Change your brain pathways for the better pathways. Be Better.

“The advances in functional MRI and SPECT scans of the brain are leading to better correlations between personality, mood and mental disorders with anatomic sections fo the brain. The SPECT scan shows hypoperfusion and hyperperfusion of areas of the brain. Depression, bipolar disorder and similar dysfunctions are associated with hypoperfusion is brain areas. The Cleveland Clinic advice has more science behind it now than ten years ago. The proof is in the pudding. Try it and you will see that your brain assumptions and reflex reactions change.” Bill Chesnut, MD

To go back to New Health News:

April 26, 2016 Cleveland Clinic Wellness Newsletter

Harness the power of positive thinking…for your health!

Pollyanna gets a bad rap. What if it turns out that her relentless optimism wasn’t naiveté, but wisdom? Considering that negative thinking contributes to chronic stress and a host of health problems, Polly may have known exactly what she was doing. Advances in neuropsychology have shown that returning to the same thought over and over creates a real neural pathway in the brain, just like taking the same path through a field day after day creates a visible trail. Once the “thought pathway” is there, you’re more likely to follow it. Take these three steps to set yourself up for good health by increasing positive thinking and interrupting negative thinking before it gets entrenched. Happy trails!

Get perspective. If you notice that you’re having a negative thought, step outside yourself (figuratively!) and take stock. This probably isn’t the worst day ever, and everyone is not, in fact, out to get you. Your brain is just in a mental rut. Really. It’s that simple.

Sit and be still. A regular meditation practice can help steer you away from negative thought pathways and lead to lasting, beneficial changes in your brain. Sitting quietly, paying attention to your breath, and noticing your thoughts and emotions without judging them (all hallmarks of meditation) will help you to cultivate a more positive frame of mind.

Revel in the good stuff. Reinforce positive pathways by basking in enjoyable experiences, like the scent of fresh lilacs, a laughing fit with your best friend, or the natural high you feel after a bike ride. Keep a “joy journal” or a “gratitude register” to record the high points. And if people start calling you Polly, take it as a compliment!

A morning meal may lead to more exercise.

“The research about breakfast is so good if you eat the right breakfast that it is hard to find good negative articles. Add to breakfast doing several one minute strengthening exercises at the beginning of the day and a better day is guaranteed.” Bill Chesnut, MD
Breakfast bonus! A morning meal may lead to more exercise.

To go back to New Health News:

Cleveland Clinic Wellness newsletter_March 13, 2016
“One thing leads to another” is more than a catchy song from an ’80s band (okay, we’ll give it to you: Pet Shop Boys). It’s a fact of life — and health. And sometimes the connections surprise you. Case in point: a compelling benefit of breakfast. No, your morning meal does not lead to immortality or hundred-dollar bills falling from the sky (sorry!), but research suggests that if you’re trying to be more active, eating breakfast may help. In a randomized, clinical trial studying people with obesity, researchers found that those who ate breakfast were more physically active during the day than those who fasted until lunch. Earlier research found similar benefits in people of normal weight. That’s a big deal, given the marked disadvantages of being sedentary. The study didn’t track what people ate, but that matters, too, of course. (In a nutshell, skip the sweet stuff and stripped carbs, and aim for whole foods, including protein.) You’ll probably notice more spring in your step! The possibilities are endless, and staying active is one of the pillars of good health.


Personal relationships with receiving and giving support are good for your health

“ Personal relationships with receiving and giving support are good for your health. They change your life experiences in great ways you cannot anticipate.” Bill Chesnut, MD

To go back to New Health News:

Cleveland Clinic Wellness Newsletter.      March 12, 2016
Reach out and text someone? When you’re offering support, face-to-face contact can’t be beat.
Whether you view the Days Before Texting as the dark ages or as the good old days probably depends on your age. Teens and twentysomethings are mystified at how people socialized in the analog days (“Mom, did you ‘call and make plans,’ as you put it, before or after being chased by a saber-toothed tiger?”). But people of all ages are sliding along technology’s slippery slope. For instance, a national survey of texting behaviors in adults ages 50 to 64 found that they averaged more than 11 texts a day, but fewer than 9 calls. And overall, U.S. smartphone users are sending and receiving five times as many texts compared with the number of phone calls each day.

There are a lot of benefits to digital communication, from streamlining logistics to staying in touch with children and grandchildren, nieces and nephews, and far-flung friends. When reaching out to a friend in need, though, kick it old school if you can. Face-to-face support is much more effective than digital support, suggests new research. Alas, we are still social animals. You’ll never be able to order up Friend 6.0 from the tech store! Remember that the next time you need someone to lean on. Instead of seeking support via social media or texting, plan to meet a friend at a café for good old-fashioned face-to-face time (and not FaceTime!).

Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.

“ This research is a heads-up for hard working people. If you must, want to or just enjoy working more than 45 hours a week, counteract the risk factor by exercise, good consistent diet habits, stress control, good interpersonal relationships, mindfulness, good sleep habits and a regular lifestyle, not having wild variations in your weeks. This risk applies to most physicians in patient care; it is unavoidable. Their skills and knowledge are so needed, they have a strong reason to work excessively.” Bill Chesnut, MD.

Working long hours may be linked to higher risk of heart disease, study suggests

The New York Times (3/10, Bakalar) “Well” blog reports that research suggests “the more hours you work, the greater your risk for heart disease.” Investigators “found that for each additional hour of work per week over ten years, there was a 1 percent increase in the risk for heart disease.” The findings were published in the Journal of Occupational and Environmental Medicine. _________________Ama 3.10.1

Journal of Occupational & Environmental Medicine: ____March 2016 – Volume 58 – Issue 3 – p 221–226


Dose–Response Relation Between Work Hours and Cardiovascular Disease Risk: Findings From the Panel Study of Income Dynamics                 Conway, Sadie H. PhD; Pompeii, Lisa A. PhD; Roberts, Robert E. PhD; Follis, Jack L. PhD; Gimeno, David PhD

Objectives: The aim of this study was to examine the presence of a dose–response relationship between work hours and incident cardiovascular disease (CVD) in a representative sample of U.S. workers.

