Physicians Would Need Almost 27 Hours A Day To Provide Optimal Patient Care, Per New Study

If you ever felt rushed in the doctor’s office, there are reasons.  Simply stated, your doctor is doing the best they can, but there just aren’t enough hours in the day – literally!!  Check out this study reported in Forbes.  Understand that the premise was a practice of 2500 patients, which is kind of a standard, not crazy busy practice.  And yet, to provide the care recommended by guidelines would require 27 hours per day (that’s work hours per day).  

It might be good to limit the number of people in a practice, but if the practice is a pure insurance based model the physician won’t be making a living.  I’m not talking about taking a pay cut, I’m talking about the Primary Care doc taking home less than the median.  The system needs some fixin’!

FROM FORBES / BY SAI BALASUBRAMANIAN, M.D., J.D.

In a new study published in the Journal of General Internal Medicine, researchers found that in order to provide guideline-recommended care, a primary care physician would require nearly 26.7 hours per day.

The study was pioneered by Dr. Justin Porter, M.D., at the University of Chicago School of Medicine, and is titled “Revisiting the Time Needed to Provide Adult Primary Care.” The study looked at a hypothetical panel of 2500 patients, and what it would take to provide them guideline directed care (e.g. per The US Preventative Services Task Force guidelines). The studied categories included preventative care, in addition to chronic disease and acute care.

The results were jarring, indicating that there are literally not enough hours in the day for physicians to abide by all the recommendations that have been stipulated for “ideal patient care,” especially with the significant time challenges that actually exist in a real practice setting.

Dr. Porter explains: “There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday […] We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately.”

The practice of medicine is very different from the theoretical delivery of it. In real time practice, physicians are often bogged down with numerous tasks and inefficiencies that constantly distract their workflow. One of the biggest time investments is charting. For years, electronic health record (EHR) systems promised to hasten the charting process, providing physicians with the digital tools required to chart faster and more efficiently. However, many physicians often find these EHR systems more cumbersome than traditional written charts, forcing them to spend more time troubleshooting complex systems than with actual patients.

And there are so many other things that a physician has to do during a workday—deal with insurance matters, call patients back about results, deal with patient queries, work with auxiliary staff on practice management, etc. The list is ever-growing.

Ultimately, the party that suffers the most is the patient.

Porter perfectly captures how patients feel about this conundrum: “If you do surveys with patients about what frustrates them about their medical care, you’ll frequently hear, ‘My doctor doesn’t spend time with me’ or ‘My doctor doesn’t follow up […] I think a lot of times this is interpreted as a lack of empathy, or a lack of willingness to care for a patient. But the reality—for the majority of doctors—is simply a lack of time.”

This has become a crucial problem in care delivery in nearly every context. In most parts of the country (and world), there is a massive physician shortage. This means that the physicians that are practicing have incredibly long patient rosters on a daily basis, and even longer waiting lists. Additionally, this is in the context of ever-growing pressure on physicians to increase their responsibilities, abide by new guidelines, and continue to maintain high patient satisfaction scores. Simply put, it is a never ending battle.

Undoubtedly, healthcare organizations and policy leaders must recognize these issues and take measures to alleviate some of these pressures. Whether that is funding more access to care opportunities or providing practices with more resources, change has to be enacted before this crisis leads to a point of no recovery.

What Is the Rarest Eye Color in the World?

Hey - it’s a question that people occasionally ask and the answer is (as usual) more complicated! It’s just another example of how complicated the human condition is, but sometimes that complexity is not really “important” to our daily lives, but it adds to the extraordinary wonder associated with what it means to be human.

FROM AARP / BY HALLIE LEVINE

How many eye colors are there, and why your shade is unique to you

At some point, you’ve probably wondered what the rarest eye color is. The answer is green, according to the American Academy of Ophthalmology (AAO). Only about 2 percent of the world’s population sport this shade.

As to why, that answer isn’t so simple. “We used to think only one gene determined eye color,” says Julie Kaplan, M.D., a physician at the Center for Personalized Genetic Healthcare at the Cleveland Clinic. In high school biology class, for example, you probably learned that brown was dominant and blue was recessive, so two blue-eyed parents would not be able to have a baby with brown eyes. The truth, however, is a bit more complicated, Kaplan notes.

What determines your eye color?

About 75 percent of eye color is due to one gene, OCA2. It makes melanin, a substance in your body that produces hair, eye and skin pigmentation. If you inherit two nonfunctional copies of the OCA2 gene from your parents, you will go on to develop blue eyes. But if you have at least one functional copy, your eyes will be darker, on the spectrum of green, hazel or brown.

In case you were planning to decorate your impending grandbaby’s nursery to match the color of their eyes, be prepared to be disappointed. It is impossible to predict what color their orbs will be. “There are several different genes involved, which we’re just beginning to learn about and understand,” Kaplan explains. HERC2, for example, is a gene that turns the OCA2 gene on or off as needed. Different variations of it can cause the OCA2 gene to produce less melanin, which leads to lighter-colored eyes. There are at least eight other genes that influence eye color. In the meantime, you can take comfort in the fact that your own individual eye color is like your fingerprints: something that is unique only to you.

Brown eyes are the most common: Over half the people in the world have them, according to the AAO. In fact, about 10,000 years ago, all humans had brown eyes. Scientists speculate that their elevated levels of melanin helped protect people from the sun’s damaging rays. But as people moved from the sweltering climates of Africa and Asia to the cooler environments of Europe, there was less need for this protection.

At some point in history, as humans migrated north, a gene mutation occurred to reduce melanin production, says Kaplan. When the eyes have less melanin, they absorb less light. That means more light is scattered out from the iris, or colored part of the eye, which reflects off the surroundings. Eyes with the smallest amount of melanin in them will appear blue, while those with a little more melanin will appear green or hazel.​

Were Elizabeth Taylor’s eyes really violet?

Most people’s eyes are blue, green or brown, with some shades in between, notes Kaplan. This explains why your eyes may be dark green or hazel or even appear bluish gray. While Elizabeth Taylor made headlines with her violet eyes, her eyes were in fact blue. Blue eyes get their color from light that is coming in and being reflected out, so it is not surprising that they appeared as assorted colors based on lighting conditions.

