A Different Perspective on Mexico

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The monologue on Mexico focuses on those crossing the border into the US. In fact, that’smexico a very narrow view of the relationship between the two countries.

According to the State Department, there are one million US citizens living in Mexico. However,

  • That figure was first reported in 2014. The number has been increasing since. The US government doesn’t  track residents living out of the country as long as they pay their taxes.
    • One US expat realtor reports a 40% increase in home sales in one US expat enclave just in the last year.
    • A commentator in The Guardian estimates the number of Americans living in Mexico as closer  to two million.
  • A number of the US citizens living in Mexico aren’t there legally (estimates vary from 50 to 90 percent). The Mexican government isn’t particularly good about tracking them, and doesn’t deport them. In fact, Mexico abolished a mandatory prison sentence for undocumented immigrants in 2008. Those who have not committed a crime are simply allowed to stay.

CNN reports that there are four reasons that Americans give for moving to Mexico:

  • Climate
  • Culture
  • Cost of living
  • Escaping the US political climate

One American comments that doctors in Mexico are more helpful and enjoyable to visit than are doctors in the US.

It’s cheap. It’s very patient-oriented. It’s like my father practiced in Illinois about 50 years ago, without all the paperwork.

Many Americans, including some in Congress, view Mexico through the prism of an out-dated stereotype. Of course, if that changes, more Americans might move there.


Sources:

  1. Instituto Nacional de Estadística y Geografíca. http://www.inegi.org.mx/\
  2. Adam Taylor, “Mexico has its own immigration problem: American retirees,” The Washington Post, 21 November 2014. https://www.washingtonpost.com/news/worldviews/wp/2014/11/21/mexico-has-its-own-immigration-problem-american-retirees/?utm_term=.dc11626a341f
  3. Leyla Santiago and Traci Tamura, “South of the border, US expats have a different take on Mexico,” CNN 24 June 2017.  http://www.cnn.com/2017/06/24/americas/mexico-american-expats/index.html
  4. “News Report: 91.2% of All Americans Who Live in Mexico Are Living There Illegally,” Latino Rebels, 5 March 2017. http://www.latinorebels.com/2017/03/05/news-report-91-2-of-all-americans-who-live-in-mexico-are-living-there-illegally/
  5. Millions of Americans live in Mexico. Can we continue to coexist?” The Guardian, 23 January 2017. https://www.theguardian.com/commentisfree/2017/jan/23/trump-futures-mexico-us-interlocked-wall-border

Impact of Weight on Friendships Between Children

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In a previous post, we discussed the link between being overweight as a child and being bullied. A new Dutch study adds to this, by documenting how excess weight affects friendships between children.

Overweight children face a form of social isolation.

  • Overweight children tend to think they have friends, when those people may not like them.
  • Overweight children tend to be excluded from friendships more often than are children of normal weight.
  • Overweight children see themselves as having more enemies than do children of normal weight.

The previous research suggested that these emotional effects may linger into  high school and young adulthood and be linked to depression and to self-harmful behaviors such as alcohol and drug abuse.

The growing literature on weight and the interactions between children strongly suggests the need to channel children at an early age into some form of physical activity, preferably team-based. If over-weight and isolation are harmful, team sports led by an appropriately trained coach would appear to be an antidote.

The good news is that managing weight in children who are heavy may be easier than expected. Another study suggests that use of a powdered prebiotic fiber could reduce weight gain in children by improving healthy gut bacteria and digestion. The fiber used in the study is oligofructose-enriched inulin.

“Powdered fiber, mixed in a water bottle, taken once a day is all we asked the children to change, and we got, what we consider, some pretty exciting results — it has been fantastic,” added Raylene A. Reimer, PhD, RD, professor and researcher in the Faculty of Kinesiology at University of Calgary, who led the study. (3)

Using an experimental design with a test and control group, the prebiotic fiber (taken mixed with water) appeared to cut weight gain among growing children by almost 2/3 (6.6 lb  gain among those using the prebiotic v. 17.6 in the control group).

Note: a prebiotic facilitates growth of good bacteria in the gut. A probiotic introduces new bacteria. They’re quite different and should not be confused.


Sources:

  1. Kayla de la Haye, Jan Kornelis Dijkstra, Miranda J. Lubbers, Loes van Rijsewijk, Ronald Stolk. The dual role of friendship and antipathy relations in the marginalization of overweight children in their peer networks: The TRAILS Study. PLOS ONE, 2017; 12 (6): e0178130 DOI: 10.1371/journal.pone.0178130
  2. Crain, “Childhood Weight, Adult Depression and . . . Bullying? Time to Connect the Dots?” May 2017.
  3. Alissa C. Nicolucci, Megan P. Hume, Inés Martínez, Shyamchand Mayengbam, Jens Walter, Raylene A. Reimer. Prebiotic Reduces Body Fat and Alters Intestinal Microbiota in Children With Overweight or Obesity. Gastroenterology, 2017; DOI: 10.1053/j.gastro.2017.05.055

Deprescribing medication

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There are two relatively new  terms in medical jargon that are worth knowing:

  • Polypharmacy: Taking a large number of prescription medications.
  • Deprescribing: Systematically reducing or eliminating medications that have been prescribed for a patient.