Methods: A retrospective cohort study of 1926 individuals from the Panel Study of Income Dynamics (1986 to 2011) employed for at least 10 years. Restricted cubic spline regression was used to estimate the dose–response relationship of work hours with CVD.

Results: A dose–response relationship was observed in which an average workweek of 46 hours or more for at least 10 years was associated with an increased risk of CVD. Compared with working 45 hours per week, working an additional 10 hours per week or more for at least 10 years increased CVD risk by at least 16%.

Conclusion: Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.


Immediate release opioids for pain control are a poorer choice than extended release

“I want to share my understanding of better ways to control pain with opioids. My comment here is not putting the post below in perspective, but a chance to share what I learned controlling acute and chronic pain by prescribing opioid medications. My comments are not research, just experience.

Immediate release (IR) opioids for pain control are the poorer choice when extended release (ER) forms of the same medication exist. The extended release drugs have a lower and slower rise in maximum blood level, do not have a trough of inadequate dose level and do not have frequency and severity of personality impairments seen with immediate-release medications. The lack of personality changes is with ER medications prescribed at drug levels controlling the pain adequately. The same degree of pain control with an IR drug can have personality changes. The personality side effects are especially concerning in co-morbidities such as depression. Ten percent of Americans studied have depression, often don’t get treatment, and are at risk for depressive exacerbations on pain control medication.

 Examples of ER medications that have been approved and used extensively are tramadol, both IR and ER, hydrocodone, both IR and ER, oxycodone IR and ER. The costs of the ER form is higher than IR of the same drug. Buprenorphine, Butrans, is available in an extended release patch that lasts a week.

 There are two factors that have delayed the more common use of ER opioids. First is the first formulations of ER drugs could be altered and injected by drug abusers. The new ER formulations are much harder to inject. They cannot be crushed by common methods using. They don’t dissolve to inject the drug intravenously and similar. The second factor is that the prescriber must create and submit a “prior authorization” form before you can get the ER medication. There are free software that makes obtaining the “prior auth” a matter of only a few keyboard clicks, if your provider uses them. I find using the software for prior authorizations and the software to look up your insurance drug formulary is efficient. It’s more work and time to get the ER form of an opioid than prescribing the IR form of the same drug.“ Bill Chesnut, MD.

To go back to New Health News:

 Leading the News  AMA Morning Rounds 3.23.2016.    FDA to update warning for immediate-release opioids

The Washington Post (3/22, Bernstein) reports in “To Your Health” that the Food and Drug Administration announced that “it will require new warnings about the risk of addiction, abuse, overdose and death for short-acting opioid pain medications.” The boxed warning for immediate-release opioids “also will warn of the danger that chronic use of the drugs by pregnant women can result in…Neonatal Opioid Withdrawal Syndrome” in newborns. The new warnings “will emphasize that immediate-release opioids should be a last resort for severe pain.”

The New York Times (3/22, A13, Tavernise, Subscription Publication) reports that “the new labels also include ‘clearer instructions’ for directions like initial drug dose and dose changes during therapy.”



Lifting Weights As You Age Cuts Your Risk Of Death By 46%

“Lifting weights is essential for bone health. Lifting weights have been shown to be at least as effective as taking Fosamax. From menopause to age 65 women without hormone replacement lose 25 percent of their bone mass.  I lift every day, and you should do. (Do I sound like your mother?).”     Bill Chesnut, MD.

To go back to New Health News:

Lifting Weights As You Age Cuts Your Risk Of Death By 46%.   Discover the science of how strength training keeps you young.                     Men’s Health by  ALI EAVESWednesday, March 23, 2016.

The secret to a longer life may be a barbell: Strength training as you age reduces your risk of death, according to a new study from Penn State College of Medicine.

Researchers surveyed people age 65 or older about their exercise habits and then tracked them for 15 years. Nearly a third of the study participants died during that period.

Less than 10 percent of the subjects strength is trained, but those select few were 46 percent less likely to die during the study than everyone else.

Sure, you could say that older folks who lift must be in better health to begin with. But even after adjusting for BMI, chronic conditions like diabetes and hypertension, and habits like total physical activity, drinking, and smoking, lifting was linked to a 19 percent reduced risk of death.

Strength training can keep you active and independent in your golden years, says study author Jennifer Kraschnewski, M.D. Not only does it strengthen your muscles, resulting in better stamina and balance, but it also increases your bone density.

Bright light therapy may benefit depression

“I include this article for emphasis that this type of treatment is not used enough. Also the Cleveland Clinic describes the details of the type to use and for how long.” Bill Chesnut, MD

 Let there be light! Bright light therapy may benefit depression — and not just the seasonal variety. Cleveland Clinic Wellness newsletter February 24, 2016
There’s a relationship, it seems, between outer light and inner light. Step outside on a sunny day, and you can practically feel your mood meter rising a few points. And while depression doesn’t lift so easily, it may respond to light. Light therapy with specialized lamps is standard treatment for seasonal depression (a.k.a. seasonal affective disorder). A new study shows that it may help chronic, year-round depression, too, possibly by affecting the mood-regulating hormone serotonin. In one study, combining light therapy with antidepressant medication was shown to be more effective than either treatment alone. If you have depression, talk with your mental health professional about adding light therapy to your treatment plan. ADVISORY: If you have been diagnosed with bipolar depression, you must be sure to check with your doctor before you use a light box. You’ll want to look for a light box that offers 10,000 lux and then schedule a time to sit nearby for about 30 minutes a day, ideally at sunrise. Be sure you’re getting regular exercise, which has also been shown to ease depression. The more mood boosters, the merrier…literally!