Makeup can bring out certain colors in the eye, Kaplan adds. Taylor also reportedly had a double row of eyelashes, a condition doctors call distichiasis, which helped accentuate her famous eyes. Some people with albinism do appear to have violet eyes, because the blood vessels in the back of their eyes can be seen under certain light conditions. People with albinism have little or no production of melanin pigment, which affects the color of skin, hair and eyes.

The science of why you have great ideas in the showers

“Dead time” is important.  Lots of reasons – stress reduction, recovery, but also opening up the opportunity for creativity and the possibility of possibilities.  If you’ve got some time, just read through the accompanying article – some reasons why the shower may offer a good spot for good ideas, and also how you might grow those opportunities – good sleep, time in nature, etc.

NATIONAL GEOGRAPHIC / BY STACEY COLINO

It has nothing to do with getting clean—and everything to do with your state of mind.

When you’re in the shower “you don’t have a lot to do, you can’t see much, and there’s white noise,” notes John Kounios, a cognitive neuroscientist and director of the Creativity Research Lab at Drexel University in Philadelphia. “Your brain thinks in a more chaotic fashion. Your executive processes diminish and associative processes amp up. Ideas bounce around, and different thoughts can collide and connect.”

If you’ve ever emerged from the shower or returned from walking your dog with a clever idea or a solution to a problem you’d been struggling with, it may not be a fluke.

Rather than constantly grinding away at a problem or desperately seeking a flash of inspiration, research from the last 15 years suggests that people may be more likely to have creative breakthroughs or epiphanies when they’re doing a habitual task that doesn’t require much thought—an activity in which you’re basically on autopilot. This lets your mind wander or engage in spontaneous cognition or “stream of consciousness” thinking, which experts believe helps retrieve unusual memories and generate new ideas.

“People always get surprised when they realise they get interesting, novel ideas at unexpected times because our cultural narrative tells us we should do it through hard work,” says Kalina Christoff, a cognitive neuroscientist at the University of British Columbia in Vancouver. “It’s a pretty universal human experience.”

Now we’re beginning to understand why these clever thoughts occur during more passive activities and what’s happening in the brain, says Christoff. The key, according to the latest research, is a pattern of brain activity—within what’s called the default mode network—that occurs while an individual is resting or performing habitual tasks that don’t require much attention.

Researchers have shown that the default mode network (DMN)—which connects more than a dozen regions of the brain—becomes more active during mind-wandering or passive tasks than when you’re doing something that demands focus. Simply put, the DMN is “the state the brain returns to when you’re not actively engaged,” explains Roger Beaty, a cognitive neuroscientist and director of the Cognitive Neuroscience of Creativity Lab at Penn State University. By contrast, when you’re mired in a demanding task, the brain’s executive control systems keep your thinking focused, analytical, and logical.

A cautionary note: While the default mode network plays a key role in the creative process, “it’s not the only important network,” Beaty says. “Other networks come into play as far as modifying, rejecting, or implementing ideas.” So it’s unwise to place blind faith in ideas that are generated in the shower or during any other bout of mind wandering.

What is the default mode network

Marcus Raichle, a neurologist at the Washington University School of Medicine in St. Louis, and his colleagues serendipitously discovered the default mode network in 2001 when they were using positron emission tomography (PET) to see how the brains of volunteers were functioning as they performed novel, attention-demanding tasks. The team then compared those images to ones made while the brain was in a resting state and noticed that specific brain regions were more active during passive tasks than engaging ones.

However, because the function of each brain region isn’t well characterised and because a specific brain area can do different things under different circumstances, neuroscientists prefer to talk about “networks of brain areas,” such as the default mode network, which function together during certain activities, according to John Kounios, a cognitive neuroscientist and director of the Creativity Research Lab at Drexel University in Philadelphia.

Raichle named this network the “default” mode network because of its heightened activity during idle periods, says Randy L. Buckner, a neuroscientist at Harvard University. But it’s something of a misnomer because the default mode network is also active in other mental tasks, such as remembering past events or engaging in self-reflective thought.

The network is also “involved in the early stages of idea generation, drawing from past experiences and knowledge about the world,” explains Beaty. “When you’re not actively working on a problem, the brain keeps spinning and you can get restructuring of elements of the problem, pieces get reshuffled, and something clicks.” The DMN, he adds, “helps you combine information in different ways and simulate possibilities.”

Researchers have discovered that when it comes to measures of creativity, there's a positive correlation between creative performance and grey matter volume of the default mode network. In other words, as far as creativity goes, size matters when it comes to the DMN.

To investigate changes in brain activation and connectivity between different regions of the DMN, researchers asked volunteers to alternate between activities involving high cognitive effort (naming colours), low cognitive effort (reading words), and no cognitive effort (resting). They found that the default mode network was most active when the participants were at rest and more active during the low effort task than the high effort one, according to the study in the April 2022 issue of Scientific Reports. This suggests that DMN activity can toggle up and down, as if on a dimmer, perhaps stopping at intermediate points along the way, depending on the level of cognitive challenge that’s required.

The link to creative thinking was demonstrated in a study published in January that involved patients who were awake during brain surgery so surgeons could map the exposed cortical surface for language functions. As direct electrical stimulation was applied to their default mode network or another area of their brain, the patients were asked to perform an "alternate-uses task" that involved inventing unusual uses for an everyday object—in this case, a paper clip—which is a way of evaluating divergent thinking abilities. The researchers found that the patients’ ability to successfully perform the alternate-uses task depended on the strength of connections between nodes of the default mode network.

“The default mode network seems to be an important source of creativity, and it’s decidedly associated with mind-wandering,” says Jonathan Schooler, a psychological scientist at the University of California, Santa Barbara. Indeed, a study in the February 2022 issue of Human Brain Mapping found that positive, constructive daydreaming—“characterised by planning, pleasant thoughts, vivid and wishful imagery, and curiosity”—is associated with activity in the default mode network and creativity.

The benefits of mind-wandering 

Whether we realise it or not, we all engage in mind-wandering on a regular basis, says Beaty, noting that there are different kinds. There’s deliberate mind-wandering, where you try to exercise some level of control or direction to your thinking; and spontaneous mind-wandering, which happens in the brain without us directing it. In a study in a 2020 issue of PNAS, researchers using electroencephalograms to track people’s brain activity found that spontaneous mind-wandering occurred 47 percent of the time.

