Tag Archives: northwestern memorial hospital

November 16, 2017 · 4:09 pm

Amish have internal ‘fountain of youth’ – Study

The first genetic mutation that appears to protect against multiple aspects of biological aging in humans has been discovered in an extended family of Old Order Amish living in the vicinity of Berne, Indiana, report Northwestern Medicine scientists.

An experimental “longevity” drug that recreates the effect of the mutation is now being tested in human trials to see if it provides protection against some aging-related illnesses.

Indiana Amish kindred (immediate family and relatives) with the mutation live more than 10 percent longer and have 10 percent longer telomeres (a protective cap at the end of our chromosomes that is a biological marker of aging) compared to Amish kindred members who don’t have the mutation, reports the new Northwestern study. (my emphasis)

Amish with this mutation also have significantly less diabetes and lower fasting insulin levels. A composite measure that reflects vascular age also is lower — indicative of retained flexibility in blood vessels in the carriers of the mutation — than those who don’t have the mutation, the research also found.

The paper was published Nov. 15 in the journal Science Advances.

These Amish individuals have very low levels of PAI-1 (plasminogen activator inhibitor,) a protein that comprises part of a “molecular fingerprint” related to aging or senescence of cells. It was previously known that PAI-1 was related to aging in animals but unclear how it affected aging in humans.

“The findings astonished us because of the consistency of the anti-aging benefits across multiple body systems,” said Dr. Douglas Vaughan, the lead author of the paper who has been studying PAI-1 for almost 30 years.

Vaughan, a cardiologist, is the Irving S. Cutter Professor and chairman of medicine at Northwestern University Feinberg School of Medicine and Northwestern Medicine.

“For the first time we are seeing a molecular marker of aging (telomere length), a metabolic marker of aging (fasting insulin levels) and a cardiovascular marker of aging (blood pressure and blood vessel stiffness) all tracking in the same direction in that these individuals were generally protected from age-related changes,” Vaughan said. “That played out in them having a longer lifespan. Not only do they live longer, they live healthier. It’s a desirable form of longevity. It’s their ‘health span.’”

“Longevity” drug developed by Northwestern and Tohoku University

Northwestern has partnered with Tohoku University in Japanin the development and testing of an oral drug, TM5614, that inhibits the action of PAI-1. The drug has already been tested in a phase 1 trial in Japan and is now in phase 2 trials there. Northwestern will apply for FDA approval to start an early phase trial in the U.S., possibly to begin within the next six months.

The proposed Northwestern trial will investigate the effects of the new drug on insulin sensitivity on individuals with type 2 diabetes and obesity because of the mutation’s effect on insulin levels in the Amish.

A mutation confers longevity

In the new study, Northwestern scientists looked at individuals who had one mutant copy of the gene, rendering their level of PAI-1 about half the level of kindred with two normal copies. Continue reading →

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June 23, 2016 · 4:13 am

What About Back Pain?

Most people have back pain at some time or another in their lives. WebMD says, “Most people have experienced back pain sometime in their lives. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms.”

Back pain is one of the most common complaints that show up in the Emergency Room, according to Alan G. Shepard, M.D., Neurologist, Northwestern Memorial Hospital, speaking to the Northwestern Memorial Healthy Transitions Program®.

“Some 60 to 90 percent of the population will experience back pain in their lifetime.

“Back pain is second only to upper respiratory infection as a cause for lost work time.

“Over 5 million people are disabled with low back pain which makes it the number one disability for workers less than 45 years old.

“The bad news is that no definitive diagnosis will be found in over 80 percent of the back pain cases.

“The good news is that over 90 percent of patients, even those with sciatica, will be better in two months regardless of the type of therapy given.

“Determining which patient with back pain is the ‘true emergency’ is one of the biggest diagnostic challenges that an emergency medicine physician can face. ”

WEbMD says to call your doctor if:

  • You feel numbness, tingling, or weakness in your groin, arms or legs; this may signal damage to the spinal cord. Seek immediate medical help.
  • The pain in your back extends downward along the back of the leg; you may be suffering from sciatica.
  • The pain increases when you cough or bend forward at the waist; this can be the sign of a herniated disc.
  • The pain is accompanied by fever, burning during urination, or frequent and/or urgent urination. You may have an infection.
  • You begin to have problems controlling your bowels or bladder; seek immediate medical help.