Why Exercise Can Help Make You Happier

“The value of exercise as a treatment has been increasing documented in the last three decades. This information is timely because of the increasing rate of injury by using prescription opioid pain medications. Controlling depression decreases pain.” Bill Chesnut, MD

Why Exercise Can Help Make You Happier   by Mladen Golubic, M.D., Ph. D. Cleveland Clinic Wellness newsletter 2.24.16

Lifestyle factors — like food choices, physical activity and stress — have a profound effect on your mood and strongly influence whether or not you may develop anxiety and depression. Here’s a fact you may not know: Depression is projected to be a leading social and economic burden worldwide by 2020, second only to coronary artery disease! In fact, about 10 percent of the U.S. population suffers from depression at any point in time. Why so much depression? It is suspected that continuously increasing levels of stress are contributing to the rapid rise in depression. Increased stress hormones not only damage nerve cells, but also prevent growth of new ones in parts of the brain responsible for positive mood states. While there are effective treatments for depression, for example psychotherapy and antidepressant medications, only about a third of depression sufferers actually receive these treatments. What can be done for the remaining two-thirds? A lot.

Physical activity has been identified as an effective alternative treatment, either alone or in combination with standard therapies. In fact, the American Psychiatric Association now includes exercise in their treatment recommendations. It’s easy to understand why: Data from randomized clinical trials provide solid evidence about the benefits of both aerobic (walking, running, biking) and resistance (strength) training for those afflicted with depression. The recommended amount? Three to five exercise sessions per week, of 45 to 60 minutes each. Here’s more great news: People with depressive symptoms may experience improvements within four weeks of starting an exercise routine. And if that’s not enough to convince you of the mental health benefits of exercise, consider this: While stress decreases the growth of new nerve cells that can boost your mood, exercise does the opposite. Exercise grows the brain!

While there is no doubt about the effectiveness of exercise in reducing symptoms of depression, it does take real effort to begin and maintain an exercise routine. To be successful, find an exercise that you love to do. Many people enjoy walking, which has several health benefits if you reach 10,000 steps a day. If you begin to lose interest in your routine, change it up. Take a new fitness class, start dancing, begin a yoga practice or take bike rides with friends or family. And if you’re pressed for time, you may want to look into short, high-intensity workouts that do not require any equipment but use only body weight. They can be performed anywhere and can be done in as little as seven minutes a day. But high-intensity workouts are not for everyone, so please discuss this idea with your doctor before attempting it on your own. Even if your exercise frequency, intensity and duration are below the current recommendation, do not despair. Engaging in at least some physical activity may still be beneficial for patients with depression, according to the authors of the report.

If you’re not suffering from depression, you should know that exercise has numerous other health benefits, too. Regular physical activity can lower your blood pressure, improve your cholesterol profile, help control blood sugar, and reduce your risk of heart disease, diabetes and common cancers. And of course, it will help you achieve or maintain a healthy weight. What medication can do all that? Yes, you’re right. None. Such a pill does not exist and probably will not for generations to come. If it is ever created, it won’t be cheap. Exercise is free and readily available. So just do it.



To combat loneliness, sign up for a class and schedule nights out with friends.

“Friends make life better, longer and happier. Having good friendships is a topic priority for good health.” Bill Chesnut, MD

Having a tough time adjusting to an empty nest? To combat loneliness, sign up for a class and schedule nights out with friends.   

by Cleveland Clinic Wellness Editors February 2016.

Sending your kids off to college signals the end of an era. Alongside those feelings of excitement and pride, it’s perfectly normal to also experience a sense of loss and loneliness. Those first few years that they’re gone can be the toughest to adjust to, so be proactive. Make plans to keep yourself busy and entertained. Schedule nights out with friends, sign up for classes, get involved with a community volunteer organization, or join a knitting circle or book club. Also, take brisk daily walks; fresh air and exercise will help buoy your mood.


The Health Benefits of Friendship

“This article was first published in 2010. The Cleveland Clinic Wellness newsletter published in again this month. This is more than listing health benefits; it discusses how to make friends. Be deliberate and see out relationships.” Bill Chesnut, MD

 The Health Benefits of Friendship     By Victoria Moran            Cleveland Clinic Wellness newsletter_Published 6/29/2010

No doubt you’ve heard the good-health prescription: Eat a colorful, natural diet; exercise regularly; manage your stress with relaxation, recreation and meditation; get enough sleep; and have the proper checkups and screenings for your age and history. Recently, a host of research has added another, perhaps surprising, to-do to that list: Make friends, and keep those friendships in good repair.

”Researchers have found that having even one close friend that you confide in can extend your life by as much as 10 years,” says sociologist and relationship coach Jan Yager, PhD, author of Friendshifts.“Numerous studies also show that recovery from a major health challenge, such as a heart attack or cancer, is enhanced because of friendship.”

The Friendship Advantage

A landmark UCLA study in 2000 showed that, for women, having a circle of friends actually provides an alternative to the traditional fight-or-flight response to stress. The researchers called this response “tend-and-befriend” and showed that when women gather with other women (and with children), they release more oxytocin, the mother-love hormone associated with breast-feeding, which has a marked calming effect.

But women aren’t alone in attaining measurable health benefits from friendship. The Australian Longitudinal Study of Aging looked at nearly 1,500 seniors — women and men — for a full decade. Among their findings was that having good friends is more likely to increase longevity than even close relationships with adult children and other family members. The study subjects with the largest number of close friends outlived those with the fewest by 22 percent. Even major life changes such as the death of a spouse could not erode the “friendship advantage.” What makes these findings exciting — and practically applicable — is that while anyone’s number of family members is limited, we can expand our network of friends for as long as we live.