It’s the spontaneous form, in particular, that allows you to combine information and ideas in new ways. “When your mind drifts away from a situation into an internal reverie, that’s where you can have creative insights,” Schooler says. “In this pleasurable state, you’re allowing thoughts to playfully cross your mind.” Keep in mind, he adds, “sometimes you have to do the work to create a problem space—that sets the groundwork for spontaneous ideas to emerge.”

This is often referred to as "the incubation effect," which occurs when you spend time away from a particular problem or challenge and your mind has the chance to wander and generate novel ideas through unconscious associative processes.

To discover when people get their most innovative ideas, Schooler and his colleagues asked professional writers and physicists to keep a diary for two weeks, in which they reported their most creative idea of the day, what they were doing when it occurred, and whether it felt like an “aha” moment. Approximately 20 percent of their most significant ideas occurred while they were engaging in an activity other than working or while they were thinking about something unrelated to the creative idea, according to the study published in a 2019 issue of the journal Psychological Science. More significantly, ideas sparked during mind-wandering moments were more likely to be associated with overcoming an impasse on a vexing problem and to be viewed as “aha” moments.

VIDEO SHOWS BRAIN WAVES PROJECTED AS ART IN REAL TIME

See how brain waves are transformed into flowing art.   

“You need that exploratory aspect of idea generation in order to be creative,” says Rex Jung, a neuropsychologist at the University of New Mexico in Albuquerque. But, he adds, you need other parts of your brain to pick an idea, evaluate its viability, and implement it in the real world. He notes, “It’s an interplay or dance between the default mode network and the cognitive control network that allows you to generate a creative idea then implement it effectively.”

How to spark creativity

Besides leading to greater self-understanding, gaining insights into these aspects of the creative process can help you maximise your brain power in various situations. But keep in mind, Jung points out, “these are early days, and there’s still a lot to learn about how the brain creates.”

As a first step, it’s wise to prioritise getting plenty of good quality sleep, which can improve your mood and help with memory, says Kounios who is co-author of The Eureka Factor: Aha Moments, Creative Insight, and the Brain. While you’re asleep, he notes, “the information you take in during the day is transformed from a fragile state into a more durable state which can bring aha moments.”

Immediately upon awakening from a full night’s sleep or even a 20-minute nap, Christoff recommends paying attention to thoughts and ideas that occur to you in that liminal state between being sound asleep and fully awake—that’s a time when your ideas are “often quite free-flowing,” she adds, which means you can tap your creative potential.

To consciously activate your DMN and creative ideas during the day, allow yourself to spend time doing activities that aren’t cognitively demanding—such as going for a walk, taking a warm bath, or gardening—without listening to music or a podcast. Simply let your mind wander. Do this when you’re “in a state of psychological safety, where there’s no danger to having an unusual thought and no immediate task to perform,” Kounios says. (In other words, don’t do this while driving.)

During the day, doing something easy and familiar, often involving some kind of movement, is likely to facilitate the flow of spontaneous thoughts. When you’re in the shower, for example, “you don’t have a lot to do, you can’t see much, and there’s white noise,” notes Kounios. “Your brain thinks in a more chaotic fashion. Your executive processes diminish and associative processes amp up. Ideas bounce around, and different thoughts can collide and connect.”

There’s some research that suggests spending time in nature—which can evoke a sense of awe, as well as inducing relaxation—is conducive to mind-wandering because it allows “your attention to expand to fill the space,” Kounios says. “Taking a walk in nature can improve your mood and expand your thoughts to include remote ideas and associations.”

That’s why if you’re trying to come up with a new idea or solve a problem, it’s a good idea to work hard on it then take a break and go for a walk if you reach an impasse. “This allows your mind to subconsciously work on something you were consciously working on,” Christoff says.

A key factor: The activity needs to last long enough “to present the opportunity to get into a different mode of thinking that we usually guilt ourselves out of,” Christoff explains. “We need to become relaxed enough mentally in order to not try to be productive or reach some goal. With habitual activities we engage in with some regularity, we don’t feel guilty about letting our minds wander—that’s when the mind can reach new places.”

So don’t be afraid to unplug and carve out time for mind-wandering and musing on a regular basis. “One of the costs of this multimedia world we live in is we don’t leave enough time for personal reverie,” Schooler says. Giving your mind a chance to roam is an investment in your creativity, and that’s time well spent.

Bottoms Up on Black Tea for a Long Life?

This study is getting a lot of media time.  It’s nice if you drink black tea – it reinforces that it’s “good for you”.  The reality is that the results are modest (about an 11% overall mortality benefit – that’s good) for those drinking 2 -3 cups a day.  But when you delve into the details, there’s some crazy stuff that runs contrary.  So it depends on where you want the benefit – 2-3 cups helps your heart, but a bit more doesn’t help.  But, if you drink 8 or more cups, you again decrease your heart attack risk.  Of course, if you want to decrease your risk of stroke, you’ve got to drink 10+ cups.  2-3 cups helps with lung disease and cancer.  

Take away?  If you like tea, drink it.  I’d suggest you get a quality tea – toxins abound in many of the mass produced products, so organic wouldn’t be a bad idea!

FROM MEDPAGE TODAY / BY KRISTEN MONACO

Prospective study found modest mortality benefit to drinking 2-plus cups per day

A few cups of tea a day might help to stave off an early death, a U.K. Biobank prospective cohort study showed.

Among nearly half a million middle-age adults, those who consumed two or more cups of tea a day saw a modest but lower risk for all-cause mortality over a median 11.2-year follow-up, reported Maki Inoue-Choi, PhD, of the National Cancer Institute in Bethesda, Maryland and colleagues in the Annals of Internal Medicine.

While those who only drank one or fewer cups per day didn't see this protective benefit (HR 0.95, 95% CI 0.91-1.00), moderate and heavy tea drinkers did see a significantly lower mortality risk:

• Two to three cups per day: HR 0.87 (95% CI 0.84-0.91)

• Four to five cups: HR 0.88 (95% CI 0.84-0.91)

• Six to seven cups: HR 0.88 (95% CI 0.84-0.92)

• Eight to nine cups: HR 0.91 (95% CI 0.86-0.97)

• 10 or more cups: HR 0.89 (95% CI 0.84-0.95)

"Almost 90% drank black tea, making black tea the predominant tea type in this population," Inoue-Choi pointed out during a press conference. She added that most previous research quantifying the benefits of tea drinking have focused on green, not black, tea.