Tony

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March 13, 2016 · 7:25 am

Does Forgetting Things Mean I am Coming Down With Alzheimer’s?

Memory starts declining when we reach our 60’s. It happens to everyone. So, forgetting your car keys doesn’t necessarily mean that you have Alzheimer’s.

As regular readers know, I am very sensitive to dementia in general and Alzheimer’s in particular having lost three family members who were afflicted. To clarify: Dementia is not a disease but a group of different diseases characterized by the gradual worsening of cognitive abilities. Dementia is seen across all ethnic groups and increasingly so with advancing age. Among 65–69-year-olds, about two percent are afflicted, with this figure doubling for every five years of age. Alzheimer’s is a form of dementia and accounts for 60 to 80 percent of cases.

Alzheimer’s doesn’t happen overnight. For that reason it is worthwhile to have your memory tested so that you have a baseline to compare. So says, Sandra Weintraub, Ph.D., speaking to the Northwestern Memorial Healthy Transitions Program®.

There is no 100 percent accurate test for Alzheimer’s while the patient is alive. Only an autopsy can confirm that there was Alzheimer’s in the brain, Dr. Weintraub said. Presently, 90 percent of people diagnosed with Alzheimer’s actually have it post-mortem.

Dr. Weintraub offered several interesting statistics on the disease. Alzheimer’s strikes African Americans more than Hispanics and the least likely to get it are Caucasians. In addition, more women suffer from it than men. She said there was no explanation for this breakdown at present.

One of the keys to memory loss and Alzheimer’s is self-awareness, according to Dr. Weintraub. If a person forgets their keys and worries about it, that is normal. However, if a person forgets their keys and doesn’t know it, that is more troublesome. Likewise, entering a room and forgetting why the person went there can happen to a normal person. However, a person who might be beginning Alzheimer’s would not remember that he had come for a reason.

Dr. Weintraub offered a number of answers to the question: Why do we forget?

She said that seniors don’t multitask as well as they did when they were younger. There can be distractions. Hearing loss plays a part as well as fatigue and amnesia.

On the emotional side, she offered medications as a reason, metabolic disorders, sensory loss and brain disorders, like stroke or tumor.

In conclusion, Dr. Weintraub suggested a visit to a cognitive neurology center and getting a brain checkup. That way, a patient can detect symptoms of concern as well as identify abnormalities for one’s age.

Tony

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December 21, 2015 · 7:56 am

Why Worry About High Blood Sugar?

You feel fine, so why worry about high blood sugar?

One of the main reasons is that chronic high blood sugar damages the walls of your arteries and blood vessels, according to Shelley Scott, RD, LDN, CDE, Clinical Dietitian and Diabetes Educator, speaking before a Northwestern Memorial Healthy Transitions Program® today.

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Since your blood circulates everywhere in your body, many parts of your body can be damaged, Ms. Scott said. Additionally, new research suggests an association with diabetes and high blood pressure and an increased risk of Alzheimer’s disease.

Occasional high blood sugar don’t cause health complications, but the chronic, uncontrolled high blood sugars do the damage, she continued.

Steven Edelman, M.D., Professor of Medicine, Division of Endocrinology and Diabetes, University of California, San Diego said, on ABC News, “Diabetes is a condition where the glucose or sugar levels are too high in the blood. Now, there are many reasons why the blood sugar levels get too high in people with diabetes, but I will only mention the two main defects now.
Continue reading →

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April 14, 2015 · 12:05 am

What You Need to Know About High Blood Pressure – Infographic

I went to a talk at Northwestern Memorial Hospital on high blood pressure a while back. I wrote the post What is High Blood Pressure then.

Some of the points made in the post included: “Normal (blood pressure) BP is 120/80, systolic/diastolic. Prehypertensive is 120-139 over 80-89. Stage one hypertension is 140-159 over 90 – 99. Stage two hypertension reads 160 -179 over 100 – 109.

“Modifiable causes of high BP or hypertension include smoking, obesity, lack of physical activity, dietary salt, alcohol consumption and stress.

“Causes of high BP over which we have no control include older age, genetics, family history of high BP, chronic kidney disease and adrenal and thyroid disorders.

“The Mayo Clinic said that most people with high BP have no signs or symptoms, even if BP readings reach dangerously high levels.”