Friends may also add to the quality of those extra years by helping us maintain brain function. A Harvard School of Public Health study that looked at older adults across the country provides evidence that social integration — through marriage, volunteer work or frequent contact with children and neighbors — delays memory loss in elderly Americans.

While it’s clear that having friends is a healthy habit, the verdict is still out on the precise reasons why this is so. The Australian researchers speculate that, in addition to the emotional support friends provide one another during difficult times, positive peer pressure may also play a role — encouraging the adaptation of healthy lifestyle practices, such as joining a gym or a smoking cessation program together — as well as the stress-reduction benefits that derive from feeling connected to other people.

Friends in Health

Stress management is, in fact, one of the great gifts of friendship. One 2009 study found that clients with the fewest friendship connections were those most likely to be dealing with depression, anxiety and heart disease. Stress is known to encourage a host of maladies, from the common cold to the arterial inflammation that contributes to cardiovascular disease.

That might explain the results of a two-year study that looked at 500 women with suspected coronary artery disease. Those with a strong support system were not only more likely to be alive after two years, but their rates of hypertension and diabetes were lower, and they were less likely to have an excess of abdominal fat.

The Friend-Weight Dilemma

It is in the area of excess fat, however, that a single dark cloud may lurk in the bright sky of friendship and health. A study reported in 2007 in the New England Journal of Medicine suggests that there could be a connection between the rise of obesity and our social interactions. In other words, obesity may “spread” through a network of friends as members of that network become more tolerant of obesity and the behaviors that lead to it.

Reflecting on this study, Michelle P. Gallant, MS, RD, of Harvard University Health Services, says, “Because we want to fit in with our peers, we might go along with their way of eating. If we’re out with people having appetizers, drinks and desserts, the brain is stimulated by that, and it can trigger us to eat more than we’re really hungry for.”

Curiously, it’s our same-gender friends that appear to be the culprits here. The New England Journal report suggests that we’re influenced more by those who “resemble us.” Even spouses, who presumably share a kitchen and routinely dine together, may not affect each other’s weight gain as much as mutual friends do.

These same friends can also exert another kind of unhelpful peer pressure, especially among young women, when they overemphasize and idealize thinness. “I see the damage friends can cause each other about body image,” says Gallant. “Too much ‘diet talk’ can cause women to be preoccupied with body size in a negative way.”

The secret seems to be choosing well-balanced, health-conscious friends and engaging together in health-promoting activities. Good habits, as well as bad, may be “contagious” when we’re in the company of people we care about and whose company we genuinely enjoy. A University of Pennsylvania study reported in the Archives of Internal Medicine looked at 344 African-American women and men, and found that exercising with a family member or friend led to more weight loss than going solo, but only if the buddy-cisers enrolled together. Being assigned an exercise partner who wasn’t a “real friend” had a negligible effect.

Making Friends 101

As positive friendships vie with dark, leafy greens as the good-health superstars, how do we get more of them, especially if we’re not the life-of-the-party type? Some ideas:

Make the first move: According to Dr. Yager, showing an interest in another person is the first step on the road to friendship.

Branch out: “Since having shared interests is an obvious way to begin a relationship that might become a friendship, get active in sports or cultural activities where you’ll meet people. If someone seems interesting, suggest getting a cup of coffee before or after the next session.”

Be interested: Once a nascent friendship is underway, be genuinely interested in learning about this person. Keep things light and allow for humor. Although strong friendships can develop in support groups and other places where people go for help, more often the person who’ll be there for you when things get rough entered your life through shared good times.

Show your appreciation: Finally, cherish the friends you already have. It’s no easy matter to stay in touch these days, especially if you’ve lived in seven cities, had a dozen jobs and your face-to-face friends are in competition with a hundred Facebook friends you may not have seen since childhood (if you’ve ever met at all). While it can be fun to “know” a lot of people, acquaintances aren’t the same as friends. Stay close to the tried-and-true by getting together in person when you can, sharing a phone call every so often and making e-mail contact or even sending a real note — on paper with a stamp! Handwritten notes were always special, but now that they’re so rare, they’re worth their weight in friendship gold.

Finally, be there for the people you care about when they could use a friend. Most of us will never save a life by running into a burning building or jumping into a churning sea, but science now tells us that we just might extend someone’s life simply by being a part of it.


US military fails to provide adequate therapy for soldiers with PTSD

“This post is of the largest independent examination of mental health treatment in the military. It shows that we fail attempting to provide even the minimum of treatment visits for these veterans in PTSD.” Bill Chesnut, MD

 US military fails to provide adequate therapy for soldiers with PTSD, depression, study finds

USA Today (2/18, Zoroya) reports that a study released Feb. 18 by the RAND Corp. suggests that the US military is “struggling to provide adequate therapy sessions for thousands of active-duty troops suffering from post-traumatic stress disorder and depression.”

According to the study, only a third of troops suffering from PTSD and fewer than a quarter of those suffering from clinical depression receive the minimum number of therapy sessions once they have been diagnosed. RAND “described the study as the largest independent examination of mental health treatment in the military.”

AMA News Febrary 21, 2016.

Neanderthal DNA may predispose some people to nicotine addiction, mood disorders

“This is a study of 28,000 people by evolutionary geneticists. It helps understand that some of the maladies we have some from “bad code.” The original study is here for more details: .” Bill Chesnut, MD

Nicotine addiction and mood disorders associated with Neanderthal Genes.    “Neanderthal DNA may predispose some people to nicotine addiction, mood disorders.”

The Washington Post (2/11, Nutt) reports in “Speaking of Science” that the “first-ever study directly comparing Neanderthal DNA to the human genome confirmed a wide range of health-related associations.” Lead author John Capra, PhD, an evolutionary geneticist at Vanderbilt University, said, “Our main finding is that Neanderthal DNA does influence clinical traits in modern humans.” The article explains that “snippets of Neanderthal DNA contribute to the contemporary risk for myriad ills, including heart attack, nicotine addiction, and mood disorders as well as incontinence, foot calluses and precancerous skin lesions.”

