Dr. Kristian Olson, MD

Lightheadedness is a common complaint in internal medicine, and can have three main causes: orthostatic hypotension, cardiac causes, or vasovagal syncope. It is important to get checked if this is a new symptom for you.
 
Transcript: "So lightheadedness is a really common complaint in internal medicine and the causes can range from benign to serious. I will encourage you to get checked if this is a new symptom that you have. But maybe just describing an approach that many physicians take to it will be helpful. The language you use is really important. When we say dizziness, your health care provider usually thinks of dizziness as an altered relationship in space. And vertigo is the description of a motion sensation that's often described as spinning, either the room is spinning around a person or the person is spinning around in a room. And those causes of dizziness and vertigo are separate than lightheadedness. Now lightheadedness really has three main causes in internal medicine. One is orthostatic hypotension, your blood pressure dropping as you go to a sitting or standing position. The second is cardiac causes, so the heart's just not able to respond appropriately to get enough blood to the brain and you get symptoms of lightheadedness. And that can be due to an arrhythmia or to a valvular abnormality. And the final one is vasovagal syncope, which is actually quite common. And we have a nerve in our body, the vagus nerve, that when stimulated can really slow down the heart rate and cause symptoms of either almost fainting or fainting itself. And a number of things can stimulate your vagus nerve such as pain. So when people that faint, when they get their blood drawn, it often makes you think of vasovagal syncope. Thank you very much and keep the questions coming."

Whole body scans on an annual basis may carry risks such as false positives, overdiagnosis, and radiation exposure. It is best to talk to a doctor about the risks before deciding to do a whole body scan.
 
Transcript: "Great question. With the advent of really effective imaging with CT scans or MRIs, why aren't we doing whole body scans on an annual basis for people just to make sure everything's OK? This is really the notion of screening, which is looking for asymptomatic disease and detecting it earlier than it would have been detected previously. And really it's only recommended now for the things that we have evidence that it does more benefit than harm. So what harm could come from this type of screening? So, one of the harms can be that you get false positive results. And that is when you appear to have the disease of interest. And when you have follow-up studies, and perhaps even a biopsy, it ends up not being there and you've actually had ill health added and all of the worry. Another similar thing is when we find incidentalomas. When we were doing CT colon atrophies, about 40% of people would find incidentalomas, things that were just incidental findings that would have had no bearing on their health, and then required follow-up, and again created ill health as people worried or underwent procedures to find something that wouldn't have impacted them in the long run. Very similarly, there's a risk of overdiagnosis. So, as some conditions will be either slow-growing and not have had an impact during your life, or some even lesions can can regress. There's a risk also of imaging itself. One CT scan has the radiation equivalent of 120 chest x-rays. And out of 70 million CT scans per year, it's estimated that there's about 29,000 excess cancers due to that. So there are risks of total body imaging, and I really encourage you to talk to your doctor about those risks. There's certain limited cases where some imaging makes sense, such as if you're a smoker with a 20 pack year history and you're between the age of 50 and 80, a low dose annual chest CT makes sense. Thank you."

Physicians generally don't have enough time to discuss nutrition with their patients, so it's important for patients to arm themselves with reliable sources of information and then ask their physicians specific questions. The Nutrition Source from the Harvard School of Public Health is a great source of information on healthy diets, including the Mediterranean diet, which has been shown to decrease cardiovascular disease, diabetes mellitus and cognitive decline.
 
Transcript: "With as important as diet nutrition is for healthy living and disease prevention, it's really remarkable how few physicians speak to their patients about nutrition. And there's two main reasons for that. One is that medical school curricula has traditionally not focused on nutrition, and most graduates from medical schools in the United States report receiving less than three hours of total nutrition training. And that is changing currently. However, there's another reason, and that's simply time. The office visit or either online or in the office is increasingly squeezed for real estate, for what to talk about. So what I really encourage you to do is find a reliable source of information about your own nutrition and then go with targeted questions to your physician and perhaps ask for referral to a dietitian or a nutritionist. The source that I use is from the Harvard School of Public Health called The Nutrition Source. You can just Google that. And their real message is focusing simply on a healthy diet of fruits and vegetables and whole grains, healthy proteins, healthy fats, and drinking water rather than sugary drinks. One of the evidence-based diets that they give some of the evidence for is the Mediterranean diet, which has consistently been shown to decrease cardiovascular disease as well as decrease the incidence of diabetes mellitus. And there's real interest in its capacity to enable healthy aging as well as decrease cognitive decline. So again, arm yourself with a reliable source of information. Keep the questions coming."