I hope this has piqued your curiosity about high blood pressure because I have found two dynamite infographics on it that will fill in a lot of details. The first is from the American Heart Association and is very personal and the second from The Centers for Disease Control and Prevention and covers a broad spectrum of high blood pressure in the U.S.
BPConsequencesmh_bp_infographicTony

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April 8, 2015 · 12:08 am

How You Can Benefit from a Positive View on Your Life – WSJ

Regular readers know that I have embraced the theory of positive psychology. I have written a number of posts on the benefits of a positive point of view. You can find an index of them at the end of this post.

Meanwhile, I was thrilled to see Elizabeth Bernstein’s piece in the Personal Journal of Tuesday’s Wall Street Journal entitled “It’s Healthy to Put a Good Spin on Your Life.”

To-Think-Positively-or-Negatively_opt

In a study of a large number of adults in their mid to late 50’s researchers found that “when people displayed higher levels of agency, communion and redemption and lower levels of contamination, their mental health improved. They consider good mental health to be low levels of depression and high levels of life satisfaction and psychological and social well-being.”

They explained the four keys to good mental health as follows:

“• Agency—Did the subjects feel able to influence and respond to events in life, or did they feel battered around by the whims of external forces?

• Communion—Are the people connected to others or disconnected?
• Redemption—Did the subjects take a negative experience and find some positive outcome?
• Contamination—Did they tell narratives of good things turning bad?”

I would like to point you to a post I wrote in May of 2011 called Super Tools for Handling Stress.

In it I quoted Maggie Crowley, Psy.D., a Health Psychologist at the center for Integrative Medicine and Wellness at Northwestern Memorial Physicians Group.

Dr. Crowley listed the following as maladaptive coping strategies:

*Demand our circumstances be different
*Devalue ourselves and others
*Demean/blame ourselves and others
*When the above fail to work, do we choose another strategy?
*Or, do we double our ill-conceived efforts and feed our downward spiral.

She said that we needed something to shift our mental gears out of the stressful/fearful response that triggers that damaging cascade of negative emotion. She suggested the following activities that set off the parasympathetic approach:

*Practicing appreciation
*Making choices that are positive
*Using constructive language
*Employing our strengths and personal power.

I think there is a great similarity between the four keys to good mental health mentioned in the Journal and the points made by Dr. Crowley in dealing with stressors.

Regarding positive psychology, I have found it answered a lot of questions for me. If you are interested you can explore it in the following posts:
What is Positive Psychology?
How to Harness Positive Psychology for You – Harvard
Breaking down 8 Barriers to Positive Thinking – Infographic
11 Ways to Become a Better, More Positive You
How to Become a Positive Thinker
7 Exercises That Train Your Brain to Stay Positive
Positive, Happy People Suffer Less Pain

Tony

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January 31, 2014 · 5:23 am

How Do I Get Relief from Arthritis in my Hands?

For more than 20 years I have suffered from arthritis of the hands. Because I am a journalist, I thought I had carpal tunnel syndrome for much of that time. However, I fell off my bike and broke a bone in my wrist when I was in my 50’s and the doctor, looking at my X-rays, said I had arthritis not CTS. Turns out about half the people in the country suffer from arthritis.

If you aren’t clear on arthritis check out my Page What you should know about arthritis. I have written more than a dozen posts on the subject. For the record, I am talking about osteoarthritis, the most common version, not rheumatoid arthritis. Mine is at the base of each thumb, so I have pain using my hands to button, unbutton, turn a key, etc. Just about anything I use my hands for. Yes, that includes typing this.

The acrylic cast build by the Hand Clinic

The acrylic splint build by the Hand Clinic

When I started doctoring, the Northwestern Memorial Hospital Hand Clinic built me an acrylic splint which I wore for several years. I stopped when I discovered trace minerals. You can read my post on that at the link.

I stumbled upon Naproxin Sodium 200 mg capsules a couple of years ago when I got Popeye Elbow and a doctor prescribed it to reduce the swelling. Turned out the Naproxin also relieved the pain in my hands, too.

The compression gloves I wear now

The compression gloves I wear now

When I discussed it with my internist, though, she said that there were some really dangerous side effects to regular use of Naproxin which is an NSAID (Non Steroidal Anti Inflammatory Drug). So, she prescribed Pennsaid which is also an NSAID ointment. Since you rub it on instead of swallowing it, there is significantly less damage to your system that the ones you swallow.