The Wall Street Journal (2/11, Long, Subscription Publication) reports that to arrive at these conclusions, the researchers compared electronic health records from 28,000 people of European ancestry with genomes from fossilized Neanderthal bones. The study was published online in the journal Science.


Happy news for happy hour: A glass of wine a day might keep the doctor away.

“This information is known. Other reports are that the good health effect is only with red wine. I posted this today because it states the current definition of over-drinking, which can be devastating.” Bill Chesnut, MD

Happy news for happy hour: A glass of wine a day might keep the doctor away.  Cleveland Clinic Wellness newsletter_February 11, 2016

A toast is in order! Recent research shows moderate alcohol consumption — defined as up to one drink a day for women and up to two for men — may improve immune system function and help us fight off infection. Based on previous research, we already know that moderate drinking can protect against cardiovascular disease, type 2 diabetes, and gallstones. It’s important to keep in mind that the key is moderation. In the U.S., one drink means 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor, such as gin or whiskey. And you can’t save up either, so use it or lose it! Higher levels of drinking (more than seven drinks a week for women and 14 for men) may cause your efforts to backfire, harming the immune system, increasing blood pressure, and damaging heart muscle. It’s also has been linked with several cancers. So keep your quantity moderate as you enjoy your special beverage. Cheers! 

Help control emotional eating by keeping a food journal.

“Help control emotional eating by keeping a food journal. This action interrupts your thought, and that can disrupt your mood causing the craving. This is another suggestion of deliberate ways to move your thinking to a more practical level.” Bill Chesnut, MD

On a mission to lose weight? Get your head in the game!   

Quick: What’s the number one reason most weight-loss programs fail? It’s probably not what you think. A new survey of more than 1,000 Americans suggests that no matter how much we think we know about losing weight — for example, that we need to eat less and move more — the majority of people don’t realize just how important psychological well-being is to lose weight and to keep it off. Researchers say we need to pay closer attention to why we’re eating, since the strongest food cravings, and the ones that can sabotage our efforts, often come when we’re weakest emotionally. If you think emotional eating may be affecting your efforts to get to your ideal weight, try keeping a food journal. In addition to writing down what and when you eat, record how you’re feeling, too. Are you hungry? Or are you bored or stressed? Once you’re able to identify patterns in your eating, you’ll have a better chance of establishing healthier ones. Keeping a food journal has the added benefits of holding yourself accountable for your choices and letting you keep track of your success over time. And success is the name of the game.

Cleveland Clinic Wellness newsletter_2.10.16

The USPSTF recommends physicians routinely screen teens for depression.

“This advisory panel is giving good advice.  There are more articles In this site  about depression. It is most effectively corrected by therapy in the young. Depression affects a large % of the population, depending on the age cohort. When you see or live with young people who are acting out or unusual, look up a depression screen and see if there may be an underlying depression showing as misbehaviors.” Bill Chesnut, MD.

“The USPSTF recommends physicians routinely screen teens for depression.

AMA Wire 2.9.16.

The Los Angeles Times (2/8, Healy) “Science Now” blog reports that yesterday, the US Preventive Services Task Force (USPSTF) “recommended that physicians routinely screen children between 12 and 18 for depression and have systems in place either to diagnose, treat and monitor those who screen positive or to refer them to specialists who can.” The USPSTF’s recommendations now “bring depression screening for adolescents into line with recently issued depression-screening recommendations that apply to adults.”

According to CNN (2/8, Storrs), the USPSTF has decided that “for children younger than 12, there is not enough evidence around which tests work and which treatments are effective to recommend that doctors screen all individuals in this age group.” For children 12 and older, the USPSTF supports “the use of antidepressant medication for treating adolescents who have depression,” in addition to cognitive behavioral therapy or a combination of CBT and medication. Therecommendations were published online in the Annals of Internal Medicine.


You’ve got the power…to banish negative thoughts!

“Here is another plea for you to improve your mood, lower your stress and secondarily enjoy better health by actively using methods that are easy to learn and use. Elsewhere here I present articles of blood and saliva tests showing the change in levels of Interleukin 6, an inflammatory marker, by changing your thinking. Practice this daily. Give this information to young people as research shows we are most effective changing habits of thinking in young people.” Bill Chesnut, MD

You’ve got the power…to banish negative thoughts!  Cleveland Clinic Wellness newsletter.

Here’s a surprising fact: A typical person has about 60,000 thoughts every day. A whopping 95 percent of those are repeated daily. (It’s like Groundhog Day in your head!) Here’s the real surprise (not!): It turns out that many of those thoughts are negative. But habitual thought patterns, your mind’s way of dealing with life’s little annoyances and daily challenges, don’t have to define you. If you’re willing, you can actually change your thought patterns, which is really pretty cool. “When we meditate, we have the opportunity to experience our thoughts as passing events,” says Jennifer Hunter, LISW-S, Cleveland Clinic’s director of wellness, employer services. “We learn to distance ourselves from the content of the thought and simply observe it as it is happening, allowing it to pass,” she says. “This helps us to develop a vital skill — the ability to accept our thinking without judgment.”

Here’s what to do: When you find yourself having a negative thought, step back and call the thought what it is: a thinking habit. Acknowledge that you’re feeling stressed, and allow the thought to pass. Then, take a deep breath and ask yourself, “I wonder what my next thought will be?” The break will give you a moment to slow down your thinking and create pauses between thoughts. The key is to get to know your negative thought patterns and work on developing more beneficial ones. “You must take a moment to pause, breathe and step back from the thoughts that feel emotionally charged,” says Hunter. “Then come back to what you’re doing and enjoy the present moment.”