"These results suggest that black tea, even at higher levels of intake, can be part of a healthy diet," she said. "While these findings offer reassurance to tea drinkers, they do not indicate that people should start drinking tea or change their tea consumption for health benefits."

Inoue-Choi's group also found that drinking tea was linked with a lower risk for cardiovascular-specific causes of death.

In fully adjusted models for sociodemographic and lifestyle factors, drinking more than two cups of tea per day was associated with a 14% to 24% lower risk for death from all cardiovascular diseases, with the heaviest tea drinkers seeing the most risk reductions.

Likewise, consuming two to three cups per day was linked with a 17% lower risk for death due to ischemic heart disease, although those who drank anywhere from four to seven cups on average didn't see a significant risk reduction. However, drinking eight or more cups on average was associated with a 26% lower risk for ischemic heart disease-related mortality.

As for stroke-related deaths, only those who drank 10 or more cups per day saw a significant risk reduction (HR 0.48, 95% CI 0.28-0.85).

Drinking an average of two to three cups of tea per day was also linked with a modestly reduced risk for respiratory disease-related death and cancer-related death.

Inoue-Choi added that these associations were seen regardless of tea temperature and whether people took their tea black or if they added milk and/or sugar. The associations were also adjusted for genetic variations in caffeine metabolism.

"Tea is very rich in bioactive compounds, such as polyphenols," she told MedPage Today. "These compounds have the potential to decrease oxidative stress and inflammation, so these mechanisms can protect against cancer, cardiovascular disease, and other health conditions."

For this analysis, the researchers assessed data on 498,043 men and women from the U.K. Biobank, ranging in ages from 40 to 69, who completed the baseline touchscreen questionnaire from 2006 to 2010. More than 90% of respondents were white.

Of this cohort, 85% said they consumed tea daily, with 11.5% drinking one cup or less, 29.4% drinking two to three cups, 25.5% drinking four to five cups, 11.8% drinking six to seven cups, 3.7% drinking eight to nine cups, and 3.4% drinking 10 or more cups.

Men were a bit more likely to be the heaviest tea drinkers. Those drinking 10 or more cups of tea per day were also most likely to be current smokers.

"Although the associations were assessed carefully and comprehensively, these results need to be replicated in future studies and extended in other diverse populations," Inoue-Choi suggested.

Regular Exercise Program May Stall Cognitive Decline

If you worry that you're having to many "Senior Moments" - do some exercise!!

While the exercise involved required 4 sessions of 30-40 minutes a week, the stretching/balance group did just as well as the aerobic group. So, if you don't like getting sweaty and raising your heart rate high, that could really work for you. Still, you HAVE TO GET UP AND GO! And then you'll remember where you're going!

FROM MEDPAGE TODAY / BY JUDY GEORGE

Trial shows promise for people with mild cognitive impairment

Sedentary older adults with amnestic mild cognitive impairment who engaged in regular exercise for a year maintained their cognition without decline, topline data from the EXERT trial showed.

Older adults who engaged in either moderate intensity aerobic training or stretching, balance, and range-of-motion exercises for 12 months showed no change from baseline in ADAS-Cog-Exec scores, a measure of global cognitive function, reported Laura Baker, PhD, of Wake Forest University School of Medicine in Winston-Salem, North Carolina, at the 2022 Alzheimer's Association International Conference.

A comparison group of similar older adults with mild cognitive impairment in an observational study -- the Alzheimer's Disease Neuroimaging Initiative (ADNI) -- who did not have the EXERT interventions showed significant cognitive decline over 12 months, Baker noted.

"An increased amount of supported exercise of at least 120 to 150 minutes a week for 12 months may slow or stall cognitive decline in previously sedentary older adults with mild cognitive impairment," she said.

EXERT is the longest-ever phase III study of exercise in older adults with mild cognitive impairment, noted Maria Carrillo, PhD, chief science officer of the Alzheimer's Association.

These topline findings are "remarkable and encouraging," Carrillo said. "They suggest that regular physical activity, even modest or low exertion activity such as stretching, may protect brain cells against damage."

The EXERT trial aimed to test whether 12 months of exercise would improve or protect cognition in sedentary people with amnestic mild cognitive impairment. Participants with a mean Mini‐Mental State Examination (MMSE) score of 28 and a mean Clinical Dementia Rating scale Sum of Boxes (CDR-SB) score of 1.5 were randomized to either aerobic or stretching, balance, and range-of-motion exercise.

Both the aerobic and stretching/balance groups exercised four times a week for about 30 to 40 minutes. The aerobic group exercised at a moderate intensity, achieving 70% to 85% heart rate reserve. The stretching/balance group exercised at a low intensity, maintaining heart rate reserve below 35%.

In the first 12 months of the trial, participants were supervised by a trainer at the YMCA. For the next 6 months, they continued exercising independently.

A total of 296 participants enrolled in the study. Most (57%) were women; about 87% were white and 10% were Black. Mean age was about 74, and 25% were APOE4 carriers.

More than 31,000 exercise sessions were completed in the first 12 months. Attendance remained high throughout the study, at 81% in the aerobic exercise group and 87% in the stretching/balance group.

Neither the aerobic group nor the stretching/balance group showed decline from baseline on the ADAS-Cog-Exec at 6 or 12 months. There were no significant treatment differences between the aerobic and stretching/balance groups on these outcomes (P=0.29).

In a usual-care analysis, the researchers compared EXERT participants with those from ADNI matched on demographics, baseline cognitive function, and APOE4 status. ADNI participants showed an expected 12-month decline in ADAS-Cog-Exec scores, but the EXERT aerobic group (P=0.012) and EXERT stretching/balance group (P=0.0005) did not.

All EXERT participants received weekly socialization from the program, which may have contributed to the findings, Baker noted. What's critical is that regular exercise must be supported for people with mild cognitive impairment: it must be supervised and have a social component, she added.

Breakthrough Research Finds Meal Timing Is Key To Longevity

Go hungry, live longer!  Huh?

Well, maybe. 

