Would #Daylight #Savings Time Be Safe If All Year?

An article in JAMA Network on March 9, 2023 addressed the debate about keeping Daylight Savings Time throughout the year. Most Americans do not like changing their clocks twice a year.

So, should Daylight Savings Time (DST) be kept throughout the entire year? More people say they would prefer that to having Standard Time year round. Recently, the Senate voted to have DST be kept throughout the year. However, the House of Representatives did not vote on the bill.

Against making DST permanent throughout the year are health concerns. Studies have shown that there is an increase in poor sleep, depression, stroke (in women), and auto accidents during the first week or two after the switch from Standard Time to DST. Many sleep experts believe that these health hazards persist to some extent during all of DST.

An article by the Sleep Research Society (SRS) stated, “After a thorough review of the existing literature, the SRS advocates the adoption of permanent Standard Time.” They oppose DST because of health, sleep, and circadian biology.” Circadian biology refers to the internal clock that regulates changes in multiple biological functioning that is synchronized to solar time.

Beth Malow, MD is a professor of neurology at Vanderbilt University who has expertise in sleep. She points out that “morning light is really needed to get going in the morning.” Having DST during the winter months would mean that children would go to school in the dark.

Dr. Malow also points out that the amount of daylight does not change by changing the clock. Our social time (e.g., when we go to school or work) determines how much daylight we experience at different times. Daylight is longer during the warmer times of the year independent of how we set our clocks.

The American Medical Association, the Sleep Research Society, and other medical organizations have endorsed eliminating DST and using Standard Time all year long.

Others argue that the greatest health risks are during the couple of weeks following the switch from Standard Time to DST; that concern would be resolved by eliminating Standard Time and making DST year round.

My conclusion is that making either Standard Time or DST year round is better than changing the clocks twice a year. It is more likely than not that Standard Time would have more health benefits than DST year round. However, the health risks from year round DST may not be as significant as they are during the first two weeks after changing from Standard Time to DST.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Autism Spectrum Disorder is More Common

Autism Spectrum Disorder (ASD) is a “developmental disability characterized by persistent impairments in social interaction and the presence of restricted, repetitive patterns of behavior, interests, or activities that can cause a wide array of difficulties in social interaction, communication, and participation in daily activities.” (Morbidity & Mortality Weekly Reports from the CDC on March 24, 2023).

This report provided data showing that the prevalence of ASD in 2020 had increased among 8-year-old children in the U.S. It affected about 4% of boys and 1% of girls. Overall, it was diagnosed in 8-year-old children at the rate of one in 36 children. This was up from 2018 when the rate was one in 44.

Out of 11 research sites only 3 showed a correlation with a lower household income. For the first time, the rate of ASD was lowest in White 8-year-old children (this age was chosen because virtually all children with ASD are diagnosed by then).

Co-occurring intellectual disability is present in 37.9% of children with ASD. The rate is highest among Black children with ASD. For the first time, ASD was less prevalent among “White children than among other racial and ethnic groups.”

Given the increasing incidence of ASD, the CDC identified the “need for enhanced infrastructure to provide equitable diagnostic, treatment, and support services for all children with ASD.”

The CDC did not offer any reason why the prevalence of ASD has been increasing in 8-year-old children. Is it because it is being identified more often, or is it because the rate has been increasing? If it is the increasing rate, why is that happening? As yet, we don’t know the answers to these questions for certain.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Stress & #Anxiety Relief

We all experience stress and anxiety at times in our lives. Prolonged stress can impair our mental and physical health.

Wouldn’t it be nice if there was a quick and easy way to reduce anxiety and the stress response? It turns out that there is a research-demonstrated way to do just that.

An article in Cell Reports Medicine by Balban and colleagues on January 17, 2022 reported on a breathing technique that reduces stress and anxiety. It is called, “exhale-focused cyclic sighing.” It must be practiced for 5 minutes a day for at least a month.

It “produces greater improvement in mood and reduction in respiratory rate compared with mindfulness meditation” also done 5 minutes daily for over a month. The authors suggest that “cyclic sighing has promise as an effective stress management exercise.”