How to beat burnout: 7 signs physicians should know

“I include this article from the AMA News for its insights which apply to many types of work and workers. It may help patients to understand their communications with some providers.” Bill Chesnut, MD.

How to beat burnout: 7 signs physicians should know

AMA News_3/4/2015, 2:36 PM

If constant stress has you feeling exhausted, detached from patients, or cynical, take notice. You may be in danger of burnout, which studies show is more prevalent among physicians than other professionals. But how can you avoid it? Learn the signs of physician burnout and what you can do to stay motivated on the job.

Mark Linzer, MD, Director of the Division of General Internal Medicine at Hennepin County Medical Center in Minneapolis, has studied physician burnout since 1996. He said he understands why many physicians eventually feel exhausted practicing medicine, but this problem is avoidable.

“Burnout doesn’t have to be highly expensive to fix,” Dr. Linzer said. “The problem is that no one is listening. People always want to say that physician wellness and performance measures will cost a lot of money, but preventing burnout can actually save money in the long run on recruiting and training new practice staff.”

If physicians want to keep burnout at bay, Dr. Linzer said there are some serious signs they should never ignore. Here are seven ways to know if your practice is getting the best of you—and when to finally do something about it:

  1. You have a high tolerance to stress.  
    Stress consistently ranks as the number one predictor for burnout among physicians, Dr. Linzer said. “Please don’t ignore the stress, even if you can take it,” he said. Physicians who consistently operate under high stress are at least 15 times more likely to burn out, according to his research.
  2. Your practice is exceptionally chaotic.  
    A quick glance around your practice will let you know if you or your colleagues may cave to stress. “People tend to think it’s the patients that always stress doctors out, but actually, it’s the opposite,” Dr. Linzer said. “Caring for patients keeps doctors motivated. What burns them out is caring for patients in a high-stress environment. Change the environment and you’ll change the overall quality of care.”
  3. You don’t agree with your boss’ values or leadership.  
    This one is particularly tricky to identify but “necessary to prevent burnout,” Dr. Linzer said. Whether at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane.
  4. You’re the emotional buffer.  
    Working with patients requires more than medical expertise. “Often, the doctor acts as an emotional buffer,” Dr. Linzer said. “We will buffer the patient from our own stressful environment until we can’t take it anymore.”
  5. Your job constantly interferes with family events.  
    Spending quality time with loved ones helps physicians perform better. “When they can’t do those things, it’s all they think about during the day and the patient suffers,” Dr. Linzer said, citing work-life interference as one of the most common predictors for burnout among physicians in his studies.
  6. You lack control over your work schedule and free time.  
    When work demands increase, but control over your schedule doesn’t, stress can kick in and spark burnout. That’s why Dr. Linzer often tells practices, “If you standardize, customize”— a medical mantra to suggest that if physicians must work a long standardized set of hours each week, practices should at least customize their schedules to flexibly fit changes or needs in their daily lives.
  7. You don’t take care of yourself. 
    When was the last time you enjoyed a nice bubble bath or morning run? If you continually neglect yourself, you may neglect your patients, too. “As physicians, we want to be altruistic but one of the keys to altruism is self-care,” Dr. Linzer said.


How physician burnout compares to general working population.

“This trend is concerning. The physician burnout rate is escalating yearly recently. The causes are multifactorial and primarily from the environment in which physicians increasing work. Burnout turns the provider’s communications toward less kindness and empathy. Those qualities are essential to enjoy being a health care provider.” Bill Chesnut, MD

 How physician burnout compares to general working population.

AMA News_1/27/2016, 4:23 PM

Over just three years, physicians reported a nearly 9 percent increase in burnout rates. But how does physician burnout compare to that of the general working population? A recent national study provides insights, including key findings on work-life balance.

Physicians compared to the general working population
Physician burnout experts at the AMA and the Mayo Clinic conducted a survey of 6,880 physicians to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population relative to 2011 and 2014,” according to a study recently published in Mayo Clinic Proceedings.

Compared with the general U.S. population, physicians in 2014:

  • Were more likely to be married (82.9 percent for physicians versus 67.5 for the general U.S. working population).
  • Worked a median of 10 hours more per week (50 hours versus 40 hours).
  • Displayed higher rates of emotional exhaustion (43.2 percent versus 24.8 percent), depersonalization (23.0 percent versus 14.0 percent) and overall burnout (48.8 percent versus 28.4 percent).
  • Reported lower satisfaction with work-life balance (36.0 percent of physicians reported being satisfied with their work-life balance, compared to 61.3 percent of the general U.S. working population).

Finding your happiness in your body.

“There is a lot of wisdom with medical bases in these comments. I am a sucker for “self-help” articles and sometimes it helps. I agree with this one.” Bill Chesnut, MD

Finding Your Happiness in Your Body

By Maureen Connolly , Cleveland Clinic Wellness Published 3/10/2010


When fear, anger, frustration, sadness or anxiety is poking a hole in your happiness bubble, every organ in the body reacts — including your heart, brain, skin, kidneys and intestines. It’s easy to spot the effects on the outside. One example is a plump belly, the result of a body that’s pumping out high amounts of the stress-related hormone cortisol, which causes us to store fat in our stomachs. Wrinkles and lackluster skin? These mood states activate our nervous system to cause inflammation and oxidation, which are known to cause wrinkles and lackluster skin.  Things inside aren’t pretty either. Your stomach may be churning, your head pounding, your back tweaking and your heart beating a little faster. In a word, when we’re the opposite of happy or balanced, our body does its best to alert us that things are out of whack. Learning ways to deal with and process stress and negative emotions will bring you one step closer to a state of balance, or what some describe as a positive state of being.