Pharmaceutical companies obviously provide information about when a drug should be used and about side effects that might indicate that the drug should not be used.

What’s rare is information about when a drug ceases to be effective or of value to the patient. Thus as people age, they tend to add prescriptions, and continue them beyond the point of the drug having any real value to the patient.

Dr Farrell notes that at her hospital in Ottawa, it is not unusual to see a patient on 25-30 medications. “Frequently, a medication is started to see whether it will help with certain symptoms—almost like a diagnostic test—but then the medication is never stopped,” she explains. “Ten years go by, and the family doctor retires or dies, and the patient sees a new family doctor who doesn’t know why the drug was prescribed in the first place but is scared to stop it. I see patients in their 80s and 90s who have been on a medication for 30 years, and no one can remember why they are taking it.” (1)

The Canadians are ahead of the US in tackling this issue, even though drug costs are substantially lower in Canada than in the US.

Dr. Barbara Farrell is a clinical scientist at the Bruyère Research Institute and the C.T. Lamont Primary Health Care Research Centre, and assistant professor in the Department of Family Medicine, University of Ottawa, Canada. She is a cofounder of the Canadian Deprescribing Network and codeveloper of deprescribing.org, a website for the dissemination and exchange of information about deprescribing approaches and research. (1)

Her Canadian team is in the process of developing guidelines for reducing or eliminating the medications prescribed for a patient.

Why is this important?

  • Some drugs lose or even reverse their effects over time (e.g., the cancer drug, tamoxifen, which can be used for no more than five years)
  • A drug to fight one illness may aggravate another condition the patient develops
  • There may be long term interactions or complex interactions from combinations of four or more medicines
  • A drug may simply cease to be of value to a patient. If a patient is confined to bed with dementia, does the cholesterol level really matter?
  • Costs

What you should consider:

  • Do you know what the medications you are taking do?
  • Have you talked with your doctor about whether you could reduce dosages?
  • Have you talked with your pharmacist recently about drug interactions and whether there are any long term risks to using a drug?

Ultimately, you’re the custodian of your body. Like a house or a car, your body needs maintenance and you need to be in control.


Sources:

  1. Lisa Brooks, “Easy to Start, Hard to Stop: Polypharmacy and Deprescribing,” Medscape, 1 June 2017. http://www.medscape.com/viewarticle/880716?nlid=115489_1521&src=WNL_mdplsfeat_170606_mscpedit_wir&uac=153634BV&spon=17&impID=1362583&faf=1
  2. Deprescribing.org/
  3. I A Scott et. al., “Reducing inappropriate polypharmacy: the process of deprescribing,” JAMA Intern Med. 2015 May;175(5):827-34. doi: 10.1001/jamainternmed.2015.0324.
  4. Matthew Clark, “Deprescribing Medications,” Indian Health Service, undated.

The Latest Bearing Sign for the US Economy

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The Federal Highway Administration reports that highway travel has declined from theben_franklin last quarter of 2016. That fits with weak consumer spending data from the first quarter of this year — but is a surprise to many economists.

Retail sales at gasoline stations are down 4.8% from this time a year ago. Those sales include gasoline, snacks and other items stations sell.

In reporting this, the Wall Street Journal speculates on a number of possible causes, including immigration enforcement.

The Journal doesn’t cite two obvious causes:

  • The decline in tourist visits to the US — down 16% from a year ago, and
  • Uncertainty about healthcare costs that may be causing consumers to cut spending.

The drop-off in tourism affects all industries that serve tourists:

  • Hotels and recreational facilities
  • Transportation, including air, rental cars and gasoline
  • Restaurants

The decline in this industry is a big deal and affects a lot of jobs as well as city and state tax  revenue.

It doesn’t look like consumer spending is going to drive economic growth.  If it doesn’t, is there anything else that can? Historically, the answer largely is no.

Further, Trump has alienated trading partners who might be interested in seeing our economy recover — Mexico, Canada, China, Germany. The downside of “America First” might be “America Alone”.


Sources:

  1. “Americans Tap Breaks on Driving,” The Wall Street Journal, 27-28 May 2017, p. B12.
  2. Kate Taylor, “Tourism in the US has drastically declined since Trump was elected,” Business Insider, 17 May 2017. http://www.businessinsider.com/trumps-rhetoric-hurt-us-tourism-and-retail-2017-5

Tai Chi and Depression

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My wife and I started classes in tai chi some months ago, so I was curious about a new study about the impact of tai chi on depression.