I didn’t get much relief from Pennsaid and I also didn’t like sitting around for periods with both my hands covered with this drug. So I quit using it.

I picked up some Acetomenaphin (Tylenol) at Costco and started taking two 500 MG tablets every morning after that. I did that for a couple of years, but the pain relief benefits seemed to be tailing off and I didn’t want to up the dose. Continue reading →

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November 17, 2013 · 3:00 pm

Healthy Holiday Eating Tips #5 – At Home

Having covered holiday eating situations in which you are the guest, what about the one(s) in which you are the host(ess)?

Here are some suggestions from a presentation by Holly Herrington, MS RD, before Northwestern Memorial Hospital’s Healthy Transitions Program®.

Experiment with Recipes

Don’t feel like you have to make all the traditional food with 100 per cent traditional recipes and ingredients.

Roast Turkey and Stuffing

Feel free to swap high calories ingredients out and put low calories ones in.  For example, you can use low-fat cheese, Greek yogurt vs sour cream, mustard vs mayo, applesauce vs oil, cinnamon vs sugar.

Most pumpkin pie recipes call for at least one cup of cream or evaporated whole milk and two eggs. Use evaporated skim milk and three egg whites to cut about 300 calories and 30 to 38 grams of fat from your pie.

Buy brown and serve bread rolls instead of the higher-fat crescent rolls to cut about 1100 extra calories and about 100 grams of fat per dozen.

Use light cream cheese instead of regular cream cheese in your dips, spreads and cheesecakes to cut about 16 grams of fat per cup of cream cheese.

Make a little less so the temptation is not so great to overeat.

Go easy on the gravy and opt for canned cranberry sauce on your turkey for a nutritious and fat-free option.

Replace the bread in your holiday stuffing with canned chestnuts, a nutritious and different alternative. To further lighten your stuffing and add valuable nutrients, mix in canned, chopped vegetables, too.

Serve meals in the kitchen instead of family-style on the table to avoid reaching for seconds out of convenience.

Put any leftovers in the freezer before sitting down ot eat so as not to be tempted for second helpings.

If you are baking for friends and family, spend a little extra time and money on individual packaging so you are less likely to dip into leftovers.

I hope these suggestions prove helpful to you in your holiday meal preparation. Please feel free to send in your own suggestions as well as substitutions.

You can read the entire Healthy Holiday eating series starting with Tips for Healthy holiday eating and scrolling backwards.

Happy and healthy holiday eating!

Tony

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November 14, 2013 · 4:12 pm

What are some Strategies to Protect My Eyesight?

“Prevention is the most powerful tool in the quest to reduce disease and healthcare costs,” according to Dr. Nicholas J. Volpe, Tarry Professor and Chairman Department of Opthalmology Feinberg School of Medicine Northwestern University, speaking before Northwestern Memorial Hospital’s Healthy Transitions Program®.

eye-parts

* Don’t smoke. Smoking triples the risk for cataracts and is also a risk factor for macular degeneration and its response to treatment.

*Wear sun glasses that are UV protective.

* Wear safety glasses for high risk activities.

* Pay attention to nutrition. You need fruits and leafy vegetables, Omega 3 fatty acids and vitamins A, C and E. In a study about folks who ate leafy green vegetables, there was a five fold increase in cataract prevention over those who ignored leafy green vegetables in their diet.

* Don’t ignore symptoms. Many afflictions of the eye like glaucoma are irreversible, however, they can be handled when caught early.

* Get regular eye examinations.

Tony

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July 26, 2013 · 2:12 pm

How Bad is Depression?

The focus of this blog – living  a long healthy life – has more to it than just keeping your weight down, eating right and exercising regularly. We need to be aware of our mental well-being as well as our physical health. So I thought you could use this introduction to the scourge that is depression. It is a killer of a disease.

One of the first things you need to know about depression is that it is a disorder of cognition not just mood, according to Robert D. Edger, M.D. speaking before Northwestern Memorial Hospital’s Healthy Transitions Program® .

Depression is significantly more than feeling down or feeling sad.

depression-2

Dr. Edger said that depression is the leading cause of disability in the world according to the World Health Organization. Women outnumber men by a factor of two-to-one. Only a quarter of the people who suffer from depression ever get treated. Continue reading →

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July 18, 2013 · 11:04 am

Should You Try a Gluten-Free Diet?