So where do you begin? Experts say that engaging your body and breath regularly and constructively are two amazing tools for getting you closer to that balance. When we’re in balance, our autonomic nervous system (ANS) — which regulates key areas of our bodies including the heart and the intestinal tract — are much happier. Try these tips for getting in balance:

Move often. According to the American Council on Exercise, one 30-minute exercise session generates 90 to 120 minutes of relaxation response. Essentially this is a state your ANS likes to be in — heart rate, blood pressure and breathing is regulated and the body is functioning normally, as opposed to being in an all-systems-alert state of arousal. And consider that for your 30-minute investment, you get a three- to four-fold gain (not to mention what the exercise is doing for your brain, heart, belly, hips and thighs). To top it off, you get a mood boost, thanks to the surge in neurotransmitters and endorphins released by the brain during exercise.

Use your breath. We’re not talking about running on a treadmill, but rather practicing a technique that focuses on finding calm through your breath. Thomas Morledge, MD, of the Center for Integrative Medicine at the Cleveland Clinic, offers this short breathing meditation, intended to stabilize the autonomic nervous system.

To start the meditation, place both hands, one on top of the other, over the center of your chest. This is your heart center. Now close your eyes and become aware of each in breath and each out breath. Now visualize an image that is emotionally endearing to you. (Dr. Morledge pictures his son when he was an infant and he was rocking him to sleep.) Stay with this image and the feeling that accompanies it for a minute, while maintaining an awareness of each breath. Then slowly open your eyes and move into your day.

It’s best to practice this on occasion, says Dr. Morledge, so that when you really need it, you can evoke the image and move into this relaxed state more effectively.

Use your senses to bring you more into the moment. While we’re making dinner, we could choose to chop and worry about the 10 million other things that need to get done this week. Or we could give our brains a break, while using our bodies — primarily our senses — to derive pleasure from the moment. Something as simple as noticing the vibrant color of an orange pepper, touching its smooth exterior, noticing the sweet smell and tasting the crispness of it engages all our senses and regulates the autonomic nervous system. All this and you’ve invested five, maybe 10 seconds of your time. This isn’t to say that we need to go through our day staring at peppers and savoring each little moment. That’s not practical or even safe. But being more attuned to the little opportunities for being physically engaged throughout your day does fuel your well-being.

Smile and mean it. A smile that’s genuine — the kind where you’re using those crow’s-feet muscles on either side of your eyes — actually grabs on to specific parts of your brain that bring joy. Research has shown that configuring the face this way actually stimulates the ANS and signals the brain that we’re happy about something. An insincere (or social) smile — the kind typically associated with stress that only engages our mouth, and not our eyes as well — actually has the opposite effect by triggering the ANS that something is not right, which in turn ups adrenaline and cortisol, hormones that feed coronary heart disease.

Build up your inventory of small, feel-good indulgences. If Egyptian cotton sheets bring a smile to your face every time you slink under the bedcovers, then treat yourself to some. If the scent of green apple or orange perks up your mood, then buy a candle or some body scrub with these scents. If all of your shoes are killing your feet by the end of the day, then hobble over to the nearest shoe store and treat your feet to comfortable shoes.

Figure out where happiness lives in your body and feed it. “If topping off your morning cereal with a handful of sweet, ripened raspberries brings a smile to your face, says Pardo, “then make a point to pick up some raspberries. If a two-minute foot rub leaves you smiling long afterwards, get one. “It sounds so simple, but so often we’re focused on other people’s happiness that we overlook small things that feed our own.”

As you set goals for yourself, allow for gradual change and setbacks. Make room for all your complicated and contradictory feelings in this process toward growth and self-awareness. Allow yourself to fully experience the ebb and flow of relationships, as well as the challenge of negotiating what you need for your one-of-a-kind recipe for happiness.

Changes in a person’s sense of humor may portend dementia

“This is another reason to pay attention to your humor. Others may think you’re going crazy.” Bill Chesnut. MD

Changes in a person’s sense of humor may portend dementia, study suggests

The CBS News (11/11, Cohen) website reports that changes in “a person’s sense of humor can be a sign of Alzheimer’s disease” or other forms of dementia “and may start to emerge years before other symptoms,” according to a study involving 48 patients with dementia and 21 healthy people. Researchers found that “laughing at ‘frankly inappropriate’ moments, taking jokes literally or missing the point, and preferring childish or slapstick humor are some of the behaviors highlighted in the study, published in the Journal of Alzheimer’s Disease.”

Jama 11.11.15

Casein in cheese may trigger dopamine receptors in the brain, study suggests

“This publication is available to the public through the National Institutes of Health through the US National Library of Medicine.   I think dopamine response is a good thing in moderation. In four decades of medical practice, I never heard  an ER reporting an overdose of cheese.” Bill Chesnut, MD

 Casein in cheese may trigger dopamine receptors in the brain, study suggests

 NBC Nightly News (10/22, story 10, 0:20, Holt) reported that “if you ever joked you’re addicted to cheese, you may actually be right.” A study suggests that “a protein in cheese can release opiates that trigger dopamine receptors in our brain like certain drugs do.”

The Los Angeles Times (10/22, Harris) reported in “The Daily Dish” that the study, which was published Feb. 18 in PLoS One, “identified addictive foods from about 500 students who completed the Yale Food Addiction Scale, designed to measure if someone has a food addiction.” It appears that cheese is particularly “addictive because of…casein, a protein found in all milk products,” which, “during digestion…releases opiates called casomorphins” that in turn “trigger” dopamine receptors.

AMA newsletter_ 10.26.15

A dazzling way to be a kinder person.

“The power of feeling the “awe” emotion does change a mood. Recently published studies of human interleukin 6 levels show feeling “awe” lowers our level of a harmful inflammatory compound. Do an internet search for “interleukin 6 and stress for significant associations with heart disease, Alzheimer’s Disease, obesity, and mood disturbance, to name a few.

