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Month: March 2021

Circadian Cycles

Circadian Cycles

The New England Journal of Medicine recently had a review article on circadian mechanisms.  What was once thought to simply control sleep/wake periodicity and females’ monthly cycles is now known to control our complex physiology even down to a cellular level.  Also, they are not unique to humans but have been present in all life forms (plant and animal) for the past 3 billion years. 

This universal presence indicates that circadian cycles are critical for both fitness and survival of all species. 

In humans there are two types of circadian clocks: the master clock in the brain and individual clocks in individual cells.  In the brain, the main timepiece is found in an area comprised of about 20,000 nerve cells called the suprachiasmatic nucleus (SCN).  But, the key input to this area comes from our eyes via photo receptor cones and rods.  The input of light sets the pacemaker cells in the SCN to our specific cycle.  These pacemakers can only reset themselves by one hour per day.    Thus, travel across multiple time zones requires one day for each zone crossed to reset.  This is called jet lag.  But many people experience a similar disruption due to “social jet lag” which occurs when sleep time varies a lot due to work/school hours versus weekends. 

Another source of disruption occurs due to the frequent use of electronic devices such as computers and smart phones.  The blue light emitted by electronics has a very strong clock resetting effect. 

Individual cells contain clock genes referred to as CLOCK-BAMAL1 that regulate DNA, RNA and protein synthesis.  By so doing, cells will perform best at certain times of the day and poorly at other times.  This has important ramifications for our immune systems and allergy.  It has

been shown that allergic reactions are more likely to be severe when there is a dysregulated clock. 

Immune defense against infection can be similarly impaired. Inflammatory diseases such as inflammatory bowel disease and arthritis worsen with clock dysfunction.  Even immune protection against cancer is reduced in shift workers and in people with frequent alterations in circadian cycles.  This has been very clearly shown for breast cancer, colon cancer and prostate cancer.  Curiously, exposure to artificial light at night increases the risk for melanomas, independent of degree of sun exposure.  Also, morning sunlight is more likely to promote skin cancer development than sunlight later in the day.

So, I guess Tom Hank’s character Chuck Noland said it best in the movie Castaway: “We live and we die by time and we must not commit the sin of turning our back on time.” 

Topical Steroids & Bone Density

Topical Steroids & Bone Density

It has been known for a long time that systemic steroids can affect bone density.  This effect is both dose and durations of therapy related. 

Until recently, there has not been a good scientific study of topical steroids and bones.  Danish scientists recently Finished (pun intended) a 15-year study of 723,000 adults using topical steroids.  They found that long term use of medium or high potency steroids did contribute to the development of osteoporosis and also increased risk for bone fractures.   

CrossFit vs Crosswords

CrossFit vs Crosswords

By: Sasha Klemawesch, MD

A few years ago, I wrote about a potential vaccine for Alzheimers. We are still a while away from having one on the market, especially since the initial trials had to be aborted due to brain swelling and other unwanted side effects. (Don’t lose hope though, a new formulation is in development and undergoing clinical validation studies.)

But in the meantime, there are many non-pharmacologic things you can do to keep your brain healthy.

When asked, “What’s the best thing to do to keep your mind sharp and ward off dementia?” Most people (myself included) would answer “crosswords” or some other sort of brain teaser. Turns out…. Yes … and/but … No.

In his new book, “Keep Sharp”, Dr Sanjay Gupta discusses strategies for preserving brain function, and he talks about the myth of the crossword puzzle. If you are someone who does crosswords, or sudoku’s, or some other form of mental exercise every day, you might not be getting as much benefit from them as you had hoped. Over time it becomes a ‘practice-makes-perfect’ phenomenon, where your brain learns how to perform the task and therefore it is no longer a struggle to complete it. The key to enhancing cognitive function (at any age) is to challenge the brain. You want to create new neural connections and force it to forge new pathways. By doing so you literally and figuratively grow your brain size. But the only way to form new neuronal paths is to engage in new activities.

If you love crosswords, by all means, keep doing them. But add in different sorts of puzzles, like cryptograms or kakuros. Even better, do something physically stimulating rather than just mentally so. Physical activity is one of THE most important aspects of maintaining a healthy brain. And despite the name of this article, you do not have to start dead-lifting 300 lbs. or running triathlons. A little exercise goes a long way.

If you spend a good deal of the day watching TV, simply standing at each commercial – yes, just standing up – will have enormous benefits. Better yet, stand and do squats. If you are more a book reader, get up at the end of each

chapter and walk around the kitchen island 10 times or march in place for 1 minute. It might sound inconsequential, but those little things will add up. Even better than doing a few minutes here and there inside your house would be to get outside in the fresh air for a walk. And if you can do it with a friend, all the better. Dr Gupta calls that a “brain trifecta.” By (1) moving, (2) socializing and (3) destressing, you “measurably detoxify” your brain, and the spontaneity inherent to friendly conversations means your brain can’t anticipate what will come up during the interaction, so you end up engaging multiple regions of it. Also, research has shown that there is an inverse proportion between your risk of cognitive decline and the size of your social network.

Finally, don’t waste your time on supplements. There is no magic pill that can prevent cognitive decay. Eating a healthy balanced diet with lots of fresh fruits and veggies, while limiting refined sugar and saturated fats will get you the antioxidants and brain food you need.

Antibodies after Covid-19

Antibodies after Covid-19

Two recently completed studies on people who sustained mild (non-hospitalized) infections with Covid revealed good immune response for the three months of the study.  The recovered patients had both lymphocyte and antibody immunity to Covid.  This is good news.  What isn’t known yet is how long this immunity will last.  Studies are ongoing in this regard.