Lots of studies show that a 10% calorie restriction (think no candy bar snack, or glass of sweetened beverage instead of having one every day) yields reasonable gain in longevity (and, it turns out health, as well).  Of note, calorie restrictions up to 30% can yield increased longevity in mice as well, but they end up getting sick along the way.

Now, adding to that research, we find that time-restricted eating (sometimes inappropriately called intermittent fasting) yields even more benefits to that mild restriction.  By limiting eating to the hours when you are actually active, and keeping the feeding window to under 12 hours, the mice got an extra 35% longer life when combined with the 10% calorie restriction.

What does this mean for humans?  Likely there is crossover – there will be benefits that parallel these findings in mice with those in people.  I personally follow a time-restricted eating pattern without really worrying about it – dinner/snack done by 8:30, breakfast maybe at 10:30 or after.  A bigger bang for the buck is exercising before breakfast, but that’s a discussion for another day.  By the way – I do have that occasional candy bar, but only VERY rarely have that sugar sweetened beverage (lemonade is an exception 😊 ).

FROM THE AMERICAN ACADEMY OF ANTI AGING MEDICINE / BY ZUZANNA WALTER

Plant-based diets have long been the focal point of longevity research as they have proven to stave off chronic disease, improve biological markers of aging, and aid in weight management, among many other benefits. Current dietary interventions primarily encourage the consumption of plant-based foods and the elimination of processed ingredients. However, emerging research suggests that it is not only the type of food consumed but also the timing of meals that can profoundly affect life- and healthspan. A new study published in the journal Science reveals the promising potential of strategic meal timing to promote anti-aging effects.

Time-Restricted, Calorie-Restricted Feeding

In modern dietary culture, intermittent fasting continues to grow in popularity along with the body of scientific evidence behind it. Variations of the method are also under investigation, including time-restricted feeding (TRF), which involves a longer daily fasting period. Preliminary studies have found that TRF can improve cardiometabolic health in rodents and humans, while caloric restriction (CR) has been associated with elongated lifespan.

Evidence supporting these findings is scarce, yet the timing of calorie restriction may contribute to life-extending effects due to the circadian system and its control of physiology, metabolism, and biological aging cycles.

To investigate this hypothesis, a team of researchers at the University of Texas Southwestern Medical Center in Dallas, TX, conducted a study on mice controlling both their caloric intake and the timing of their meals. The subjects were split into six groups to determine whether meal timing had an independent effect on lifespan. One group served as the control cohort, while the remaining five consumed meals on varying feeding schedules.

Impact on Lifespan

As anticipated, caloric restriction extended the lifespan by an estimated 10% – irrespective of meal timing. The control mice that ate when and as they pleased had a median lifespan of 800 days, compared with 875 days for mice on a calorie-restricted diet.

Mice on the calorie-restricted diet that only ate during the day or the inactive phase of their circadian cycle and spent the remaining 12 hours fasting overnight had a median lifespan of 959 days – nearly 20% longer than the controls.

Calorie-restricted mice that only ate during their active phase and fasted during their inactive phase lived the longest. This group averaged a lifespan of 1,068 days which was almost 35% longer than the control mice.

Anti-Aging Benefits of Calorie-Restricted Meal Timing 

The study also revealed that calorie-restricted diets could improve the animals’ regulation of glucose levels and insulin sensitivity – important healthy aging markers – with the greatest improvements reported in mice that only ate during their active phase.

In all mice, aging increased inflammatory activity and decreased gene activity in metabolism and circadian rhythms. While caloric restriction slowed age-related changes, mice that only ate during their active phase showed the most significant improvements.

Limitations and Future Implications

Sleep disruption in mice that ate during their inactive phase may have been a study limitation and could have contributed to their shorter lifespan. Additionally, all studied mice were male, and thus the findings do not account for possible ovarian hormone protection against circadian disruptions. Finally, the animal model of the study may not translate to humans.

The researchers also discussed the possible development of drugs that could target circadian genes to mimic the anti-aging effects of calorie-restricted, strategically-timed dietary patterns. If the latest findings were replicated in large-scale, well-designed human studies, this knowledge could introduce a new aspect for consideration in longevity-oriented nutrition and transform current approaches to anti-aging dietary interventions.

Mortality Risk Linked With Balance On One Leg

There are decades of data showing that poor balance impacts all sorts of increased risks of all sorts of disease, including Alzheimer’s. Turns out that being unable to stand on one leg for 10 seconds carries with it an increased mortality risk. So, can you stand on one leg? For how long?

A great device to build your balance is the Slackblock (SlackBow Balance Training). It’s inexpensive and very effective. Training balance requires a few minutes a day (watching TV commercials would be plenty of Zme). The benefits of balance training are explained very well on the SlackBow website – it’s total body exercise and improves brain function! And don’t be discouraged if you don’t do well to start. I thought I had pretty good balance, but I could only manage 20 seconds on the Block. Now I’m better (over a minute most of the time), but still room to improve.

If you have other questions or ideas you want to share – give me a ring!

FROM MEDPAGE TODAY / BY JUDY GEORGE

One-legged standing test during routine checkups may add useful information about risk of death

The ability to complete a 10-second one-legged stance in mid- to late life was associated with all-cause mortality, longitudinal data showed.

People who could not hold a one-legged stance for 10 seconds had nearly twice the risk of death over the next 7 years (HR 1.84, 95% CI 1.23-2.78, P<0.001), after adjusting for age, sex, BMI, and comorbidities, reported Claudio Gil Araujo, MD, PhD, of Clinimex Medicina do Exercicio in Rio de Janeiro, Brazil, and co-authors in the British Journal of Sports Medicine.

Previous research has linked one-legged standing time, a measure of postural instability, with cognitive decline and asymptomatic cerebrovascular damage.

But overall, there's little research linking one-legged stance to clinical outcomes other than falls, Araujo and colleagues pointed out.

"The advantages of the 10-second one-legged stance test include that it is simple and it provides rapid, safe, and objective feedback for the patient and healthcare providers regarding static balance," Araujo told MedPage Today.

"It can be easily incorporated into the routine of the most clinical consultations, especially for older adults," he added. "Importantly, the 10-second one-legged stance results add useful information regarding mortality risk in middle-age and older men and women beyond ordinary clinical data."

The researchers included 1,702 participants ages 51 to 75 in the Clinimex Exercise cohort study, which was started in 1994 to evaluate fitness, health, and cardiovascular risk factors.