Take mood control and manipulation for better emotional states seriously!” Bill Chesnut, MD.

Some kind of wonderful: Experience awe-inspiring moments to become more benevolent.     Cleveland Clinic Wellness newsletter September 9, 2015.

When was the last time you were dazzled and amazed? If it has been a while, add a trip to the woods, beach, symphony, or art museum to your calendar. You’re not the only one who will benefit; the people around you will too. Besides making you feel relaxed and happy, the awe-inspiring wonders found in nature, music and art make you a kinder person. Feelings of awe tend to make people more generous, helpful and cooperative, according to numerous studies. Exactly how sequoia trees and Picasso make you a kinder person is unknown, but it may be that being surrounded by greatness and beauty — something bigger than yourself — helps you transcend self-centered forces within. Your own awe-inspiring moments don’t have to be at Yosemite or the Cleveland Orchestra. Surround yourself with whatever beauty you can, and change things up: hiking trails, botanical gardens, museums, and the classical music station will all leave you wonderstruck. Get the whole family involved, and let the good vibes roll.

Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age

“This is a pressing report of 5,034 children. The authors address childhood experiences that are associated with mental and behavioral health problems as your adults. Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services.  This deserves wide dissemination.” Bill Chesnut, MD

 Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age

Andre Sourander, MD, PhD1,2; David Gyllenberg, MD, PhD1; Anat Brunstein Klomek, PhD3,4; Lauri Sillanmäki, Stud SocSc1; Anna-Marja Ilola, MD1; Kirsti Kumpulainen, MD, PhD5

JAMA Psychiatry. 2016;73(2):159-165. doi:10.1001/jamapsychiatry.2015.2419.

 Importance. Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear.

Objective.  To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age.

Design, Setting, and Participants.  Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015.

Main Outcomes and Measures.  Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment.

Results.  Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms.

Conclusions and RelevanceExposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.


Could Chronic Stress Increase Your Risk of Getting Cancer?

“Recent reports show changes in Interleukin in human saliva change with stress levels. Interleukin is bad. See reference below.” Bill Chesnut, MD

 Could Chronic Stress Increase Your Risk of Getting Cancer?   by Mladen Golubic, M.D., Ph. D.   Cleveland Clinic Wellness

Chronic stress has been associated with increased risk of cancer. How could stress impact your risk of getting cancer? Here’s how it works: Stress leads to hyper activation of the sympathetic nervous system – otherwise known as the “fight or flight response” – and the release of stress hormones, such as epinephrine, norepinephrine, cortisol and neuropeptide Y (NPY). In test tube experiments, norepinephrine and epinephrine may contribute to cancer progression by preventing cancer cell death. And in recent studies, NPY was shown to stimulate cell division (needed for cancer growth) and cell motility (needed for cancer spread) of human breast cancer cells. Cancer survivors who practice relaxation techniques like meditation or yoga, show a decrease in stress response, have less anxiety and better mood and quality of life. To what degree these desirable and beneficial effects are related to modulation of stress hormones remains to be examined. Regardless of the mechanisms involved, low-tech but highly beneficial interventions like yoga and meditation can be practiced by any cancer survivor. Needless to say, such practices do not interfere at all with any cancer treatment modality. Having good social support (friends, friends, friends) and being physically active are other ways to diminish the negative effects of chronic stress.

Ann N Y Acad Sci. 2012 Jul;1261:88-96. doi: 10.1111/j.1749-6632.2012.06634.x.

Role of interleukin-6 in stress, sleep, and fatigue..

Rohleder N1Aringer MBoentert M.

Chronic low-grade inflammation, in particular increased concentrations of proinflammatory cytokines such as interleukin (IL)-6 in the circulation, is observed with increasing age, but it is also as a consequence of various medical and psychological conditions, as well as life-style choices. Since molecules such as IL-6 have pleiotropic effects, consequences are wide ranging. This short review summarizes the evidence showing how IL-6 elevations in the context of inflammatory disease affect the organism, with a focus on sleep-related symptoms and fatigue; and conversely, how alterations in sleep duration and quality stimulate increased concentrations of IL-6 in the circulation. Research showing that acute as well as chronic psychological stress also increase concentrations of IL-6 supports the notion of a close link between an organism’s response to physiological and psychological perturbations. The findings summarized here further underscore the particular importance of IL-6 as a messenger molecule that connects peripheral regulatory processes with the CNS. (emphasis mine. BC.)

© 2012 New York Academy of Sciences.



Words spoke aloud change mood.

“Want your happiness to grow? Think as a gardener. Words spoken aloud change mood, proven fact. Try it!” Bill Chesnut, MD. 

Happiness is creatable every day. Words spoke out loud, exercises, appreciation, mindfulness all work with a little practice.

Cleveland Clinic Wellness newsletter_November 15, 2015
Instead of the casino approach to happiness, which relies on Lady Luck — try the gardener’s methods.

Cultivate your soil. Just as plants need nourishing soil to grown in, so too does happiness. Think of your daily habits as your “soil.” Too much work and stress, and not enough sleep and exercise, deplete it. Nourish your soil with nutritious foods, daily exercise, relaxation, quality sleep, and time for friends — a pro-happiness environment.

Plant the right seeds. “Planting seeds of happiness takes intention, but it works,” says Jane Ehrman, Med, Cleveland Clinic behavioral health specialist. When something positive happens — anything from noticing a beautiful sunset to being offered a job you want — bask in the feeling for 20 to 30 seconds. That’s how long it takes to start to rewire your brain — or plant more seeds. “When you’re faced with something difficult, deal with it, but then focus on the positive facts within the situation,” Ehrman says.

Water and sun. Daily meditation and a few morning sun salutations will help your happiness garden thrive. Get plenty of actual sunshine and water, too!