Category: Live Well Age Well

Live Well Age Well

Nutrition Blog 1: Challenges and controversies in Nutritional Science

This series of blogs, based on the strong research done by the Journal of the American College of Cardiology, will serve to provide recently discovered information on Nutrition and to dispel common myths on its relationship to Cardiologic health.
For decades, it has been known that a well-rounded, heart-healthy diet is vital for the prevention of atherosclerotic cardiovascular disease, or ASCVD, which includes coronary death, nonfatal myocardial infection, as well as fatal or non-fatal stroke.
What is the reason for the confusion?

There are several challenges to setting a scientific evidence base when it comes to nutrition, mostly due to the inter-weaving functions and effects of nutrients, the correlation of healthy behaviors such as exercise and activity and good dietary habits. To compound this, there is a lot of hype in the media and books about miracle diets and there is a lot of data without accompanying facts.


Evidence about the role of diet in prevention of ASCVD has been gathered in several different forms. Most which has been determined from Randomized Controlled Trials (RCTs), cohort and case control studies, case series and reports, as well as reviews and analysis. While there is a large body of information gathered from the many RCTs, it is unfeasible to measure data for every diet and health relationship, due to the vast number of results and effects. These studies can also be very time consuming or expensive. In addition, many confounding variables (or unaccountable variables that result in skewed data) may result from imperfect diet control. There also exists an ethical barrier, as the negative effects of certain nutrients cannot be studied as they are linked with the increase of major risk factors of CVD.

Why is nutritional research difficult?
Prospective Cohort Studies, which are longitudinal studies that follow over time a group of similar individuals who differ with respect to certain factors under study, are most effective to determine how these factors affect rates of a certain outcome. This is because, the measurement of dietary exposure will precede the actual development of the disease. However, these studies are not without limitations, which arise due to imprecise exposure quantification, similarity amongst dietary exposures and consumer bias. Case Control studies, while inexpensive, easy, and insightful about associations between exposures and outcomes, manage to have their own limitations as well. The largest being selection of the study population, as well as collection of retrospective data. Nutrition studies that require a detailed log keeping, can lead to errors due to a over reliance on accurate memory.

This Blog will be continued with Part 2, which will focus mainly on healthy dietary patterns that have been proven and tested.

Live Well Age Well

Outdoors and positive health effects

Although this post is about exercising and associated health impacts, let me begin by stating that being outdoors is good for your mental wellbeing. Even a small amount of outdoor time goes a long way to improve focus, creativity and also self-esteem! Perhaps, this is what prompted the great Naturalist John Muir to state “In every walk with nature one receives far more than he seeks”.

A simple act of walking or a leisurely stroll for an hour burns close to 350 calories and moderate hiking burns up to 600 calories. Furthermore, hiking near water especially helps with mental health1. When you are outdoors, you generally feel good, and this feeling continues to stay with you for the next few hours, maybe even the rest of the day2. When we feel better about ourselves, we tend to make better decisions with our lifestyles, interpersonal relationships and also our food intake.

Gardening is another powerful activity. In my medical practice, I often notice people who garden on a regular basis tend to age with good health. Even if they are hypertensive, are on medications and in some instances have severe arthritis, they tend to be happier and well-adjusted with their activities. It is a great habit to cultivate, and one I am personally hoping to incorporate in my life.

Let us now embark on the simple question, “why should one exercise?”
There are plenty of reasons why one should exercise, I have listed four reasons below.
• Individuals who exercise regularly report overall better health.
• Individuals who exercise regularly have fewer mobility constrains.
• Individuals who exercise regularly stay younger!
• Individuals who exercise regularly have lower health care costs.

The importance of regular exercise becomes more relevant after the age of 30. This is usually the time when one tends to stop playing sports or indulge in physical activities like regular biking and running. This is often due to family and work needs that forces time to be devoted to other tasks. We need to prioritize exercise at the same level as all other commitments and make sure we do not abandon this in lieu of others. Regular exercise helps maintains a good balance and lends itself to being more productive in our day.
Another important fact is, we begin to lose aerobic capacity and muscle mass as we age. Things we could do easily, for instance, running up three or more flight of stairs can get more difficult, lifting heavier objects may seem challenging. This decline hastens as we get older. For this reason, exercise is an imperative especially for older people.