Participants had a mean age of 61.7 at their first checkup from February 2009 to December 2020, and most (68%) were men.

Only people with stable gait were included in the study. As part of the checkup, participants were asked to stand on one leg for 10 seconds without additional support.

Barefoot participants were asked to place the front of their free foot on the back of the opposite lower leg, keeping their arms down by their sides while looking straight ahead. Up to three attempts on either foot were permitted.

Overall, 20.4% of participants failed the 10-second test. Failure rate rose with age: it was 4.7% in 51- to 55-year-olds, 8.1% in 56- to 60-year-olds, 17.8% in 61- to 65-year-olds, and 36.8% in 66- to 70-year-olds. Over half of those ages 71-75 (53.6%) could not successfully complete the test.

During a median follow-up of 7 years, 7.2% of participants died, including 4.6% of people who could complete the test and 17.5% of those who could not.

Adjusting only for age, the HR for all-cause mortality was 2.18 (95% CI 1.48-3.22, P<0.001). "It is quite amazing that the magnitude of the difference in HR between age-adjusted and multivariable-adjusted mortality was so small," Araujo said.

Those who failed the test generally had poorer health: a higher proportion were obese or had heart disease, hypertension, or dyslipidemia. Type 2 diabetes was three times as common in this group.

The study was observational and can't establish cause, Araujo and colleagues acknowledged. All participants were white Brazilians, and results may not apply to other populations. In addition, potential confounders such as recent history of falls, physical activity levels, diet, smoking, and medication use may have influenced results.

Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality: A Nationwide Cohort Study

…As much as guys who sit on their butt all week. And, interestingly, it seems that, as long as they get their 150 minutes a week of real activity (the general recommendation for the population – usually 30 mins 5 x/wk) on the weekend, there isn’t much difference in mortality rate. That’s some good news for folks who can’t get it together to do any exercise during the week.

FROM JAMA / Mauricio dos Santos, MS; Gerson Ferrari, PhD; Dong Hoon Lee, ScD

Key Points

Question  Does performing the recommended levels of weekly physical activity in 1 to 2 sessions (weekend warrior) vs 3 or more sessions (regularly active) influence mortality?

Findings  This large prospective cohort study of 350 978 adults in the US did not find any significant difference in mortality rates between weekend warriors and regularly active participants. Compared with physically inactive participants, active participants (both weekend warrior and regularly active) had lower all-cause and cause-specific mortality rates.

Meaning  Adults who perform 150 minutes or more of moderate to vigorous physical activity (or 75 minutes of vigorous activity) per week may experience similar health benefits whether the sessions are spread throughout the week or concentrated in a weekend.

Abstract

Importance  It is unclear whether the weekly recommended amount of moderate to vigorous physical activity (MVPA) has the same benefits for mortality risk when activity sessions are spread throughout the week vs concentrated in fewer days.

Objective  To examine the association of weekend warrior and other patterns of leisure-time physical activity with all-cause and cause-specific mortality.

Design, Setting, and Participants  This large nationwide prospective cohort study included 350 978 adults who self-reported physical activity to the US National Health Interview Survey from 1997 to 2013. Participant data were linked to the National Death Index through December 31, 2015.

Exposures  Participants were grouped by self-reported activity level: physically inactive (<150 minutes per week [min/wk] of MVPA) or physically active (≥150 min/wk of moderate or ≥75 min/wk of vigorous activity). The active group was further classified by pattern: weekend warrior (1-2 sessions/wk) or regularly active (≥3 session/wk); and then, by frequency, duration/session, and intensity of activity.

Main Outcomes and Measures  All-cause, cardiovascular disease (CVD), and cancer mortality. Statistical analyses were performed in April 2022.

Results  A total of 350 978 participants (mean [SD] age, 41.4 [15.2] years; 192 432 [50.8%] women; 209 432 [67.8%] Non-Hispanic White) were followed during a median of 10.4 years (3.6 million person-years). There were 21 898 deaths documented, including 4130 from CVD and 6034 from cancer. Compared with physically inactive participants, hazard ratios (HR) for all-cause mortality were 0.92 (95% CI, 0.83-1.02) for weekend warrior and 0.85 (95% CI, 0.83-0.88) for regularly active participants; findings for cause-specific mortality were similar. Given the same amount of total MVPA, weekend warrior participants had similar all-cause and cause-specific mortality rates as regularly active participants. The HRs for weekend warrior vs regularly active participants were 1.08 (95% CI, 0.97-1.20) for all-cause mortality; 1.14 (95% CI, 0.85-1.53) for CVD mortality; and 1.07 (95% CI, 0.87-1.31) for cancer mortality.

Conclusions and Relevance  The findings of this large prospective cohort study suggest that individuals who engage in active patterns of physical activity, whether weekend warrior or regularly active, experience lower all-cause and cause-specific mortality rates than inactive individuals. Significant differences were not observed for all-cause or cause-specific mortality between weekend warriors and regularly active participants after accounting for total amount of MVPA; therefore, individuals who engage in the recommended levels of physical activity may experience the same benefit whether the sessions are performed throughout the week or concentrated into fewer days.

The Many Uses of CRISPR: Scientists Tell All

FROM THE NEW YORK TIMES / BY OLIVER WHANG

CRISPR is the technology that allows scientists to “play God” with genes. There are all kinds of challenges inherent in its use, but the article describes where the technology is being looked at and how it might affect us in the future. Beware the law of unintended consequences…

Over the past 7 or 8 years I’ve tried to use the latest gene technologies to get ahead of some of our more difficult health issues – before they become diseases, or to help bring people back from problems. Unfortunately, the availability of user-friendly, consumer useful information was variable. I moved away, but now after probably three separate forays, I’ve moved back, as there are several companies that can provide very useful information about people’s genetic makeup and how that effects their outcomes. Understand that it’s all yin and yang – we have genes that enhance certain processes, and they are balanced by genes that inhibit those processes. When they are out of balance, the system ultimately suffers. It might take decades for those out of balance processes to become evident, but if we can see the underlying story, we can anticipate the problem and avoid it. The test is a super-simple one-time cheek swab, and it’s a lifetime’s worth of information. Let’s talk about the possibilities!

What do infectious diseases, T-cells, tomatoes, heart failure, sickle cell anemia and sorghum harvests have in common?

Smartphones, superglue, electric cars, video chat. When does the wonder of a new technology wear off? When you get so used to its presence that you don’t think of it anymore? When something newer and better comes along? When you forget how things were before?

Whatever the answer, the gene-editing technology CRISPR has not reached that point yet. Ten years after Jennifer Doudna and Emmanuelle Charpentier first introduced their discovery of CRISPR, it has remained at the center of ambitious scientific projects and complicated ethical discussions. It continues to create new avenues for exploration and reinvigorate old studies. Biochemists use it, and so do other scientists: entomologists, cardiologists, oncologists, zoologists, botanists.

For these researchers, some of the wonder is still there. But the excitement of total novelty has been replaced by open possibilities and ongoing projects. Here are a few of them.

BOTANY: The Tomato Queen

Cathie Martin, a botanist at the John Innes Centre in Norwich, England, and Charles Xavier, founder of the X-Men superhero team: They both love mutants.

But while Professor X has an affinity for superpowered human mutants, Dr. Martin is partial to the red and juicy type. “We always craved mutants, because that allowed us to understand functionality,” Dr. Martin said of her research, which focuses on plant genomes in the hopes of finding ways to make foods — especially tomatoes in her case — healthier, more robust and longer lasting.

When CRISPR-Cas9 came along, one of Dr. Martin’s colleagues offered to make her a mutant tomato as a gift. She was somewhat skeptical, but, she told him, “I would quite like a tomato that produces no chlorogenic acid,” a substance thought to have health benefits; tomatoes without it had not been found before. Dr. Martin wanted to remove what she believed was the key gene sequence and see what happened. Soon a tomato without chlorogenic acid was in her lab.

Instead of looking for mutants, it was now possible to create them. “Getting those mutants, it was so efficient, and it was so wonderful, because it gave us confirmation of all these hypotheses we had,” Dr. Martin said.

Most recently, researchers at Dr. Martin’s lab used CRISPR to create a tomato plant that can accumulate vitamin D when exposed to sunlight. Just one gram of the leaves contained 60 times the recommended daily value for adults.

Dr. Martin explained that CRISPR could be used across a broad spectrum of food modifications. It could potentially remove allergens from nuts and create plants that use water more efficiently.

“I don’t claim that what we did with vitamin D will solve any food insecurity problems,” Dr. Martin said, “but it’s just a good example. People like to have something that they can hang on to, and this is there. It’s not a promise.”

INFECTIOUS DISEASE: Bringing Testing to Remote Parts of Africa

Christian Happi, a biologist who directs the African Centre of Excellence for Genomics of Infectious Diseases in Nigeria, has spent his career developing methods to detect and contain the spread of infectious diseases that spread to humans from animals. Many of the existing ways to do so are costly and inaccurate.

For instance, in order to perform a polymerase chain reaction, or PCR, test, you need “to go extract RNA, have a machine that’s $60,000 and hire someone who is specially trained,” Dr. Happi said. It’s both costly and logistically implausible to take this kind of testing to most remote villages.

Recently, Dr. Happi and his collaborators used CRISPR-Cas13a technology (a close relative of CRISPR-Cas9) to detect diseases in the body by targeting genetic sequences associated with pathogens. They were able to sequence the SARS-CoV-2 virus within a couple of weeks of the pandemic arriving in Nigeria and develop a test that required no on-site equipment or trained technicians — just a tube for spit.

“If you’re talking about the future of pandemic preparedness, that’s what you’re talking about,” Dr. Happi said. “I’d want my grandmother to use this in her village.”

The CRISPR-based diagnostic test functions well in the heat, is quite easy to use and costs one-tenth of a standard PCR test. Still, Dr. Happi’s lab is continually assessing the accuracy of the technology and trying to persuade leaders in the African public health systems to embrace it.

He called their proposal one that “is cheaper, faster, that doesn’t require equipment and can be pushed into the remotest corners of the continent. This would allow Africa to occupy what I call its natural space.”

HEREDITARY ILLNESS: Searching for a Cure for Sickle Cell Disease

In the beginning there was zinc finger nuclease.

That was the gene-editing tool that Gang Bao, a biochemical engineer at Rice University, first used to try to treat sickle cell disease, an inherited disorder marked by misshapen red blood cells. It took Dr. Bao’s lab more than two years of development, and then zinc finger nuclease would successfully cut the sickle cell sequence only around 10 percent of the time.

Another technique took another two years and was only slightly more effective. And then, in 2013, soon after CRISPR was used to successfully edit genes in living cells, Dr. Bao’s team changed tack again.

“From the beginning to having some initial results, CRISPR took us like a month,” Dr. Bao said. The method successfully cut the target sequence around 60 percent of the time. It was easier to make and more effective. “It was just amazing,” he said.

The next challenge was to determine the side effects of the process. That is, how did CRISPR affect genes that weren’t being purposefully targeted? After a series of experiments in animals, Dr. Bao was convinced that the method would work for humans. In 2020 the Food and Drug Administration approved a clinical trial, led by Dr. Matthew Porteus and his lab at Stanford University, that is ongoing. And there is also hope that with CRISPR’s versatility, it might be used to treat other hereditary diseases. At the same time, other treatments that have not relied on gene editing have had success for sickle cell.

Dr. Bao and his lab are still trying to determine all the secondary and tertiary effects of using CRISPR. But Dr. Bao is optimistic that a safe and effective gene-editing treatment for sickle cell will be available soon. How soon? “I think another three to five years,” he said, smiling.

CARDIOLOGY: Looking Into the Secrets of the Heart

It is hard to change someone’s heart. And that’s not just because we are often stubborn and stuck in our ways. The heart generates new cells at a much slower rate than many other organs. Treatments that are effective in other parts of the human anatomy are much more challenging with the heart.

It is also hard to know what is in someone’s heart. Even when you sequence an entire genome, there are often a number of segments that remain mysterious to scientists and doctors (called variants of uncertain significance). A patient might have a heart condition, but there’s no way to tie it definitively back to their genes. “You are stuck,” said Dr. Joseph Wu, director of the Stanford Cardiovascular Institute. “So traditionally we would just wait and tell the patient we don’t know what’s going on.”