Here is how it is done: Sit or lie down and set a timer for 5 minutes. Slowly inhale through your nose as deeply as you can, then, without exhaling, take another breath to completely fill your lungs (much shorter breath than the first one). Next, exhale slowly and fully through your mouth. Continue this method of breathing for 5 minutes.

Repeat this breathing exercise for 5 minutes daily for a minimum of a month. Controlled breathing has been shown to produce “physiological and psychological calming due to increased vagal nerve tone during slow expiration.”

The biological mechanisms that produce these improvements are described in greater detail within the article. It can be accessed by typing this into your internet search engine:

doi:https//doi.org/10.1016/j.xcrm.2022.100895

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Exercise as Treatment for #Depression, #Anxiety, and Psychological #Distress

A review of multiple research studies on the benefits of exercise for the treatment of depression, anxiety, and psychological distress was published in the British Journal of Sports Medicine in 2022. The bottom line is that exercise provides significant improvements in depression, anxiety, and psychological distress in adults.

The researchers reviewed studies involving healthy people, others with mental health disorders, and people with various chronic diseases. They found that “physical activity had medium effects on depression, anxiety and psychological distress, compared with usual care.”

“The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals.” Higher intensity physical activity led to more improvements.

For years we have known that Behavioral Activation is beneficial for depressed and anxious patients. This report supports the benefits of increased physical activity for these individuals. Almost any form of physical activity was helpful. Ideally, the physical activity involves doing something that is found to be rewarding and enjoyable.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Is #Salt a Health Risk?

The World Health Organization (WHO) says it is, and they urge countries to strengthen processes to reduce salt intake. They state that there could be 7 million deaths throughout the world by 2030 as a result of “excessive salt intake.”

The WHO shared this concern in a report released on March 9, 2023. They pointed out that high salt intake increases the “risk of heart disease, stroke, gastric (stomach) cancer, obesity, osteoporosis (thinning of bones), kidney disease, and premature death.”

Table salt is chemically sodium chloride and is often referred to in foods simply as sodium. So, the WHO urges people to decrease sodium in their diet. They recommend checking the sodium content of food listed on the container. The WHO is urging countries to require food companies to print the sodium content in foods more clearly including placing it on the front of food packages.

The recommended salt intake by an adult should be less than 5 grams per day. However, the global average intake is estimated to be 10.8 grams per day. The WHO urges people to reduce the amount of salty foods they consume.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Proper # Nutrition

A review on nutrition by the American College of Lifestyle Medicine was published in the AMA Hub on January 20, 2023. They point out that diet is the “single most important risk factor for morbidity (disease) and mortality (death) in the U.S.”

Sadly, in the U.S. a “majority of the population faces over-nutrition (too much unhealthy food) due to a high intake of ultra-processed, calorie-dense, high saturated fat-laden foods.”

What is recommended is to limit processed foods, junk food, and food with saturated fats, excess sodium (salt), and high caloric content. Instead, increase unrefined, plant-based food; they “help prevent, treat, and reverse chronic disease.”

One good approach is to utilize a “whole-food, plant-based (WFPB) eating pattern emphasizing vegetables, fruits, whole grains, and legumes.” The Mediterranean Diet is a tasty way to do this. In addition to an emphasis on vegetables, it includes lots of olive oil, fish, and modest amounts of red wine.

You certainly can eat meat as part of a healthy diet but with an emphasis on chicken, turkey, and fish. Having other meats can be consumed but in limited amounts.

There are six essential micronutrients (vitamins and minerals), i.e., iron, vitamin A, folate, zinc, vitamin D, and iodine. It is generally best to obtain them by means of a well-rounded diet rather than taking supplements.

The bottom line is to eat a balanced diet with an emphasis on non-processed foods with limited saturated fats and sodium, as well as limiting high-calorie foods. The Mediterranean diet mentioned above is one helpful guide to eating a healthy diet.

Peter M. Hartmann, MD

Family Medicine & Psychiatry