It is never too late to start an exercise program. Anyone and everyone, with or without existing medical conditions can begin to exercise. There is a study where it was shown that even individuals who were previously sedentary and initiated exercise as late as age 85, demonstrated significant improvement as compared to the group that remained sedentary. Nursing Home residents time and time again show improved fitness with structured exercise programs.

As the life span of humans is increasing with advances in medical technology, medications and standard of living, we have to learn to be smart to live healthier as well. We need to keep our body and minds in good shape as we age and get into and past our golden years. I will soon write about the types of exercise for the body and also will comment on the importance of training our minds and the mind-body relationship.
If you have not exercised in a while and especially if you have medical conditions that may affect you, please consult with your physician before you begin a program.

For inspiration and motivation, following are a few links:


Live Well Age Well

Overcome Seasonal Affective Disorder (SAD)

As we are in the peak days of winter and have lesser and lesser natural light, it’s important to talk about SAD or Seasonal Affective Disorder. There are two types of SAD namely fall onset SAD and spring onset SAD. The fall version usually affects an individual in late fall or early winter and the spring version affects in early spring although it is less common. You need to know that SAD affects more than half a million Americans annually.

Fall onset SAD is characterized by increased need to sleep, increased appetite with carb craving, weight gain, irritability, interpersonal difficulties and feeling of heaviness in arms and legs. These changes affects other aspects of your life, and therefore should be recognized and addressed. No studies have proven the cause of this condition, but there is evidence to suggest the role of serotonin (a neurotransmitter).

The incidence of fall onset SAD is significantly greater in higher latitudes compared to that in the lower latitudes. Decreased daylight time is therefore a strong predisposing factor. In the US, the prevalence of SAD ranges from 9.7% in New Hampshire to 1.4% in Florida. SAD affects both women and men. The average age of people who develop SAD for the first time in 23 years. People of all ages can develop seasonal affective disorder. Fall onset SAD starts in late fall or early winter and most symptoms do tend to improve during the spring and summer months. The symptoms are worse during the coldest months.

Light therapy is helpful for some patients with fall onset SAD. This can be achieved with a light box, dawn simulators or using a computer-controlled heliostat to reflect sunlight into the windows of a home.

Some people with SAD may have immediate response to light therapy though typically it may take 2-4 days to see a positive response. It may take longer and yet some may need other modes of therapy including melatonin and anti-depressants.

It is also helpful to exercise regularly to release the feel-good endorphins and eat a diet rich in a variety of fruits and vegetables.

Always discuss your symptoms with your physician before starting any treatments.


Live Well Age Well

Ten things you need to know about Colon Cancer Screening

Ten things you need to know about Colorectal Cancer (CRC) screening

Colorectal cancer, or colon cancer, occurs in the colon or rectum. Colon cancer, when discovered early, is highly treatable. However, many people are simply afraid of the screening procedures, the prep work and are not well informed. Only 60% of the American adults 50 and older and currently getting screened. Following are ten commonly asked questions on screening procedures for CRC.

  1. Do I really need a colonoscopy? Is it beneficial?  No one in my family has had colon cancer before.

Colonoscopy is an effective procedure and everyone needs to be screened. Colorectal Cancer (CRC) is the third leading cause of non-skin cancers in the US. It is the second leading cause of cancer related deaths in the US. Every one irrespective of race and ethnicity is at risk.

The good news is that when caught on time, it may be completely curable. However if it is let to progress, it is a very difficult cancer to treat.

  1. When should I start screening for colon cancer?

Screening for CRC usually starts at age 50. However, the American College of Physicians and American College of Gastroenterology recommend starting at age 40 to 45 in high risk African Americans. Other guidelines do not have this recommendation

  1. How often should I be screened, or have the test? Is it every 5 years or 7 years or 10 years?

One time testing is insufficient. The incidence of CRC keeps increasing with age up to the age of 90s. If the initial colonoscopy is negative for any abnormalities then the next one is usually recommended in 10 years. However if polyps or other changes are seen then a repeat study can be recommended anywhere from 1 to 5 years.