The pilot study, conducted at Mass General in Boston, focused on Chinese-Americans. This group is just as subject to depression as the rest of the population, but tends to be skeptical regarding western therapeutic techniques.

The key finding of the study is that a twelve-week course of instruction in tai chi could lift depression symptoms, and could be used as the primary course of treatment for depression among Chinese-Americans.

The researchers made an assumption that there are cultural factors that make tai chi effective among Chinese-Americans that might make it ineffective with individuals from other backgrounds. Thus they limited the study just to Chinese-Americans, and even more narrowly, to those speaking Cantonese or Mandarin.

I’m not sure that limitation is appropriate.

  • First, while tai chi is a form of martial art, it is also exercise. Exercise is known to lift depression symptoms. (2) There’s no compelling reason to limit tai chi to those of Chinese descent.
  • Second, I’ve noticed that I feel better emotionally after an hour of tai chi.

Tai chi may be a virtually universal therapy. It has several forms, and there’s a low impact version that can be done easily by seniors.


Sources:

  1. Albert S. Yeung, Run Feng, Daniel Ju Hyung Kim, Peter M. Wayne, Gloria Y. Yeh, Lee Baer, Othelia E. Lee, John W. Denninger, Herbert Benson, Gregory L. Fricchione, Jonathan Alpert, Maurizio Fava. A Pilot, Randomized Controlled Study of Tai Chi With Passive and Active Controls in the Treatment of Depressed Chinese Americans. The Journal of Clinical Psychiatry, 2017; 78 (5): e522 DOI: 10.4088/JCP.16m10772
  2. Mayo Clinic, “Depression and Exercise: exercise eases symptoms.” http://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495

 

Sleep Loss and Weight Gain — How It Works

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One of the hallmarks of a good theory is that it defines a mechanism that makes the theory work. Understanding the “why” is critical.ben_franklin

If you ask most nutritionists, you’ll probably hear about how important good sleep habits are to health. You might hear that sleep is important to managing weight and that people who are well rested aren’t as hungry.

Now we are starting to get the rest of the story. A team of researchers at Upsala University (Sweden) have developed a body of research about the impact on short and interrupted sleep on the body.

The behavioural data reveal that metabolically healthy, sleep-deprived human subjects prefer larger food portions, seek more calories, exhibit signs of increased food-related impulsivity, experience more pleasure from food, and expend less energy.

How does this happen? Sleep loss . . .

  • Shifts the hormonal balance from hormones that promote fullness, such as GLP-1, to those that promote hunger, such as ghrelin.
  • Increases levels of endocannabinoids, which promote appetite.
  • Alters the balance of gut bacteria, which has been widely implicated as key for maintaining a healthy metabolism.
  • Reduces sensitivity to insulin (management of blood sugar levels).

The researchers want to conduct longer duration studies to assess long term effects of sleep loss. In the mean time, they’ve given us an initial assessment of what happens.

If you’re in a situation in which you can’t get adequate sleep, then you need to control carefully what you eat to offset these effects to the extent possible. You may want to consult a doctor or nutritionist about specific steps you should take.


Sources:  European Society of Endocrinology. “Sleep loss affects your waistline.” ScienceDaily. ScienceDaily, 22 May 2017. <www.sciencedaily.com/releases/2017/05/170522081109.htm>.

Childhood Weight, Adult Depression and . . . Bullying? Time to Connect the Dots?

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Being narrow-minded affects people in a broad range of occupations, including ben_franklinacademia. Most people working in one field don’t see what people in related field are doing. Truth literally “falls between the cracks” separating different areas of work.

The people to whom we ascribe brilliance, like Steve Jobs, are those who are able to gather information from a broad array of sources and disciplines and connect the dots to form a coherent picture that others can’t see. Others fail to see the same because they don’t look. They limit what they see to the portion of the world in which they live and work.

Now for an example . . .

In an earlier blog, I reported on research linking being a victim of bullying to depression and health issues in high school. (1) The theory is that the impact of bullying can last well into adulthood.

A new study by Deborah Gibson-Smith from VU University Medical Center in the Netherlands and colleagues reports on a link between being overweight as a child and adult depression. The study doesn’t explain how extra pounds as a child effect adult emotions; it simply reports a statistical relationship. (2) The premise is that it has something to do with self-image.

My theory: Overweight children get bullied, and that bullying causes negative attitudes and behaviors that can linger into adulthood. It’s a simple idea, testable, and provides a concrete mechanism for converting excess weight as a child into adult depression.

However, because we have one group studying the effects of weight, and a different group studying the effects of bullying, apparently no researchers have tried to connect these dots.

Does that make sense?


Sources:

  1. Crain, “Bullying and Depression.”
  2. European Association for the Study of Obesity. “Being overweight in childhood may heighten lifetime risk of depression.” ScienceDaily. ScienceDaily, 18 May 2017. <www.sciencedaily.com/releases/2017/05/170518221006.htm>.