A popular diet myth is that everyone can benefit from a gluten-free diet. It can give you more energy and is anti-inflammatory. Sales of gluten-free products increased 16 percent in 2010.

Celiac disease is an autoimmune condition in which the body can’t digest gluten, a protein found in wheat, rye and barley. Less than two percent of the population suffers from celiac disease. So, the odds are that you don’t. Nonetheless, there are hundreds of Gluten-Free products.
gfree
The Mayo Clinic says, “A gluten-free diet is used to treat celiac disease. Gluten causes inflammation in the small intestines of people with celiac disease. Eating a gluten-free diet helps people with celiac disease control their signs and symptoms and prevent complications.”

If you don’t have a medical reason for following a gluten-free diet, there is no benefit, according to Erin McCarthy, MS, RD, LDN at theCenter for Lifestyle Medicine at Northwestern Memorial Hospital.

The Mayo Clinic also pointed out, “People who follow a gluten-free diet may have low levels of certain vitamins and nutrients in their diets. Many grains are enriched with vitamins. Avoiding grains with a gluten-free diet may mean eating fewer of these enriched products.

So, if it ain’t broke don’t fix it. A gluten-free diet is very difficult to adhere to and you will likely get no direct benefit from it for your troubles.

Tony

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July 17, 2013 · 4:04 pm

Important Facts About Skin Cancer

The incidence of melanoma is rising, according to Mary Martini, MD, FAAD Associate professor Dermatology, Director, Melanoma and Pigmented Lesion Clinic Northwestern University.

Dr. Martini said that in 1900 the incidence of melanoma was one in 2000. In 2004 it had risen to one in 70 and by 2012 melanoma incidence had climbed to one in 58. Melanoma is the rarest form of cancer, but it is the most deadly.

Melanoma is an odd duck. The website Second Opinions points out that “During the 1980s and early ’90s more than a dozen studies compared histories of sunburn in patients with melanoma and controls. But differences in design and definition of sunburn make it difficult to quantify a single estimate of risk.”

“There is five times more melanoma in Scotland on the feet than on the hands. And melanoma in Orkney and Shetland is ten times that of the Mediterranean islands.”

Dr. Martini was speaking before a Northwestern Memorial Hospital Healthy Transitions Program® .

sun-drawing
Another sobering statistic she offered was the changes in overall cancer mortality from 1975 to 2000. Prostate cancer mortality has fallen five percent, breast cancer mortality has fallen 15 percent, colorectal cancer is down 25 percent, but death from melanoma has risen 28 percent. Continue reading →

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July 6, 2013 · 7:17 pm

Should We Cut Carbohydrates to Lose Weight?

“Carbs are fattening – cut down on them” is another of the popular food myths. Many people think that by reducing their carbohydrate consumption they will lose weight.

Not true, according to Erin McCarthy, MS. RD, LDN, professional dietician at the Center for Lifestyle Medicine at Northwestern Memorial Hospital.

McCarthy said that no matter what food group you choose, if you cut out the items from that group, you will reduce your caloric intake and lose weight.
570973-overweight
So, cutting down on carbs is not necessarily the way to go if you want to lose weight.

Back when I first started writing this blog, I took a course called Nutrition Made Clear from the Great Courses.

It was taught by Professor Roberta Anding, registered dietician and a certified specialist in sports dietetics.

Professor Anding said that carbohydrate is a maligned nutrient. She considers it a nutritional powerhouse.

“It is the exclusive fuel of the central nervous system, your brain and for exercising muscle.”

It is necessary for both brain and muscle function. She considers carbohydrates central to our human physiology.

“For most of us, Carbohydrates should account for about 50 percent of our diets,” Anding said.

The functions of carbohydrates to provide energy. “folks on a low carbohydrate diet are irritable, fatigued and lethargic….” and the reason is that they have eliminated a major source of energy.

One further function of carbohydrates is that they protect proteins which are used for building our muscles and tissues. If we are low on carbohydrates, the body will burn protein for energy. Ironically, it is protein and not fat that is taken by the body when carbs are low. The liver is able to convert protein into carbohydrates, but not fat.

So, as always, the answer is balance. Cut out extra calories, but don’t distort the basic nutrients. Try to eat a balanced diet. I have written repeatedly about the benefits of the Mediterranean Diet. You can read further by typing Mediterranean Diet into the search box at the right.

Tony

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July 4, 2013 · 2:17 pm

Does Eating Late Make You Gain Weight?