But over the past couple of years, Dr. Wu has been using CRISPR to see what kind of effects the presence and absence of these befuddling sequences have on heart cells, simulated in his lab with induced pluripotent stem cells generated from the blood. By cutting out particular genes and observing the effects, Dr. Wu and his collaborators have been able to draw links between the DNA of individual patients and heart disease.

It will be a long time before these diseases can be treated with CRISPR, but diagnosis is a first step. “I think this is going to have a big impact in terms of personalized medicine,” said Dr. Wu, who mentioned that he found at least three variants of uncertain significance when he got his own genome sequenced. “What do these variants mean for me?”

BIOTECHNOLOGY: Reinventing Cereal

Sorghum is used in bread, alcohol and cereal all over the world. But it hasn’t been commercially engineered to the same degree as wheat or corn, and, when processed, it often isn’t as tasty.

Karen Massel, a biotechnologist at the University of Queensland in Australia, saw quite a bit of room for improvement when she first started studying the plant in 2015. And because millions of people eat sorghum worldwide, “if you make a small change you can have a huge impact,” she said.

She and her colleagues have used CRISPR to try to make sorghum frost tolerant, to make it heat tolerant, to lengthen its growth period, to change its root structure — “we use gene editing across the board,” she said.

Not only could this lead to more delicious and healthier cereal, but it could also make the plants more resistant to the changing climate, she said. But it is still no small task to accurately edit the genomes of crops with CRISPR.

“Half the genes that we knock out, we just have no idea what they do,” Dr. Massel said. “The second we try to get in there and play God, we realize we’re a bit out of our depth.” But, using CRISPR combined with more traditional breeding techniques, Dr. Massel is optimistic, despite being a self-described pessimist. And she hopes that further advances will lead to commercializing gene-edited foods, making them more accessible and more acceptable.

ONCOLOGY: A New Treatment for Cancers

Dr. Ed Stadtmauer, a hematologist-oncologist at Penn Medicine. “Even though it’s really sort of science fiction-y biochemistry and science, the reality is that the field has moved tremendously,” he said.Credit...Hannah Yoon for The New York Times

In 2012, a 6-year-old girl was suffering from acute lymphoblastic leukemia. Chemotherapy had been unsuccessful, and the case was too advanced for a bone-marrow transplant. There didn’t seem to be any other options, and the girl’s physicians told her parents to go back home.

Instead, they went to the Children’s Hospital of Philadelphia, where doctors used an experimental treatment called chimeric antigen receptor (CAR) T-cell therapy to turn the girl’s white blood cells against the cancer. Ten years later, the girl is cancer free.

Since then, Dr. Carl June, a medical professor at the University of Pennsylvania who helped develop CAR T-cell therapy, and his collaborators, including Dr. Ed Stadtmauer, a hematologist-oncologist at Penn Medicine, have been working to improve it. That includes using CRISPR, which is the simplest and most accurate tool to edit T-cells outside the body. Dr. Stadtmauer, who specializes in dealing with various types of blood and lymph system cancers, said that “the last decade or so has just seen a revolution of treatment of these diseases; it’s been rewarding and exciting.”

Over the past couple of years, Dr. Stadtmauer helped run a clinical trial in which T-cells that underwent significant CRISPR editing were inserted into patients with treatment-resistant cancers. The results were promising.

Nine months into the trial the edited T-cells had not been rejected by the patients’ immune systems and were still present in the blood. The real benefit is that scientists now know that CRISPR-aided treatments are possible.

“Even though it’s really sort of science fiction-y biochemistry and science, the reality is that the field has moved tremendously,” Dr. Stadtmauer said. He added that he was less excited by the science than how useful CRISPR had become. “Every day I see maybe 15 patients who need me,” he said. “That’s what motivates me.”

The “No 7s” Rule Has Been A Life Saver For My Decision Making

Too much to do? You might be suffering from the FOMO, but more likely, you are saying “yes” to too many things that either don’t require your aRenSon, or don’t DESERVE your aRenSon. As my friend Jim Bunch would say “is it worth trading your life for?... because that’s what you’re doing.”

No 7’s is a great rule I live by. It’s not a 1980’s “Just Say No” – it’s a “No, I don’t need/want/care about that enough to go there”.

It’ll save you a lot of grief and stress. We all get enough of that – we don’t need to produce more on our own.

FROM MEDIUM.COM / BY SAM KILIC

Especially as a hyper-analytical thinker.

The simplest way to make decisions is to have a personal policy about recurring “crap.”

It’s a great way to say “no” without dealing with excess peer pressure or justifying your actions. The response to “Why don’t you want to stay out?” becomes “Oh sorry, it’s a policy of mine not to have more than two drinks on a weeknight.”—it’s one rule that removes a thousand decisions.

And that’s where the “No 7s” rule comes in for me.

Think about every time you’ve “kinda” wanted to do something.

If you’re a relaxed person, there are a lot of activities, options, decisions that you might feel indifferent towards. And this might have been okay when you had a lot of time, but as you get older, you have less of that. And to live your optimal lifestyle, you really want to be doing things that you genuinely enjoy.

Time’s not a renewable resource, and with the abundance of leisure, business, and career opportunities, we need to be on point with what we say yes to.

Because saying yes to something mediocre is an opportunity cost for something fulfilling.

And to make sure we say yes to fulfilling things and not waste an extraordinary amount of time analyzing a decision until we pass out from stress, we use the “No 7s” policy.

“No 7s” is just another way of saying, “If it’s not a f*ck yeah, it’s a no.”

When you’re faced with a decision, an opportunity, you could assess it in a hundred ways, or you could ask yourself, “What would I rate this opportunity out of 10?”

The catch is that you’re not allowed to give it a 7.

That’s the No 7s rule.

Because now, the decision is likely either a 6/10, barely a passing mark, so why would you do that? Or it’s an 8/10, a great opportunity that you really should consider.

With this one policy, I’ve been able to very practically be in tune with my gut — something I’ve always struggled to do as a very analytical person.

The policy forces you to decide based on one variable, and it’s practical enough where you actually will.

So next time you’re stuck with whether to accept a job offer, go on a particular vacation, or make an expensive purchase — think to yourself, out of 10, what do I rate this job, holiday, or purchase?

But of course, no 7s allowed.

You might be surprised with how effective it can be.