Metformin has been studied in animals and roundworms, and there are three complementary ways that it may decrease cellular aging: inhibiting Mitochondria Complex I, decreasing reactive oxidative species, and down regulating pro-inflammatory cytokines. The Targeting Aging with Metformin study is currently underway to investigate its effects on humans.
 
Transcript: "So a really fascinating question about how metformin might contribute to longevity. Two of my colleagues have already answered this, and I completely agree with them. I wanted to add to this because I think it's one of the most fascinating areas of medical investigation currently. We have a great safety profile for metformin with really knowing over decades that the biggest side effects that we've seen are that people get some stomach upset and diarrhea that's usually mild and able to be managed. What's really fascinating is that for the first time metformin is going to be trialed to see what its impact is on aging itself. So that's called the targeting aging with metformin study or TAME. It's going to be a multi-site study at 14 sites across the country. Really looking at enrolling 3000 patients aged 65 to 79. And we'll get a lot of answers from that. But at the biological level, it's been studied in animals, and in roundworms, and really looking at the effects of cells. And there's three complementary ways that metformin may truly have an impact on cellular aging. One is that inhibits mitochondria complex I. Mitochondria are the energy factories of cells. And really by inhibiting complex I, it decreases oxidative phosphorylation and downstream helps with the biogenesis of mitochondria. The second non-AMCE dependent mechanism is that it seems to really decrease the levels of reactive oxidative species or ROS in the in the cells. And the third reason is that it seems to down regulate pro-inflammatory cytokines. So there's actually three complementary ways that metformin may decrease the aging process. Thanks for the question."

I practice mindfulness meditation by becoming aware of my surroundings, focusing on my breath, doing a body scan, and then doing a visualization exercise. I try to meditate 4 times a week for 10-20 minutes, but if I can't, I'll do shorter intervals throughout the day to remind myself of my last meditation.
 
Transcript: "So, for meditation, I find it's most helpful to have a repeated action that you use on a daily basis. I focus on mindfulness meditation. And the four steps that I go through really as frequently as I meditate is, first of all, just becoming aware of my surroundings. I'm actually in my favorite meditation spot right at the moment. And I become aware of the physical surroundings, my weight of my body, the sounds and smells. And then after taking a few deep breaths, I close my eyes and focus on the breath itself, and do that for a short period of time. And then transition where I do what's called a body scan, where I scan down from the top of the head to the tip of the toes, and really think about areas of discomfort or comfort, and try not to make any judgment about those. And finally, I then go through a visualization exercise. And those can range from performance to creativity to stress reduction. And then I finish after that. So, the big thing that changes in trying to work this into all of our busy lives is just recognizing that you won't have as much time on any given day. So I really vary meditation from 10 minutes to 15 minutes to 20 minutes, depending on how much time I have. I'd love to do it every day, and it just doesn't work out. So I really shoot for four times a week, with 30 second intervals of reminding myself of my last meditation, during the day if at all possible. I hope that helps."

Whether it is ok to drink alcohol in moderation depends on what you define as "moderate drinking". The federal recommendations for moderate drinking are having two or less drinks per day or less than 14 drinks per week if you're a man, or less than one drink per day or seven drinks per week if you're a woman. However, if you have certain conditions or are pregnant, it's recommended that you do not drink alcohol. There are certain benefits such as reduced risk of diabetes mellitus and decreased risk of cardiovascular disease, but this is offset by increased risk of certain cancers.
 
Transcript: "I'm asked this question quite a lot-- is it OK to drink alcohol in moderation? And the key component of that question is, what does moderate drinking mean? And so if we just define "drinks" as one drink is either 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof alcohol, then the recommendations, the federal recommendations, which really are helpful here is that moderate drinking is having two or less drinks per day or less than 14 drinks per week if you're a man, or less than one drink per day or seven drinks per week if you're a woman, and never more than four drinks on any given day. If you're 65 years of age or older, we just limit that to one drink per day or seven per week. Now, it is important to recognize that there is a number of conditions where you just shouldn't consider drinking alcohol, and that's if you have a strong family history of alcohol-use disorder. If you have alcohol-related liver or pancreatic disease, you shouldn't drink. If you have esophagitis, or inflammation in your esophagus, or gastritis, inflammation in your stomach, you should probably limit alcohol intake. And, of course, if you're pregnant, it's really recommended that you not drink alcohol. There are certain benefits in meta-analysis. It seems that alcohol at low or moderate levels reduces your risk of diabetes mellitus and also decreases your risk of cardiovascular disease, the number one cause of death in the country. But this is offset by the increased risk of certain cancers, such as liver cancer, head and neck cancers. And we should recognize that alcohol is a source of many things such as violence in this country, and about 50% of serious assaults are related to alcohol. So really weighing your risks and benefits and really striving for moderation, then it's OK. Thank you."