3 Science-Based Secrets to a Youthful Brain

By Everyday Health Guest Columnist

Published Sep 14, 2015

By Henry Emmons, MD, and David Alter, PhD, Special to Everyday Health
Chances are you know someone whose mental abilities have declined with age. And if you’re like most people, you’re a bit afraid of aging yourself.
Surprisingly, those fears are not limited to those of us who are in the second half of life. A large 2013 U.S. poll published in International Psychogeriatrics revealed that young people between ages 18 and 39 are even more concerned about their memory than those in older groups.
Whatever your age, you are wise to take action now to protect what scientists have poetically called “the 3-pound universe” of your brain. The actions you take today will influence what your brain becomes tomorrow, next year, and even decades from now.
In our book, Staying Sharp, we outline nine keys for a youthful brain that are based on sound neuroscience. We also weave in principles from ageless wisdom to help create a resilient brain, a vibrant mind, and an awakened heart. Here, we introduce three of those keys to staying sharp, with examples of simple steps you can take right now to build a healthier, happier, and more authentic future.

A Youthful Brain is a Well-Rested Brain

Sleep is perhaps the most non-negotiable self-care measure for brain health. With good sleep, everything about the brain works better — immediately. Sleep improves your mood, clears your mind, and repairs your body. It is not an exaggeration to call sleep a miracle drug for the brain.
While it’s a myth that we need less sleep as we age, most people find it harder to get enough deep, restful sleep. Here is one simple, surprisingly effective strategy to improve your sleep: Manage your exposure to light.
Our bodies take their cues from nature, and one of the most universal and powerful of these cues is the rhythm of light and dark. We are designed to get bright light during the day but negligible light at night.
Try these tips for better sleep: Regulate your light exposure by better aligning it with nature. Try to give yourself at least an hour of very bright light early in the day. If you can’t get it from the sun, buy an inexpensive dawn simulator for your bedroom, or a blue-spectrum light therapy device for your desk.
In the evening, use great care to minimize your exposure to light.

• Turn off your room lights and screen devices one to two hours before you go to bed.
• Read with very low-level light from a book light or a backlit screen.
• If you need a nightlight for safety, use a very dim one without blue-spectrum light.

A Youthful Brain Cultivates Curiosity

Enough restful sleep allows the possibility for you to enjoy, engage, and even be enchanted by the next day’s opportunities. Cultivating curiosity helps you make use of those opportunities.
When you expose yourself to new ideas or novel situations, your brain may be momentarily challenged or befuddled. But the mental thrill of finding creative solutions to such challenges tickles your brain’s pleasure centers with molecules of dopamine, a neurotransmitter that helps focus attention on the new solution and lock it into memory. That’s why it’s so important to develop the skill of curiosity. Deliberately seeking what is new and different leads to a more flexible and adaptable you.
Try this tip to find more novelty in your life: Exercise your curiosity muscles. The next time you face a choice between doing the same old, same old, or something new and bold, choose the novel option. It may just put a smile on your face, as well as light up your brain as it forms new connections. That is neuroplasticity — the brain’s ability to change and adapt — at work.

A Youthful Brain is a Well-Connected Brain

When it comes to the brain, size doesn’t matter. Connections do. The same might be said about one of life’s greatest rewards: our degree of connection to others. A more deeply connected life can translate into a more youthful brain — not to mention a more joyful life.
At our core we are social beings. Enriching your social connections produces powerfully protective benefits for your brain. Chief among them is a reduction in the fear and anxiety that can arise if you are not immersed in a supportive social network. Social connections protect the brain from the chronic stress of feeling alone and misunderstood. Seeking open-hearted connections activates empathy circuits that lie deep within your brain. Doing this regularly strengthens the channels among your brain’s centers of emotion, reasoning, and judgment. In short, deepening your connections to others makes you more flexible, compassionate, and emotionally balanced — a person with equanimity and substance.
Try these tips for connecting with others: Here is a simple first step: Instead of exchanging the perfunctory greetings — “How are you doing?” “Fine, and you?”— linger just a few moments. Prolong the encounter. Ask another question. Extend a more heartfelt wish. Make the interaction a tad more full of meaning.
When you consistently practice connecting, you will have taken a significant step toward awakening your heart to express your true and authentic potential. And that makes your brain sing at any age!
Henry Emmons, MD, is a psychiatrist who integrates mind-body and natural therapies, mindfulness, and compassion practices into his clinical work in Minneapolis with Partners in Resilience. He is also the author of the books, The Chemistry of Joy and The Chemistry of Calm, and is a popular workshop and retreat leader for healthcare professionals and the public.



David Alter, PhD, is a psychologist with 30 years of experience in health psychology, neuropsychology, and clinical hypnosis, which he integrates into his work. He is also a sought-after speaker, teacher, and trainer offering talks, workshops, and retreats to general and professional audiences. He is a co-founder of Partners in Healing, a center for holistic health in Minneapolis, and conducts his practice there.


PHOTO CREDITS: Getty Images, top image. Henry Emmons, MD, photo by Patsy Dew. David Alter, PhD, photo courtesy David Alter.