  1. What if I had a Sigmoidoscopy instead of a Colonoscopy and the study was normal?

In such cases, the study should be repeated in in 5 years. Any time an abnormality is found on sigmoidoscopy, a follow up Colonoscopy should be performed.

If Fecal Occult Blood Testing is used for screening instead of colonoscopy or sigmoidoscopy, then this test needs to be repeated yearly. If any one of the annual test is positive, further testing with Colonoscopy may be necessary.

  1. When do I stop screening?

Screening should continue for most, up to age 75 to 85. When to stop is a decision best made in partnership with your physician. Usually if the life expectancy is less than 10 years, it is recommended to stop.

  1. I have never had a colonoscopy, and I am 80 years old. Should I still get one?

It is important to note that if someone has never had a screening test for colorectal cancer, a one time screening with colonoscopy or sigmoidoscopy is recommended up to ages 83-84. However this is a decision best made after a discussion with your physician.

  1. If the recommended screening is at age 50, there is no need to worry before that age, right?

Risk assessment (history taking by your Primary Care provider) should start at around age 20 and this should be updated periodically, about every 3-5 years.

This is because the individuals at higher risk need to be identified. They may need screening sooner. These are usually individuals with one or more first-degree relatives (parents and or siblings) with CRC that was diagnosed before the age of 60.

Those who have such a family history should be screened at age 40 or 10 years before the diagnosis was made in the first degree relative.

For example, if John’s father or mother was diagnosed with CRC at age 55, then John and his siblings will need screening at age 40, but if his father was diagnosed earlier at age 45, then John will need screening at 35.

There is also a similar increase in risk if there are two second degree relatives with h/o CRC.

  1. Are there any other conditions associated with an increased risk?

Yes. Other high risk groups include those with a personal history of Inflammatory Bowel Disease (Crohn’s colitis, Ulercative Colitis). There is increase in the occurrence of colon cancer in this group of people and they may need earlier and/or more frequent screening.

Another group at higher risk are individuals with past history of childhood cancer and required abdominal radiation therapy.

Also certain genetic syndromes, can predispose to CRC. These include family history of Lynch Syndrome or Heriditary Non polyposis colon cancer, Familial Adenomatous Polyposis. (FAP) and MUTYH associated polyposis. However these account for only around 5% of the CRC cases.

  1. So family history is important, right?

As we have seen there are a few conditions that require an earlier intervention for screening. It is important to know your family history and also any significant past history. This will help you and your Primary Care Physician come up with the correct screening strategy for you.

  1. Is Colon Cancer less likely to affect women?

Colon Cancer is the second leading cause of cancer death in women worldwide. It affects a lot of women too. Overall life time risk of developing colon cancer is 1 in 20 (5%), risk is slightly lower in women, but it still remains one of the leading causes of cancer related death in women.

Following are the test available for CRC Screening

  1. Stool guaiac test, needs to be done yearly. However, this test can have false positives leading to more work up. This test is less expensive and non invasive.
  2. Fecal Immunochemical testing (FIT) is more expensive than guaiac but has fever false positives and therefore fewer follow up studies therefore ultimately may be less expensive.
  3. Stoll DNA test requires collection of entire Bowel movement.  This is a newer procedure and the significance of occurrences of false positive remains unknown at present. Not commonly used.
  4. Flexible Sigmoidoscopy is a test that only identifies disease in the distal 60 cm of the bowel. However, this test requires less patient preparation and does not require patient sedation. If any abnormality is found this should be followed by colonoscopy.
  5. Colonoscopy is good at identifying disease as the whole colon is visualized, done by a GI specialist, who is trained in removing lesions (polyps). Sometimes this serves not only as diagnosis but also as cure if the polyp identified was precancerous or very early in the stage of the disease. However, as it is invasive there is risk of bleeding and perforation with this procedure
  6. CT Colonography gives almost same visual as a colonoscopy and requires prep work.   Newer studies that tag stools may do away with prep work. If any abnormality is found, a colonoscopy is needed.


Screening for Colorectal Cancer: A Guidance Statement From the American College of Physicians. Ann Intern Med. 2012;156:I-30. doi:10.7326/0003-4819-156-5-201203060-00003


Algorithm for Screening: