Wednesday, February 25, 2009

Mental exhaustion makes workouts harder: study

By Reuters - Tue Feb 24, 3:06 PM PST
CHICAGO (Reuters) - Being mentally exhausted can impair a person's exercise performance, a finding that may help explain why it is sometimes so hard to work out, British researchers said on Tuesday. They said people who did a mentally tiresome task just before exercising reached exhaustion much more quickly than when they had been mentally rested.

Mental fatigue did not affect the performance of the heart or muscles, but it did affect their "perceived effort," Samuele Marcora, Walter Staiano and Victoria Manning of Bangor University in Wales wrote in the Journal of Applied Physiology. "Our study provides experimental evidence that mental fatigue limits exercise tolerance in humans through higher perception of effort," the team wrote. For the study, the researchers had 16 people take a demanding, 90-minute test that required close attention, memory, and left participants feeling tired and listless. Next, they rode a stationary bicycle to exhaustion, while the researchers tracked their heart rate and other vital signs. On a different day, the same group simply watched a 90-minute documentary film before riding the bike. The researchers found participants stopped exercising 15 percent earlier on average when they were mentally exhausted, even though there was little difference in their cardio respiratory or muscle function. "It provides strong evidence that brain function can limit short-term endurance performance," the team wrote. The researchers said the next step is to look at the brain to find out exactly why people with mental fatigue perceive exercise to be more difficult.
Interesting study. I wonder if the authors wrote this article before or after exercising.

Q1: Does this mean that poor exercise performance can be "all in our heads?"

Q2: Is any other performance decreased due to mental fatigue, such as work or parenting?

I believe the answers are yes, yes and yes, but, a better question would be:

How do we get past the mental fatigue and continue to perform optimally?

As it pertains to exercise, Andy Dick of Optimal Fitness, has the following thoughts on getting past the exhaustion, or as some athletes call it, "getting past the wall".

I believe that this research points out an important point. You can (and should) only focus on so much without breaking down in one aspect or the other. Just like multi-tasking and juggling too many things at work can lead to reduced production in all of your work goals, exercise can suffer as a result of a long day at work. If one can focus on exercise as a method to relieve the day’s stress rather than as a an all-out He-Man workout, it can and should help break up the tightness in your mood. Rather than skipping the workout, re-focus on why you hit the gym!

Andy Dick
Owner, Optimum Results
(609) 304-7598

Check out Optimum Results - Personal Training for this month's healthy tip!

Thanks Andy!!

As I mentioned earlier, I believe mental fatigue, or as we should call it "STRESS", decreases our performance in many daily activities which then leads to phrases like "I woulda, I coulda and I shoulda." These phrases only perpetuate the stress and do not help in finding a way to release it.

My favorite stress release methods include reading a favorite book or magazine, or cooking a favorite meal, low carb of course ; )

If you have any favorite methods to reduce your mental fatigue, please visit my blog and post your annonymous methods in the comments section. This is where I hope we can all learn from each other. And I hope they are better than this next cartoon.

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

Saturday, February 21, 2009

Vitamin D 'is mental health aid'

February 21, 2009
Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!

As many of you already know, I am a big proponent of prevention of medical illness through easy lifestyle changes. The key to prevention is understanding how the different parts of your day impacts on your health.

The diet you follow is of utmost importance, especially when it comes to getting the proper amount of vitamins and nutrients to not only sustain your energy levels, but also to optimize your body to run efficiently.

While not a believer in megadoses of vitamins, I am a strong believer in getting optimal amounts, which in many cases is very different from the governments RDA, or recommended daily allowance.

Vitamin D is one vitamin that we are learning more and more about, especially with prevention of disease. My belief is that the RDA is much too low for optimum health.

The following article is from BBC online and discusses Vitamin D as a preventive for cognitive decline as we age.

Vitamin D 'is mental health aid'

From the BBC news online: Jan 23, 2009

Vitamin D, found in fish and produced by sun exposure, can help stave off the mental decline that can affect people in old age, a study has suggested.

UK and US researchers looked at 2,000 people aged 65 and over.

They found that compared to those with the highest vitamin D levels, those with the lowest were more than twice as likely to have impaired understanding.

Alzheimer's charities said the research was interesting, but more work was needed to understand vitamin D's role.

Vitamin D is important in maintaining bone health, in the absorption of calcium and phosphorus, and in helping the immune system.

The body makes vitamin D when it is exposed to the sun, or it can be obtained from foods such as oily fish, and those fortified with vitamin D, such as milk, cereals, and soya drinks.

But older people's skin is less able to absorb vitamin D from sunlight so they are more reliant on obtaining it from other sources.


Animal and lab studies have previously suggested that the vitamin can have a beneficial effect on cognitive function.

The team from the Peninsula Medical School in Exeter, the University of Cambridge and the University of Michigan, assessed people's cognition, or comprehension skills.

People who have impaired cognitive function are more likely to develop dementia.

The researchers looked at people who had taken part in the Health Survey for England in 2000.

Just over 200 had significant cognitive impairment, assessed by looking at people's attention, orientation in time and space and memory.

The study found that as levels of vitamin D went down, levels of cognitive impairment went up.

The paper will appear in a forthcoming issue of the Journal of Geriatric Psychology and Neurology.

Dr Iain Lang from the Peninsula Medical School, who worked on the study, said: "For those of us who live in countries where there are dark winters without much sunlight, like the UK, getting enough vitamin D can be a real problem - particularly for older people, who absorb less vitamin D from sunlight.

"One way to address this might be to provide older adults with vitamin D supplements.

"This has been proposed in the past as a way of improving bone health in older people, but our results suggest it might also have other benefits.

"We need to investigate whether vitamin D supplementation is a cost-effective and low-risk way of reducing older people's risks of developing cognitive impairment and dementia."

Risk factor?

Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "Many foods that contain vitamin D, such as oily fish, eggs and breakfast cereals, are also good sources of vitamin B12, which, as previous studies have shown, can help protect the brain.

"Diet is known to influence dementia risk. The best way of reducing your risk of developing dementia is to maintain a balanced diet with regular exercise and frequent social interactions."

She added: "These findings may be significant, but much more research is needed."

Dr Susanne Sorensen, head of research at the Alzheimer's Society, added: "One in three people over 65 will die with dementia so research into how we can reduce risk is to be encouraged.

"There was some previous evidence to suggest that people with dementia may have a lower level of vitamin D in their blood but it was not clear if this happened after the onset of disease.

"It would be interesting if a low level of vitamin D was found to be a risk factor for cognitive problems as it is cheap and easy to remedy.

"We look forward to seeing the published results of this new research to help us better understand the potential role of vitamin D in reducing risk."

So, yet more information on the potential benefits of Vitamin D. Naysayers will argue that the "studies" were not run properly, or that the study was too small. Instead of focusing on statistics, let's use a little logic. We have found out that Vitamin D has many functions other than calcium and bone development. Please refer to the Vitamin D council website for a long list of other beneficial effects. I like to look at how our body would naturally obtain a nutrient both in today's world and a thousand years ago, before we had vitamin supplements. As our bodies are able to manufacture Vitamin D from sunlight, in amounts of 10,000 - 15,000 units from a good summertime sun exposure, the RDA of 400-800 units seems pretty low.

Question: Why do many retirees first head south for the winter, and then eventually move south for good?

Is it the warmer weather, lower taxes, lower cost of living, OR possibly they feel better due to more sunshine naturally increasing their Vitamin D?

If you have any comments or questions about this newsletter please visit my blog and post it for discussion.

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

Tuesday, February 17, 2009

Colds and Sleep

Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!

February 17, 2009

I often get asked, "Hey Doc, Why do I always get sick. It seems like I am in here for a cold all the time."

A new study from the Archives of Internal Medicine on Sleep habits and the susceptibility to the common cold may give us a little clue.


Colds and Sleep

Sleep habits and susceptibility to the common cold.
Arch Intern Med. 2009; 169(1):62-7 (ISSN: 1538-3679)

Cohen S; Doyle WJ; Alper CM; Janicki-Deverts D; Turner RBDepartment of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA.

BACKGROUND: Sleep quality is thought to be an important predictor of immunity and, in turn, susceptibility to the common cold. This article examines whether sleep duration and efficiency in the weeks preceding viral exposure are associated with cold susceptibility.

METHODS: A total of 153 healthy men and women (age range, 21-55 years) volunteered to participate in the study. For 14 consecutive days, they reported their sleep duration and sleep efficiency (percentage of time in bed actually asleep) for the previous night and whether they felt rested. Average scores for each sleep variable were calculated over the 14-day baseline. Subsequently, participants were quarantined, administered nasal drops containing a rhinovirus, and monitored for the development of a clinical cold (infection in the presence of objective signs of illness) on the day before and for 5 days after exposure.

RESULTS: There was a graded association with average sleep duration: participants with less than 7 hours of sleep were 2.94 times (95% confidence interval [CI], 1.18-7.30) more likely to develop a cold than those with 8 hours or more of sleep. The association with sleep efficiency was also graded: participants with less than 92% efficiency were 5.50 times (95% CI, 2.08-14.48) more likely to develop a cold than those with 98% or more efficiency. These relationships could not be explained by differences in prechallenge virus-specific antibody titers, demographics, season of the year, body mass, socioeconomic status, psychological variables, or health practices. The percentage of days feeling rested was not associated with colds.

CONCLUSION: Poorer sleep efficiency and shorter sleep duration in the weeks preceding exposure to a rhinovirus were associated with lower resistance to illness




Sorry, sometimes reading medical studies makes me sleepy ; )

To rephrase this study in a language we can all understand, individuals who achieved less than 7 hours of refreshing sleep a night had an almost 3x greater likelihood of "catching a cold".

So in today's rush-rush hectic world, where we do not have time to do all the things we feel are needed, it seems like a good time to adjust our schedules back to include time for a good 8 hours or more of sleep. And sleep should be something we look forward to at the end of the day, not something to dread because " I don't have time for sleep. I am too busy!"

The better we sleep, the better we function during our waking hours, which means better production at work, or at least better than the guy pictured below.

Here are some suggestions to try if you are having issues with sleep:
1) Avoid all products with caffeine after 4 PM.
2) Follow a routine at bedtime-- with consistent adherance to the routine: Example: warm bath and warm decaffeinated drink
3) TV off the same time every night.
4) Save bed for sleep and intimacy. DO NOT read or watch TV in bed.
5) If you are unable to sleep after 30 minutes in bed then get up and do something constructive in another room such as housework, a hobby, or watch TV. The idea is that this will avoid frustration with not being able to get to sleep and tell your brain/body: that if your are going to be awake then you will do "waking hours activities". Should you become sleepy then return to bed.
6) Learn yoga, Tai Chi, or other meditative breathing exercises to help you "turn off your brain" at night. The Mount Laurel Library is offering a one hour class the First Friday of every month, from 7-8 pm, in the ancient healing art of Tai Chi. For more info on this class or Tai Chi please click here.
For further sleep tips, please follow this link to the National Sleep Foundation,

If you have any sleep tips that you would like to share, please visit my blog at and leave your annonymous tips in the comments section. The blog also contains all the previous newsletters with an easier search feature.

Good night and I hope you sleep well !!!

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

Friday, February 13, 2009

Valentines Day and Philematology

Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!

February 14, 2009


An excellent spelling bee word and good segway towards Valentines Day.

So what is philematology and how does it relate to a wellness newsletter?

Keep reading.

The answer is written below.
Kisses unleash chemicals that ease stress levels
By RANDOLPH E. SCHMID, AP Science Writer Randolph E. Schmid, Ap Science Writer

CHICAGO – "Chemistry look what you've done to me," Donna Summer crooned in Science of Love, and so, it seems, she was right. Just in time for Valentine's Day, a panel of scientists examined the mystery of what happens when hearts throb and lips lock. Kissing, it turns out, unleashes chemicals that ease stress hormones in both sexes and encourage bonding in men, though not so much in women.
Chemicals in the saliva may be a way to assess a mate, Wendy Hill, dean of the faculty and a professor of neuroscience at Lafayette College, told a meeting of the American Association for the Advancement of Science on Friday.
In an experiment, Hill explained, pairs of heterosexual college students who kissed for 15 minutes while listening to music experienced significant changes in their levels of the chemicals oxytocin, which affects pair bonding, and cortisol, which is associated with stress. Their blood and saliva levels of the chemicals were compared before and after the kiss.
Both men and women had a decline in cortisol after smooching, an indication their stress levels declined.
For men, oxytocin levels increased, indicating more interest in bonding, while oxytocin levels went down in women. "This was a surprise," Hill said.
In a test group that merely held hands, chemical changes were similar, but much less pronounced, she said.
The experiment was conducted in a student health center, Hill noted. She plans a repeat "in a more romantic setting."
Hill spoke at the session on the Science of Kissing, along with Helen Fisher of Rutgers University and Donald Lateiner of Ohio Wesleyan University.
Fisher noted that more than 90 percent of human societies practice kissing, which she believes has three components — the sex drive, romantic love and attachment.
The sex drive pushes individuals to assess a variety of partners, then romantic love causes them to focus on an individual, she said. Attachment then allows them to tolerate this person long enough to raise a child.
Men tend to think of kissing as a prelude to copulation, Fisher said. She noted that men prefer "sloppy" kisses, in which chemicals including testosterone can be passed on to the women in saliva. Testosterone increases the sex drive in both males and females.
"When you kiss an enormous part of your brain becomes active," she added. Romantic love can last a long time, "if you kiss the right person."
Lateiner, a classical scholar, observed that kissing appears infrequently in Greek and Roman art, but was widely practiced, despite the spread of skin disease at that time by facial kissing. And there was a potential for social faux pas by kissing the wrong person at the wrong time.
Overall, the science of kissing — philematology — is under-researcherd, Hill concluded.


Philematology- the science of kissing.

The perfect subject for Valentine's Day.

An interesting article that has some interesting results.

If a well timed hug can relieve stress and anxiety, why not kissing.

Cortisol, the stress hormone, decreases in both males and females with kissing.