‘The Milk and Cookie Disease’ Epidemic: How Much Candy Is Your Child Drinking?

By Everyday Health Guest Columnist

Published May 2, 2014

By Julie L. Wei, MD, Special to Everyday Health
As an Ear Nose and Throat (ENT) surgeon who sees up to 30 kids per day, I’m all too familiar with the illnesses that affect our children. So much so, that I’ve come up with a new name for such childhood maladies — Milk and Cookie Disease (MCD).
MCD consists of ear, nose, and throat complaints that mimic actual infections and illness as a result of sugar and dairy consumption before bedtime.

A Sugary Scourge: Sinus Symptoms

When my family moved to Orlando last June after 10 wonderful years in Kansas City, I was unsure of the prevalence of Milk and Cookie Disease in Florida. In addition to enjoying a busy surgery practice, I had had the pleasure of helping Kansas and Missouri children and families end their chronic suffering from cough, runny nose, stuffy nose, recurrent croup, sinus infections, breathing difficulties, sore throats, and other problems. I was determined to continue my practice in Orlando and Central Florida.
Thousands of children have these sinus symptoms in the absence of fever or positive strep tests, and are still able to go to school even though they are “sick.”  I have met and treated countless children who, despite seeing many specialists and being treated with numerous nasal steroid sprays, allergy medications, inhalers, and other medications, are still somehow unable to completely get rid of their chronic symptoms — the essence of Milk and Cookie Disease.
So it is bittersweet for me to report that MCD is alive and well here in Florida. I am confident that it is prevalent across our nation and probably affecting almost every child. Why? Because so many of our children are not only addicted to sugar, but are also drinking their weight in sugar! Literally!

You Are What You Drink – and Eat – at Bedtime

For several years I have been telling families that drinking milk before bed is REALLY bad for a child or anyone after 12 months of age. Why? Imagine milk sitting at 96.8 degrees Fahrenheit for a few hours, mixed with some stomach acid.  It will probably curdle and form yogurt-like clumps, and it can reflux back up to the child’s throat.  Drinking milk with sugary snacks is a common evening and bedtime routine for American children.
I have spent years observing that when kids stop consuming sugar and dairy in the evenings and before bed, many are completely “cured” of their ENT symptoms. Even if they are not cured, at least it makes it clear to someone like me what their real medical problems may be.
My goal is to increase parents’ awareness that late-night dairy and sugar are also the probable culprits in their kids’ indigestion. Along with ENT and digestive problems, excessive sugar intake leads to obesity, followed by high blood pressure, and even diabetes.

Adding Up the Sugar Totals

I believe MCD is a crisis, a serious epidemic facing our children.  Once I started asking parents about their children’s diets the problem became clear. So many children are eating and drinking more sugar than most of us would deem healthy. I asked parents to fill out a questionnaire about it:
What does your child consume throughout the day on most days?  Check all that apply:

• Danimal or some type of yogurt drink
• Go-gurt
• Cheese “stick”
• Apple juice
• Lemonade
• Sweet tea
• Soda
• Orange juice and any other juice
• Gatorade
• Capri-Sun

Now repeat for what they get at daycare or in preschool…
Every day, in almost every clinic appointment, I check the above list and then I add up the items to get the approximate number of grams of added sugar a child is consuming in a given day.
Many of the children I meet eat and drink between 150 to 200 grams of added sugar a day, and that’s only counting juices and flavored milk! The human digestive system was never meant to process so much sugar, which means that your child’s stomach needs even more time to get this stuff out of the stomach into the intestines.  So while that fermenting sugar and processed liquid sits around in the stomach (and gets more rancid with each passing moment) it can come back up and cause symptoms that can mislead doctors into treating asthma, allergies, or whatever else we think may be wrong.

The Sugar-Water Diet

Every child in America is at risk because they’re unknowingly consuming a ridiculous and eventually life-threatening amount of sugar every day in “innocent” liquids that are pretty much just sugar water  –   juice boxes, pouches, lemonade, sodas, and fortified “water.”
Every day I meet parents who tell me that their 3, 5, 8, or 12 year old “won’t drink water” or will not eat “fruits and vegetables.”  This generation of parents has lost to the food industry and stopped being in charge of their child’s eating and drinking habits. Every day I tell families, “If your child won’t drink water now, he or she will probably not drink water over sugary drinks for the next 90 years…”
Moving and exercising is important, but let’s be clear. No child can move faster and exercise enough to burn all the calories consumed by guzzling these sugary drinks (see my chart below). Until the government and FDA step in and regulate conveniently packaged, highly processed drinks with falsely reassuring labels like “No Sugar Added,” and “100% juice,”  our only choice is to tell every parent to boycott and stop this epidemic, and teach our children to make better choices.

Make Better Choices

We are all too busy to think about how much added sugar our children are drinking every day, but this is what we MUST get busy thinking about.  Save a child. Model and encourage good eating and drinking behavior. Take your kids to the grocery store and look at the food labels together to choose items lower in sugar whenever possible. Cook at home. Eat well. And please, drink nature’s perfect drink: water.
I’m pleased to report that I’ve shared my career epiphany with countless families who are implementing these suggestions, and many have seen their children recover into the healthy bodies they were born with and minimize chronic medication use. Less time spent seeing doctors is more time for fun, learning, and living a fulfilled and great life.
Nutrition IS the only comprehensive solution, and when partnered with appropriately prescribed medications and surgeries, is what America needs – and we needed it yesterday. Help your children be healthy, today and every day, by reducing their liquid sugar intake, avoiding milk and cookies before bedtime, and working on living A Healthier Wei.

Type 2 Diabetes Complications You Can Avoid

• By Jennifer Anderson
• Reviewed by Farrokh Sohrabi, MD

• Cut Your Risks With Better Diabetes Management

  Without a solid management plan, type 2 diabetes can be like a house of cards, causing your overall health to come crashing down.
  Heart attack, kidney failure, vision issues, and nerve damage are among the problems that can result from poorly managed diabetes, says William Sullivan, MD, a senior physician at the Joslin Diabetes Center and an assistant professor of medicine at Harvard Medical School in Boston. But by working on diet and exercise and following your treatment plan, you can reduce your risk of diabetes complications, and live a healthy life.
  Here are potential type 2 diabetes health risks and serious complications you can help prevent:
  
  

  High Blood Pressure

  
  High blood sugar levels in the bloodstream can cause the blood to thicken, forcing the heart to work harder to pump blood, says Lori Zanini, RD, CDE, of Manhattan Beach, California, spokesperson for the Academy of Nutrition and Dietetics.
  In fact, high blood pressure is very common with diabetes, impacting about 70 percent of affected adults, according to the American Diabetes Association (ADA). It doesn't always have noticeable symptoms and you may not know you have it unless your doctor checks. Still, it can lead to serious complications including heart attack, stroke, eye problems, and kidney disease.
  “Achieving better glycemic control will be helpful in reducing the blood pressure of individuals with diabetes,” Zanini says. Other strategies for lowering blood pressure include eating a healthy diet, limiting sodium intake, utilizing successful stress management techniques, and participating in regular physical activity, if cleared by a physician.
  
  

  Heart Disease

   Someone with type 2 diabetes has the same level of heart attack risk as someone who's already had a heart attack, according to the National Heart, Lung, and Blood Institute. There are numerous reasons for the link between diabetes and heart disease, Dr. Sullivan says, including a "group attack" from diabetes and other heart disease risk factors like high blood pressure and high cholesterol, which already affect many people with type 2 diabetes.
  Taking control of your diabetes management, lowering your blood pressure and cholesterol levels, and not smoking can lower your risk of heart disease
  

  Stroke

   Most strokes happen when a blood clot blocks a blood vessel within or leading to the brain. Type 2 diabetes increases your risk of stroke by two to four times, according to the American Heart Association. Fortunately, the same steps that will help you prevent heart disease — controlling your blood sugar and blood pressure levels, maintaining a healthy weight, exercising regularly, and not smoking — are also the best ways to reduce your risk of stroke.
  
  
  

  Kidney Failure

  Diabetes is the primary cause in more than 40 percent of cases of kidney failure — the kidney's inability to filter waste and fluid from the blood, according to the ADA. As blood flows through tiny vessels in the kidneys, waste products are filtered out and leave the body through urine. Too much sugar in the blood can stress these filters, making it hard for the kidneys to work effectively. After a while, the filters can break down and leak protein into the urine. If kidney damage continues, you may need dialysis or a kidney transplant.
  The ADA recommends regular checks for protein in the urine, an early sign of loss of kidney function. Good diabetes control, including a low-sugar diet, weight control, exercise, and medications, can help prevent the loss of kidney function from type 2 diabetes.
  
  

  Eye Problems

  Several vision complications can result from type 2 diabetes, the most common of which is diabetic retinopathy. Over time high blood sugar levels can damage the blood vessels in the eyes, Sullivan says. If left untreated, diabetic retinopathy can cause severe vision loss and even blindness. Nearly half of everyone diagnosed with diabetes has some degree of diabetic retinopathy, according to the National Eye Institute. Diabetes also increases the risk of glaucoma and cataracts.
  Since diabetic retinopathy can go undetected until it reaches advanced stages, Sullivan recommends annual eye exams.
  
  

  Nerve Damage

  Chronically elevated blood sugar levels can lead to nerve damage (neuropathy). About half the people with diabetes have nerve damage, which feels like a tingling or burning sensation, usually in the feet, or even a loss of sensation, the ADA states.
  Keeping your blood sugar levels in check may help you prevent nerve damage or lessen the symptoms of it. Once you have nerve damage, regular visits with your doctor should supplement your own daily foot examinations and care routine so that any problems can be spotted early.
  
  

  Infection

  Once nerve damage sets in, your risk of infection increases because you may not be able to feel an injury, like a cut on your foot, to help it heal early on. In addition to examining your feet every day, check in with your doctor at the first sign of infection, such as redness or swelling. Protect your feet by keeping your skin moisturized with a coat of petroleum jelly or rich cream, but make sure to keep the areas between your toes dry because extra moisture there can increase the risk of infection, the ADA suggests.
  
  

  Digestion Problems

  Also called neuropathy of the stomach, gastroparesis is a type of nerve damage that results in food taking a long time to be emptied from the stomach and digested. This condition can be caused by high blood sugar levels over time. Symptoms include abdominal bloating and decreased appetite, which can make diabetes harder to control, Sullivan says.
  Eating small, frequent meals can reduce further complications. Medications such as metoclopramide can be helpful, Sullivan says. In severe cases, intravenous feeding may be needed.
  
  

  Weight Gain

  Many people who develop type 2 diabetes are overweight or obese, and weight loss is a big factor in controlling diabetes. Occasionally, medications essential to managing diabetes can exacerbate weight gain. These include insulin, sulfonylureas to encourage the pancreas to secrete more insulin, and glitazones to decrease insulin resistance.
  If you are obese, your doctor may suggest medications to suppress the appetite and promote weight loss, Sullivan says. Gastric bypass surgery may be another option if you have significant weight to lose. "Exercise works better in some people than others," he says, "and it's always encouraged as the first line of therapy."
  
  
  
  
  
  
• 

  High Blood Pressure

  High blood sugar levels in the bloodstream can cause the blood to thicken, forcing the heart to work harder to pump blood, says Lori Zanini, RD, CDE, of Manhattan Beach, California, spokesperson for the Academy of Nutrition and Dietetics.
  In fact, high blood pressure is very common with diabetes, impacting about 70 percent of affected adults, according to the American Diabetes Association (ADA). It doesn't always have noticeable symptoms and you may not know you have it unless your doctor checks. Still, it can lead to serious complications including heart attack, stroke, eye problems, and kidney disease.
  “Achieving better glycemic control will be helpful in reducing the blood pressure of individuals with diabetes,” Zanini says. Other strategies for lowering blood pressure include eating a healthy diet, limiting sodium intake, utilizing successful stress management techniques, and participating in regular physical activity, if cleared by a physician.
  
• 

  Heart Disease

  Someone with type 2 diabetes has the same level of heart attack risk as someone who's already had a heart attack, according to the National Heart, Lung, and Blood Institute. There are numerous reasons for the link between diabetes and heart disease, Dr. Sullivan says, including a "group attack" from diabetes and other heart disease risk factors like high blood pressure and high cholesterol, which already affect many people with type 2 diabetes.
  Taking control of your diabetes management, lowering your blood pressure and cholesterol levels, and not smoking can lower your risk of heart disease.
  
• 

  Stroke

  Most strokes happen when a blood clot blocks a blood vessel within or leading to the brain. Type 2 diabetes increases your risk of stroke by two to four times, according to the American Heart Association. Fortunately, the same steps that will help you prevent heart disease — controlling your blood sugar and blood pressure levels, maintaining a healthy weight, exercising regularly, and not smoking — are also the best ways to reduce your risk of stroke.
  
• 

  Kidney Failure

  Diabetes is the primary cause in more than 40 percent of cases of kidney failure — the kidney's inability to filter waste and fluid from the blood, according to the ADA. As blood flows through tiny vessels in the kidneys, waste products are filtered out and leave the body through urine. Too much sugar in the blood can stress these filters, making it hard for the kidneys to work effectively. After a while, the filters can break down and leak protein into the urine. If kidney damage continues, you may need dialysis or a kidney transplant.
  The ADA recommends regular checks for protein in the urine, an early sign of loss of kidney function. Good diabetes control, including a low-sugar diet, weight control, exercise, and medications, can help prevent the loss of kidney function from type 2 diabetes.
  
• 

  Eye Problems

  Several vision complications can result from type 2 diabetes, the most common of which is diabetic retinopathy. Over time high blood sugar levels can damage the blood vessels in the eyes, Sullivan says. If left untreated, diabetic retinopathy can cause severe vision loss and even blindness. Nearly half of everyone diagnosed with diabetes has some degree of diabetic retinopathy, according to the National Eye Institute. Diabetes also increases the risk of glaucoma and cataracts.
  Since diabetic retinopathy can go undetected until it reaches advanced stages, Sullivan recommends annual eye exams.
  
• 

  Nerve Damage

  Chronically elevated blood sugar levels can lead to nerve damage (neuropathy). About half the people with diabetes have nerve damage, which feels like a tingling or burning sensation, usually in the feet, or even a loss of sensation, the ADA states.
  Keeping your blood sugar levels in check may help you prevent nerve damage or lessen the symptoms of it. Once you have nerve damage, regular visits with your doctor should supplement your own daily foot examinations and care routine so that any problems can be spotted early.
  
• 

  Infection

  Once nerve damage sets in, your risk of infection increases because you may not be able to feel an injury, like a cut on your foot, to help it heal early on. In addition to examining your feet every day, check in with your doctor at the first sign of infection, such as redness or swelling. Protect your feet by keeping your skin moisturized with a coat of petroleum jelly or rich cream, but make sure to keep the areas between your toes dry because extra moisture there can increase the risk of infection, the ADA suggests.
  
• 

  Digestion Problems

  Also called neuropathy of the stomach, gastroparesis is a type of nerve damage that results in food taking a long time to be emptied from the stomach and digested. This condition can be caused by high blood sugar levels over time. Symptoms include abdominal bloating and decreased appetite, which can make diabetes harder to control, Sullivan says.
  Eating small, frequent meals can reduce further complications. Medications such as metoclopramide can be helpful, Sullivan says. In severe cases, intravenous feeding may be needed.
  
• 

  Weight Gain

  Many people who develop type 2 diabetes are overweight or obese, and weight loss is a big factor in controlling diabetes. Occasionally, medications essential to managing diabetes can exacerbate weight gain. These include insulin, sulfonylureas to encourage the pancreas to secrete more insulin, and glitazones to decrease insulin resistance.
  If you are obese, your doctor may suggest medications to suppress the appetite and promote weight loss, Sullivan says. Gastric bypass surgery may be another option if you have significant weight to lose. "Exercise works better in some people than others," he says, "and it's always encouraged as the first line of therapy."

Detoxing for Diabetes: My 10-Day Jumpstart to Better Health

By Tara Bellucci

Published Jul 10, 2014

If you had told me a year ago that I’d be gluten- and dairy-free, I would have laughed and then served up a huge lasagna. This Italian American practically has pasta running through her veins — which likely contributed to my current health dilemma.
After my type 2 diabetes diagnosis in January, I began to read everything I could get my hands on about reversing the disease through diet and exercise. I watched Forks Over Knives and omitted animal products, saw a nutritionist and counted carb grams, and through it all, I drank a lot of kale.
Then, I picked up Dr. Mark Hyman’s book Blood Sugar Solution. In it, he explains how common allergens like gluten, dairy, alcohol, and caffeine affect our bodies, even if we’re not technically allergic. Certain foods are more likely to cause inflammation, which is a stress response that the body produces when we are fighting off something. A little inflammation helps you heal and then goes away, a ton of it hurts you and becomes constant. Inflammation and insulin resistance go hand in hand, and one of the ways to combat diabetes is to remove the triggering foods.
Dr. Hyman’s research made sense to me, so I thought I’d give his diet a try. With little less than a month until my follow-up doctor’s appointment, I wanted to jumpstart my progress. I read his 10-Day Detox Diet, which cuts out not only the inflammation triggers of gluten, dairy, caffeine, and alcohol, but also all grains, most fruit, legumes, and starchy vegetables, to help maintain balanced blood sugar levels. I welcomed the return of humanely-produced lean protein and an almost laughable amount of healthy fats — nearly 20 g per meal — which was absolutely shocking to someone who grew up in the 1980s and 1990s, when fat was the enemy. Could this really produce results? I was about to find out.

Lowdown on Detox: Diabetes Buster or Buzzkill?

While it felt like an undertaking to commit to such a change, I figured that I could do practically anything for 10 days, so why not give it a shot? As I prepared to make everything that passed my lips for the next week and a half, I filled my shopping cart with raw nuts and coconut oil, hemp and flax and chia seeds, a lot of avocados, and a farmers market’s worth of leafy greens and cruciferous veggies. I was ready to detox.
Though it wasn’t all about the food. Stress causes inflammation, so a big part of healing yourself is to actively work on relaxation techniques. Detoxifying baths, journaling, breathing, media fasting, and exercise were all part of the plan, too. It’s also a lot easier to make better food choices after you’ve taken a few deep, calming breaths.
As with most detoxes, it gets worse before it gets better. I had intense gluten withdrawal, which caused headaches, irritability, and the craziest cravings I had ever experienced. I felt like I would die (or someone in my immediate vicinity might) if I didn’t immediately eat a pizza-pasta-bread sandwich. Thankfully, it passed in a couple of days, and the other side saw a lifting of “brain fog” that I didn’t even know I had. So much energy! Such clarity! It felt pretty great.
At the end of 10 days, I had lost 8 pounds, bringing my overall weight loss to 25 pounds. My lab results showed marked improvement, with improved cholesterol and a reduction in my A1c (average blood sugar over three months) from 9.8 to 6.5.
While I have dabbled in gluten and dairy since the detox, I’ve noticed that I have more energy and fewer cravings when I avoid them. Though it doesn’t hurt to hit the reset button every once in a while, diet remains a balance, and making good choices most of the time is the way to get and stay healthy.
Tara Bellucci is a lifestyle writer and marketing consultant focused on helping entrepreneurs boost their small businesses. Her work has appeared on Apartment Therapy, The Kitchn, and Boston.com. A co-founder of the Boston Food Swap, she hosts monthly events where people swap homemade and homegrown food. She writes openly about her health journey at MindMouthMantra.com.

Medical students’ motivations for studying medicine: changes and relationship with altruistic attitudes, expectations, and experiences of learning at university.

Type:	Thesis
Title:	Medical students’ motivations for studying medicine: changes and relationship with altruistic attitudes, expectations, and experiences of learning at university.
Author:	Xu, Maoyi
Issue Date:	2014
School/Discipline:	School of Population Health
Abstract:	Background: Altruism is regarded as a core attribute of medical practice and an important motivation for medical students to study medicine. Medical students’ motivations for studying medicine have also been found to have an impact on multiple aspects of their learning at medical school. These are important areas of investigation because medical students are expected to graduate with the professionalism which prepares them for providing care to patients, and a commitment to continuous learning of skills and knowledge. To date there has been little longitudinal research into changes in medical students’ motivations for studying medicine during medical school and factors that affect motivational changes. This study aims to explore medical students’ motivations for studying medicine before and during medical school, and its relationships with altruistic attitudes and expectations/experiences of learning at university. Method: The study was conducted within the University of Adelaide undergraduate entry medical program. The medical applicants completed the entry baseline questionnaire at the application stage for 2012 and then the entry follow-up questionnaire 12 months later in 2013 (as second year medical students). Meanwhile, the fourth year medical students completed the fourth-year baseline questionnaire in the middle of their fourth year in 2012 and then the fourth-year follow-up questionnaire 12 months later in 2013 (as fifth year medical students). Not everyone who completed the baseline questionnaires completed the follow-up questionnaires, and vice versa. The questionnaires included a socio-demographic section and Likert items concerning the reasons for studying medicine, altruistic attitudes, and expectations/experiences of learning at university. Results: Baseline responses from medical applicants and fourth year medical students showed that desire for helping others and the enjoyment of interacting with people were the most important reasons for studying medicine, followed by scientific curiosity. Four factors of reasons for studying medicine were identified through factor analysis: people-orientation, science-orientation, job status/security, and external pressure. Those medical applicants who rated people-orientation as more important tended to have significantly higher levels of altruistic attitudes, and to consider ready access to staff and interaction with other students to be significantly more important. The medical applicants who rated science-orientation as more important were in greater agreement about the likelihood of continuing study after graduation. Similar relationships were found among the fourth year medical students. Comparison between baseline and follow-up responses showed that the second year medical students considered people-orientation and science-orientation significantly less important than the medical applicants, while job status/security and external pressure were significantly more important as reasons for studying medicine than for the medical applicants. However, job status/security and external pressure made only a small contribution overall to student motivations for studying medicine. Importantly, medical students’ altruistic attitudes declined significantly after the first year. The first year university experiences also differed significantly from expectations at the application stage in various aspects, such as access to staff, interaction with other students, attending lectures, and activities outside university. These discordances were also detected in the paired baseline and follow-up responses. In contrast, few significant changes in reasons for studying medicine and altruistic attitudes, or differences in experiences of learning at university, were found after the fourth year at medical school. Discussion: This study finds that altruism is the most important reason for studying medicine and it persists in later years at medical school, despite its decline during the first year. The first year at medical school is a critical year of adjustment. The changes in altruistic attitudes and mismatches between expectations at the application stage and first year experiences may reflect the adaptation to university. This study suggests that medical schools should aim at maintaining and enhancing first year medical students’ motivations for studying medicine. Medical schools should also consider assisting students in their professional socialisation and their transition from secondary schools to medical schools.
Advisor:	Braunack-Mayer, Annette Joy Laurence, Caroline Olivia Mary Giles, Lynne Catherine O'Keefe, Maree Frances
Dissertation Note:	Thesis (Ph.D.) -- University of Adelaide, School of Population Health, 2014
Keywords:	medical students; motivation; altruistic attitudes; learning experiences
Provenance:	This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals
Appears in Collections:	Research Theses

Uncovering Hidden Sources of Carbohydrates

• By Diana Rodriguez
• Reviewed by Pat F. Bass, III, MD, MPH

Counting carbs can be essential to your type 2 diabetes management game plan, but you could be missing hidden grams in your favorite foods and beverages.

Managing your intake of carbohydrates plays an important role in controlling blood sugar when you have type 2 diabetes. Carbohydrates are an essential part of your diet, but you need to choose wisely and be aware of hidden carb sources, says Angela Ginn-Meadow, RD, LDN, CDE, a spokeswoman for the Academy of Nutrition and Dietetics.
Some foods — such as white rice, white pasta, mashed potatoes, and pastries — are obvious high-carb, low-nutrition sources that you most likely already know to limit in your diet because they can spike your blood sugar. However, there are many less obvious sources of carbohydrates, such as jarred spaghetti sauce, which can contain as many as 24 grams of carbohydrates per cup. That’s about half of the 45 to 60 grams of carbohydrates per meal suggested by the American Diabetes Association.
“Make pasta sauces at home and use a sugar substitute for sweetness,” Ginn-Meadow says. Start with a can of crushed tomatoes, add some spices along with the sugar substitute, and heat. This way, you cut back on the carbs without missing the flavor of jarred sauce.
Uncovering the Carbs
Here are six other hidden sources of carbohydrates and their lower-carb substitutions:

• Condiments. “Barbecue sauce, cheese sauce, cocktail sauce, and mole sauce range from 10 to 15 grams of carbs per serving,” Ginn-Meadow says. “The key is to keep the portion size small.” Use a pastry brush to spread on the condiment rather than pouring it straight from the bottle. You’ll still get plenty of flavor but with fewer carbs. Ginn-Meadow recommends tartar sauce instead of cocktail sauce for fish, but says to stick to a 2-tablespoon serving to avoid too many calories. And for fewer calories and carbs, top pasta with freshly shredded cheese instead of making a creamy cheese sauce.

• Smoothies. “Beverages always seem to surprise everyone,” Ginn-Meadow says, noting that a 12-ounce smoothie can pack 60 grams or more of carbs. Control your carbs by making your own using a cup of unsweetened almond milk, a cup of frozen strawberries, and about 3.5 ounces of plain Greek yogurt. You’ll have a filling, healthy breakfast for less than 20 grams of carbs.

• Flavored coffees. If a café mocha is your sweet treat, you’re packing in a lot of carbs for just a few sips. A typical 16-ounce mocha contains more than 40 grams of carbohydrates. A cappuccino, which has just 12 grams of carbs, is a better choice. Sprinkle on cinnamon for a flavor boost. And keep in mind that plain black coffee has no carbs.

• Yogurt. While yogurt is packed with protein and calcium, watch out for carbs, especially in flavored yogurts and varieties with lots of add-ins. A typical 6-ounce serving of a low-fat, fruit-flavored yogurt contains more than 20 grams of carbohydrate so it's important to read and compare nutrition labels. “Yogurt is a natural source of carbohydrate, which comes from milk,” Ginn-Meadows says. To cut carbs, choose Greek yogurt or select light flavored yogurt, she says. One container (170 grams) of plain, nonfat Greek yogurt has just over 6 grams of carbohydrates.

• Oatmeal. Oatmeal, which is a whole grain, makes a healthy breakfast when you make it fresh. But one of those convenient packets of instant flavored oatmeal can pack about 33 grams of carbohydrates, while one-third cup of uncooked old-fashioned oats has about 18 grams of carbs. Top with some fresh fruit for natural sweetness.

• Fat-free and sugar-free foods. “Fat-free products are often high in carbohydrates due to the removal of the fat and adding flavor with sugar,” Ginn-Meadow says. One-half cup of fat-free vanilla ice cream has nearly 21 grams of carbs, while the full-fat version has less than 16 grams. Fat-free sour cream has nearly 36 grams of carbs per cup; full-fat sour cream has less than 7 grams. Many sugar-free varieties of foods contain sugar alcohols, according to the Joslin Diabetes Center, which are heavy on carbs. Opt for a full-fat product and limit your portion size, Ginn-Meadow recommends. Compare the carbohydrates from the fat-free to sugar-free and original varieties and choose the one-serving product that will satisfy you, she adds.

Last Updated: 7/16/2015

Biggest Myths About Type 2 Diabetes Treatment

• By Natalia Macrynikola
• Reviewed by Clifton Jackness, MD

Are myths about diabetes keeping you from getting the most out of your treatment?

"At least it's not as bad as cancer."
You may have heard that statement after you've aired your complaints about the challenges of managing type 2 diabetes. While it's usually meant well, this type of response is misleading, since it promotes the unfounded idea — the myth — that diabetes isn't as serious as other chronic conditions. But type 2 diabetes raises your risk of dying prematurely by 50 percent, and according to the CDC it's a leading cause of death in the United States.
The good news is that diabetes "is absolutely manageable with proper diet, exercise, and medication," says Jenny Champion, a registered dietitian, diabetes educator, and personal trainer in New York City.
As you manage the various aspects of your medical care — the healthy lifestyle habits, the self-monitoring of blood glucose, and any medication regimen — don't be waylaid by these nine other diabetes myths, any or all of which might be keeping you from getting the most out of your treatment.
Myth: You can feel when blood sugar is high or low, so you don't have to check it often.
Waiting to feel physical effects of blood sugar (glucose) that is too high or too low is dangerous: According to the American Diabetes Association (ADA), this can lead to accidents, injuries, coma, and even death.
"Many good studies have been conducted on the ability of people to sense blood sugar levels, and most people are woefully inaccurate," says Amber Taylor, MD, an endocrinologist and the director of the Diabetes Center at Mercy Medical Center, in Baltimore. Says Champion, "By the time you end up feeling the telltale signs of low blood sugar, or hypoglycemia, your levels have already sunk too far."
Aside from determining whether your blood sugar levels are within a healthy range, regular glucose monitoring offers psychological benefits: A study that was presented at the American Association of Diabetes Educators Annual Meeting and Exhibition, in August 2015, showed that participants with diabetes who stuck to a regular self-monitoring schedule not only had better-controlled blood sugar levels but felt more in control of their condition than before the study.
As for how often you should check your blood sugar levels, Dr. Taylor recommends three to four times daily for those who take insulin, and once a day for those who use oral medication. However, there are exceptions to these general recommendations, so Taylor emphasizes that your specific schedule for testing and timing should come from your diabetes care team.
Myth: Needing insulin means you're failing to take care of your diabetes properly.
Insulin is a naturally occurring hormone produced by the pancreas that allows your body either to use sugar from food as energy or to store it for later use. When you have type 2 diabetes, your body isn't able to use insulin properly. And because diabetes is progressive, the body may eventually lose its ability to make enough insulin on its own. Insulin therapy is a viable treatment option in these cases —  whether the person is newly diagnosed with diabetes or has been managing for 15 years or more.
Says Champion, "If your doctor suggests you start using insulin, it doesn't mean you're failing. It just means your body needs a different treatment so that you can continue to stay healthy."
Myth: Managing diabetes is painful and complicated.
People with diabetes used to have to follow strict mealtime schedules and endure painful insulin injections, but that's not so anymore. "There have been huge advances in diabetes technology over the past 50 years," says Taylor. "Tiny needles, fast glucometers, and new medications have made the management of diabetes easier and more convenient."
A variety of insulin delivery methods are available nowadays, and needles are so small that injections don't hurt. Pain and complication should belong to the past, so talk to your doctor if you find that any part of your treatment plan is too challenging or uncomfortable.
Myth: Medication controls your blood sugar, so you can eat whatever you want.
Dietary recommendations for people who don't have diabetes apply just as strongly to those who do. "Just because you take medication doesn't mean you can eat an unhealthy diet," says Taylor. "We should all eat healthier foods, whether we have diabetes or not."
To minimize your risk of health problems and diabetes complications, plan balanced meals ahead and include protein, fat, and carbs, and keep processed foods to a minimum.
"Remember that what you eat influences the efficacy of your medication and how much of the medication you need," says Champion, "so it's important to continue eating healthfully, even after starting a medication regimen."
Myth: You can't lead an active life when you have diabetes.
"Being active is actually a fantastic way to manage blood sugar and help prevent complications in the future," says Champion. The ADA recommends 30 minutes of moderate to vigorous aerobic exercise at least five days a week. If you can't set aside 30 minutes every day, you can break up your activity into several 10-minute workouts. According to the ADA, effective workouts include brisk walking, stair-climbing, swimming, and dancing.
You can also try soccer. In a study published in December 2013 in the journal Medicine & Science in Sports & Exercise, the heart muscle tissue of the participants, who all had been diagnosed with type 2 diabetes, was found to work up to 29 percent faster after six months of regular soccer training, and their exercise capacity had increased by 42 percent.
Keep in mind that exercise can lower blood sugar, so you might need to eat a snack before you work out, especially if you're taking medication that lowers your blood sugar. Talk to your doctor before starting any new exercise regimen, and ask about smart steps you can take to help prevent low blood sugar.
Myth: Using insulin causes complications like amputations and even death.
Quite the opposite, says Champion. Insulin can be a lifesaver. It allows cells to absorb and use glucose that can build up in the body — in effect, lowering blood sugar and preventing long-term organ damage and other complications of diabetes.
"Insulin may get a bad name because some people wait much too long to start it," says Taylor, "and once damage has been done from years of high blood sugar, people incorrectly attribute it to the insulin. For example, a patient who comes to the hospital with very high blood sugar and gangrene may start insulin at the hospital but ultimately lose the affected limb — the patient might think the amputation was related to the insulin, but in reality, insulin might have prevented the complication if the treatment had been started earlier."
Myth: If my relative is on a certain medication, I should be on it, too.
"Diabetes is not treated with a one-size-fits-all approach," says Taylor. The specific recommendations for which medication you should take are based on various factors, she explains, including how long you've had diabetes and what other medications you're taking, as well as other risk factors and health conditions — all of which may be very different from your relative's.
In addition, says Champion, "people respond differently to different medications, so what works for your relative may not be right for you. Each person with type 2 diabetes is different, so naturally, treatment is individualized."
Myth: You have to lose a lot of weight for your diabetes to improve.
Being overweight or obese does increase your risk of diabetes complications. The good news, says Champion, is that even a small amount of weight loss can significantly improve your diabetes. Says Taylor, "Usually, 5 to 10 percent of your body weight is sufficient, and many people notice better blood sugar levels immediately after they change their diet."
The ADA recommends that you lose weight gradually, by setting a few realistic goals and working toward them steadily. A good place to start is to incorporate one healthful change into your diet and make one tweak to increase your physical activity.
Myth: No matter what I do, I'll eventually end up with disabling complications.
This is perhaps the biggest myth of all — that if you have diabetes, it's guaranteed that you'll develop serious health issues, such as vision loss, nerve damage, or kidney failure. Fortunately, that's not the case. "We work really hard to avoid reaching that stage," says Taylor. "People can have insulin-requiring diabetes for many years and never develop complications."
Taking steps to keep your blood sugar under control, continuing to learn as much as you can about diabetes, and communicating regularly with your health care team — these are the best ways to protect your health. If you're doing all that but you still feel that there's no hope, talk to your doctor, says Taylor. "You may be suffering from diabetes burnout," she says. Fortunately, your care team will be able to come up with a plan to help you manage that, too.

Last Updated: 8/28/2015

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