people now have immunity to the Omicron variant. Additionally, a prerelease of a study is showing enduring strength of natural immunity. The combination of immunity from infection, vaccination, and hybrid "superimmunity" should move us forward and allow us to continue to lower restrictions. As I've mentioned before, I believe that SARS-CoV-2 will be with us in some form moving forward. There will be new variants developing but at this point, there are no major new variants on the horizon. The BA.2 Omicron strain is getting a lot of hype and may become the new dominant strain in the US soon, but it does not appear to be any more virulent than the current Omicron BA.1 variant (except perhaps in Japanese hamsters) and seems unlikely to cause a surge in hospitalizations or deaths.

It still appears that we will all likely acquire or reacquire COVID infection, but we may not know the difference between this and any other cold virus (unless we are testing for it). Our memory B cells are able to produce high levels of antibodies if we see it again and these memory B cells produce antibodies adapted against any variants! Memory B cells are like blueprints for making antibodies but can be modified on the fly. Additionally, exposure to the virus generates T-cell memory even without a detectable viral infection.
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I am happy to announce that I have one of the newest diagnostic tests available. The Galleri test is a blood test that can detect over 50 types of cancer before they are apparent through regular screening testing (and many cancers don't have a screening test). The test detects methylation patterns of cell-free DNA which can indicate cancer and thus has the potential to detect cancers at the earliest stages. If you are interested in learning more about this test please let us know. I'm constantly on the lookout for cutting-edge tests and procedures for my patients and I have a few more things on the horizon that I am evaluating.
Eat to Live!
I talk to people about healthy lifestyles including exercise and nutrition daily. Physicians often talk in generalities but what if we could quantify how many years of life we could gain from dietary modifications? Maybe have a tool to make this calculation, something like the sliding tabs we can use when monitoring our credit reports, where we can lower debt or pay off bills and see what happens to our credit score. What if I told you this tool exists? The authors of this paper have developed a decision support model that predicts how dietary choices affect life expectancy. We can now see how specific changes in our nutrition can affect our longevity. Want to know how many years of life you could gain if you cut out sugar-sweetened soda? The calculator will tell you!

Walk Away From Death
We all know that exercise and physical activity are good for our health. But can we quantify this? How much activity do we actually need? What are the benefits of more physical activity and what is the threshold to gain these benefits? This article examines the relationship between physical activity and mortality and gives us an idea of how much exercise we need, and how adding as little as 10 minutes a day can make a big difference in our potential risk of death. 
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After Dinner Diabetes
Eating late at night can cause us to gain weight. I don’t think any of us reaches for celery as a snack at night. But is it as simple as eating junk before bed that causes us to gain weight? What is the mechanism for weight gain and possible increased risk of diabetes with late-night eating? How long should we wait after eating to go to bed? The hormonal interaction behind this isn’t what we might think and may be of special interest for people who use melatonin supplements to help with sleep. 
To Your Health...
Thank you for taking the time to read through this newsletter. We hope you have found this information useful. Feel free to pass this on to anyone you think would benefit from this newsletter.

Mark Niedfeldt, M.D.


Old-fashioned medicine with 21st Century convenience and technology