On the subject of popular diet myths, this one ranks weigh up there. Some folks believe strongly that eating much after dinner will pack on the pounds.

Not true, according to Erin McCarthy, MS, RD, LDN, professional dietician at the Center for Lifestyle Medicine at Northwestern Memorial Hospital.

McCarthy said, “It makes no difference what time you eat. What matters is how many calories you consume vs how many you burn through activity over time.”
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I must confess this was music to my ears. As a calorie counter, this makes perfect sense to me. You can read further on calorie counting and weight control principles on my page How to lose weight and keep it off.

The following is point eight from that page: “To lose weight you want to create a negative energy balance. Take in less calories than you need in a day and your weight will melt off. Any calorie table can give you that number. Simple math: 3500 calories = 1 pound, never forget that. Cutting 500 calories a day loses 1 pound a week. If you eat 250 fewer calories and burn off an extra 250 calories, it will have the same effect as cutting 500 calories.”

To summarize, it’s not how late you eat, but how much. You don’t have to count calories to lose weight, but it really helps. Maybe you ought to give it a try.

Tony

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April 9, 2013 · 9:03 am

How Much Sleep Do I Need?

This is not an easy question to answer. The National Sleep Foundation offers ranges for various ages, but with the range for adults being two whole hours, from seven to nine hours, it is certainly not definitive.

Time Magazine quoted Daniel Kripke, co-director of research at the Scripps Clinic Sleep Center in La Jolla, Calif., who compared death rates among more than one million American adults who reported their average nightly amount of sleep. While his results were surprising, they have since been corroborated by similar studies in Europe and East Asia.

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“Studies show that people who sleep between 6.5 hr. and 7.5 hr. a night, as they report, live the longest. And people who sleep 8 hr. or more, or less than 6.5 hr., they don’t live quite as long. There is just as much risk associated with sleeping too long as with sleeping too short. The big surprise is that long sleep seems to start at 8 hr. Sleeping 8.5 hr. might really be a little worse than sleeping 5 hr.” Kripke said.

“Morbidity [or sickness] is also “U-shaped” in the sense that both very short sleep and very long sleep are associated with many illnesses—with depression, with obesity—and therefore with heart disease—and so forth. But the [ideal amount of sleep] for different health measures isn’t all in the same place. Most of the low points are at 7 or 8 hr., but there are some at 6 hr. and even at 9 hr. I think diabetes is lowest in 7-hr. sleepers [for example]. But these measures aren’t as clear as the mortality data.”

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The best explanation I have heard was from Associate Professor Ramadevi Gourineni in Neurology and Director of the Insomnia Program speaking before the Northwestern Memorial Hospital’s Healthy Transitions Program®. In answer to the question how much sleep do I need, she offered, “The amount that permits us to be wide awake, alert and energetic throughout the day. This amount varies from person to person and may be genetically determined.” She also noted that not only do we need the proper quantity of sleep, but also the proper quality of sleep. Continue reading →

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April 8, 2013 · 7:17 pm

What are Healthy Sleep Habits?

I have written repeatedly about The Importance of a Good Night’s Sleep. That is one of my links highlighted at the top of this page. If you click on it you will be directed to at least seven blog posts on the importance of sleep.

This is my dog, Gabi, I wish I could sleep as soundly as she does.

This is my dog, Gabi, I wish I could sleep as soundly as she does.

This afternoon I went to one of Northwestern Memorial Hospital’s Healthy Transitions Program® that happened to be about healthy sleep habits. Associate Professor Ramadevi Gourineni in Neurology and Director of the Insomnia Program gave us the following list of Good Sleep/Wake Habits:

Daytime factors included:
*Avoiding excessive caffeine. She said not to consume more than two or three (10-12 ounce) beverages with caffeine and not to take anything with caffeine after 2:00 p.m.
*Avoid excessive napping. A 30 to 45 minute nap prior to 2:00 p.m. is all right.
*Exercise three to five days a week for 30 minutes or longer.
*Do Not Smoke.
*Stay active during the day and get sunlight exposure.

Evening Factors included:
*Avoid unintentionally falling asleep sitting and relaxing in the evening.
*Avoid alcohol before bedtime.
*Finish heavy meals at least three hours before bedtime, particularly if you have problems with regurgitation. *On the other hand, a light bedtime snack is all right. Continue reading →

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