And oxytocin, a hormone that helps us bond, went up in males, but down in females. Interestingly, oxytocin rises during pregnancy and childbirth and is critically important in mother-child bonding.
Does this mean that women are better kissers than men?
Or maybe it means that college women have their priorities more in order than college men.

This study was completed at Lafayette College.

As with most medical research, more studies need to be done.

Rumor has it that Lafayette College applied for a research grant from the federal government for future studies. If granted, that would give the "stimulus bill" a new meaning ; )

Now a few words of warning:
1) Any parents of Lafayette college students should be made aware of the planned future studies to be conducted in a "more romantic setting."
2) And any soon to be college students? Lafayette College may warrant a second look ; )

But in all seriousness, being with those we love, and hugging and kissing, does relieve stress, and this study shows how our bodies make this happen. So after a hard day at work, go home and kiss your spouse and hug your kids. We now know that you will probably feel better for the effort!!

Best Wishes to One and All for a Happy Valentine's Day!!

And as for a picture of one of my favorite kisses, it is pictured below:

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

Sunday, February 01, 2009

Chocolate may be Beneficial for Chronic Fatigue

Dr. Steven Horvitz- Reading between the Lines:
Bringing you healthcare information you can trust!
February 1, 2009
Article from Natural News- Thursday, January 29, 2009 by: Sheryl Walters, citizen journalist
(NaturalNews) Regularly consuming chocolate could be beneficial to those with chronic fatigue syndrome, according to a study at Hull York Medical School. People who suffered with the illness found that they had more energy when they consumed high cocoa content.

Chronic fatigue syndrome (CFS) is an illness that has a vast array of diverse symptoms; the primary one being exhaustion. Most chronic fatigue specialists advise their clients to avoid chocolate because of the caffeine and sugar it contains.

Professor Steve Atkin, who led the study, said he had clients who reported feeling much better after swapping normal milk chocolate for dark chocolate with a high cocoa solid content. This sparked him to investigate further.

The trial consisted of 10 patients who received 45g of dark chocolate or white chocolate dyed to look like dark chocolate everyday for two months. After the month was over, they avoided chocolate for one month and then began taking the other type of chocolate for two months.

When the patients were taking a daily dose of dark chocolate, they reported significantly less fatigue, but felt the fatigue return when they stopped eating it.

Atkin was surprised at what good results were achieved. "Although it was a small study, two patients went back to work after being off for six months."

He explained: "Dark chocolate is high in polyphenols, which have been associated with health benefits such as a reduction in blood pressure. Also high polyphenols appear to improve levels of serotonin in the brain, which has been linked with chronic fatigue syndrome and that may be a mechanism."
Although more research was needed to confirm the findings, Atkin said that patients would not do themselves any harm by eating small amounts of dark chocolate. He added that no one in the study put on any weight.

Chronic fatigue is a very complex illness with many different causes including food intolerances, Candida, heavy metals and parasites. There is no single cure that works for everyone, and most people require quite a few lifestyle changes along with herbs, nutrients and detoxing.
Because of this, chronic fatigue specialists warn against believing that eating chocolate daily is going to completely solve the problem.

Most importantly, consuming chocolate with sugar in it should be generally avoided by everyone, especially those with a disabling illness.

Raw Chocolate

While dark chocolate is high in antioxidants and other nutrients, raw chocolate is even more potent since none of the nutrients have been destroyed through heating and processing. Further, raw chocolate is sugar free. Most people make raw chocolate with agave nectar, stevia or xylitol. All of these are fine in moderation for those with chronic fatigue syndrome because they don`t create blood sugar imbalances and they don`t feed the imbalances like sugar does.

OK everyone.
First I write about breakfast shakes and now I bring you information about the benefits of chocolate. What's next? Maybe telling you that eating lots of protein and fat is healthy. In many cases it is, but that is not the purpose of today's newsletter, which is CHOCOLATE.
When reviewing a patient's diet history, chocolate almost always plays a part, and not one that most want to give up. I have also been known to rummage through the rooms in my office looking for chocolate to "give me a lift".
So should we be excited that this new research allows more chocolate in your diet?
The answer is Yes and No.

Anecdotally, many of us feel more energetic and/or get a "mood lift" when we eat chocolate. So, Yes, if this research is correct, then eating darker, minimally processed chocolate may help with chronic fatigue. So if a chocolate craving occurs, look for the chocolate with a higher cocoa percentage. These are usually the darker variety.

And, No, please do not go and start eating the normal heavily processed milk chocolate that contains more sugar and "fake fat" and that carries other risks. To be fair, this study contained only 10 people, which does not meet criteria for a valid population based study. But I am sure if they want to enroll more volunteers for a future study, that I could fill the group with my practice alone. But get in line behind me, because I am first!!
I would like to thank everyone who read my previous newsletter and sent in their breakfast shake recipes. These recipes are now posted on my website.
Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness