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Lifestyle Changes, Dry January, and Vitamin D Fortification · Morning Medical with Dr. Chow

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  Welcome back to Morning Medical with Dr.
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  Chow, where we bring you the latest updates in medical and health news from around the globe.
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  I'm your host, Dr.
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  Chi-Ming Chow, and today we're diving into some fascinating findings on how small changes in
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  our lifestyle could potentially extend our lives.
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  A recent study highlighted by CNN suggests that combining small changes in diet, exercise, and
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  sleep may extend life by a year when implemented together.
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  More interestingly, larger changes could potentially add over nine years to one's
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  lifespan.
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  The study emphasizes that these lifestyle behaviors should be considered as a package
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  rather than individually.
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  The lead author of the study, Nick Koemel, a research fellow at the University of Sydney,
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  points out that by targeting small improvements across multiple behaviors simultaneously, the
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  change required for any single behavior is significantly reduced.
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  This approach may help overcome common obstacles to maintaining long-term behavior
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  changes.
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  However, it's important to note that the findings are not conclusive.
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  Kevin McConway, a professor emeritus of applied statistics in the United Kingdom, who wasn't
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  involved in the study, mentioned that the paper uses complex statistical methods which aren't
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  always clearly described.
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  This makes it hard to determine if the findings are due to the statistical analyses chosen by
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  the researchers or the data itself.
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  Using scientific modeling, Koemel and his team found that even minor changes—such as adding
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  five minutes of sleep, two minutes of moderate to vigorous physical activity, and an extra
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  half cup of vegetables daily—might lengthen life by a year.
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  However, this outcome was specifically for individuals with extremely poor lifestyle
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  habits.
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  The study also projects that the greatest gains in longevity and health span—more than nine
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  years—could be achieved by incorporating 42 to 103 minutes of exercise, sleeping seven to
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  eight hours each night, and maintaining a diet rich in fish, whole grains, vegetables, and
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  fruits.
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  Dr.
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  Andrew Freeman, a preventive cardiologist who wasn't involved in the study, emphasized that
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  exercise remains a crucial element.
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  "Exercise is the elixir of youth," he said, advising individuals to aim for 20 to 30
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  minutes of brisk, breathless physical activity daily, combining both strength and cardio
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  exercises.
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  The study, published in the journal eClinicalMedicine, analyzed data from nearly
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  60,000 participants from the United Kingdom Biobank.
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  These individuals were followed for an average of eight years, providing insights into their
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  diet, exercise, and sleep habits.
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  This data was used to create theoretical scenarios predicting improvements in longevity
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  and health span.
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  It's crucial to remember that enjoying a longer life and a longer health span are not the same.
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  Koemel noted that combined improvements in sleep, physical activity, and diet were
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  associated with longer lifespans, even if individuals developed some chronic conditions
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  later in life.
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  The key takeaway from this research is that it's not about the specific minutes you
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  exercise or the exact number of vegetables you eat.
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  It's about ensuring that all aspects of your lifestyle align with health.
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  This is an excellent time of year to reflect on your habits and make significant changes that
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  can enhance your well-being and potentially extend your lifespan.
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  Social media has been buzzing about "Dry January," a month where people voluntarily
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  abstain from alcohol as a form of reset or personal challenge.
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  Friends often applaud the discipline, and employers promote it as a wellness initiative.
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  The underlying message is clear: choosing not to drink, even temporarily, is considered
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  admirable.
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  Recent data from CivicScience reveals that 56 percent of adults of legal drinking age in the
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  United States planned to abstain from alcohol this month.
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  This movement, officially developed by Alcohol Change United Kingdom, has been gaining
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  traction since 2013, with over 200,000 people signing up to participate last year.
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  However, the enthusiasm for Dry January highlights a deeper contradiction.
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  While abstinence is praised when it is a choice, individuals who need to change their
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  relationship with alcohol for health or recovery reasons often face suspicion or shame.
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  Alcohol remains a normalized part of American culture, with 85 percent of adults in the
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  United States having consumed alcohol at some point, and 10 percent meeting criteria for
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  alcohol use disorder annually.
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  The distinction between voluntary abstinence and necessary abstinence is significant.
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  When alcohol is both common and stigmatized, assumptions can easily be made, often
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  incorrectly.
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  This stigma does more than harm those with addictions; it influences medical care,
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  distorts clinical judgment, and can ultimately shorten lives, affecting both drinkers and
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  non-drinkers alike.
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  A poignant example of this is a story shared by a substance use researcher, Rachel Hoopsick.
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  Her father, diagnosed with stage IV metastatic pancreatic cancer, had long been assumed to
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  have alcohol-related pancreatitis due to recurrent symptoms.
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  Despite his repeated assertions that he did not consume alcohol, these assumptions persisted,
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  delaying the correct diagnosis of a genetic mutation linked to his cancer until it was too
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  late.
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  He passed away just 17 days after his diagnosis, leaving a lasting impact on his
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  family.
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  This case illustrates how stigma, when discussed abstractly, can seem negligible, but
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  its real-world effects are profound.
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  Stigma accumulates in medical records, clinical shorthand, and assumptions that limit
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  attention, leading to missed diagnoses and lost years of life.
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  Research consistently shows that individuals who anticipate stigma around their substance
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  use are less likely to seek medical care or disclose important information, leading to
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  delays in treatment even when symptoms are severe.
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  The concept of Dry January sits within this complex tension.
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  For one month, abstaining from alcohol is framed as a form of self-optimization.
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  Indeed, research from Brown University indicates that even a short break from alcohol
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  can improve sleep, mood, and physical health.
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  Yet, outside designated months like Dry January or Sober October, choosing not to drink often
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  invites pressure or scrutiny.
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  This double standard has tangible consequences, as patients learn to censor themselves in
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  medical settings.
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  Reducing stigma does not mean promoting abstinence as the sole solution.
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  Evidence-based harm-reduction approaches recognize that individuals modify their
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  drinking habits in various ways, and effective care aligns with personal goals rather than
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  moral judgments.
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  When stigma takes the place of listening, the cost is more than discomfort or judgment—it is
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  time, and sometimes, it is the precious time of life.
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  Let's turn our attention to an insightful study published in JAMA Network Open.
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  This research highlights the clustering of diabetes risk factors within families, offering
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  a unique perspective on diabetes prevention strategies.
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  The study was led by Tainayah Thomas from Stanford University School of Medicine, and it
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  underscores the potential of using electronic health records to identify households at risk
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  and implement family-centered diabetes prevention initiatives.
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  The study examined a cohort of adults with prediabetes and found that nearly 76 percent of
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  these households had additional members showing diabetes risk factors.
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  These factors included conditions such as overweight or obesity, gestational diabetes,
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  hypertension, dyslipidemia, cardiovascular disease, prediabetes, and evidence of diabetes.
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  Overweight or obesity was the most common risk factor, present in 54.9 percent of adults and
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  34.8 percent of children within these households.
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  Interestingly, the study found that 32.5 percent of adults living with someone with
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  prediabetes had abnormal blood glucose levels, while 20.3 percent had prediabetes, and 12.2
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  percent had evidence of diabetes.
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  Additionally, 19 percent had hypertension, and 16.1 percent had dyslipidemia.
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  These findings suggest a significant opportunity for family-based prevention
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  programs, leveraging electronic health records to facilitate coordinated care within
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  households.
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  The researchers suggest that diabetes is a transgenerational disease, impacting children,
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  parents, and grandparents, often within the same health system.
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  By utilizing electronic health records, health systems could screen family members for risk
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  factors and support care coordination, potentially reducing health system costs.
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  However, the study notes that few prevention programs currently enroll households at risk,
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  marking a missed opportunity for broader diabetes prevention efforts.
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  In an accompanying commentary, Rohit Vashisht from the University of California, San
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  Francisco, pointed out that diabetes prevention strategies often focus on individuals rather
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  than families.
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  He emphasized the value of a household-based approach, which recognizes the interconnected
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  health risks within family units.
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  Such an approach could transform routine care by implementing family-centered interventions
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  rather than addressing each family member separately.
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  Despite the clear benefits, family-based prevention programs remain relatively rare.
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  Barriers include logistical challenges, inconsistent family support, program costs, and
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  social determinants of health, such as food access.
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  Vashisht highlighted the need for thoughtful implementation across data infrastructure,
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  clinical workflows, and financing to make family-centered diabetes prevention a standard
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  of care.
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  The study utilized electronic health record data to identify a cohort of over 356,000
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  adults with prediabetes, defined by fasting plasma glucose levels and body mass index
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  criteria, from 2022 to 2023.
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  These adults were predominantly women, with a diverse racial and ethnic composition,
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  including White, Asian American, Hispanic or Latino, and Black or African American
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  participants.
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  The study also identified over 364,000 household members sharing insurance coverage,
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  providing a comprehensive view of diabetes risk factors within families.
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  While the study offers valuable insights, the researchers acknowledge limitations, such as
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  the potential underestimation of household size due to only identifying co-insured members.
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  Despite these limitations, the findings underscore the importance of family-centered
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  approaches in diabetes prevention and the role of electronic health records in facilitating
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  such efforts.
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  The U.S.
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  Food and Drug Administration has recently directed Novo Nordisk and Eli Lilly to remove
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  warnings about potential suicidal thoughts and behaviors from their popular weight-loss
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  medications.
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  This decision follows a comprehensive review that found no increased risk of suicide among
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  users of these glucagon-like peptide-1 receptor agonists, or GLP-1 drugs, which are used for
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  obesity management.
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  The medications in question, including Novo Nordisk’s Wegovy and Saxenda as well as Eli
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  Lilly’s Zepbound, had previously carried these warnings based on a preliminary review
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  conducted in January 2024.
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  At that time, the FDA acknowledged that while no direct link was found, a small risk could
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  not be entirely ruled out.
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  However, the new analysis has alleviated those concerns, leading to the removal of these
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  warnings.
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  The FDA emphasized that labeling for other GLP-1 receptor agonists approved to treat
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  diabetes did not include similar warnings, and this recent action ensures consistent messaging
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  across all FDA-approved GLP-1 medications.
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  This decision is significant for both patients and healthcare providers, as it may influence
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  the perception and acceptance of these medications in managing obesity.
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  By removing these warnings, the FDA aims to provide clearer and more consistent information
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  about the safety of these drugs.
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  Recent research has been delving into the concerning relationship between nighttime
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  screen use and suicide risk among children.
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  This topic gained significant attention following a tragic incident involving a
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  10-year-old girl from Virginia who died by suicide, prompting her mother to advocate for
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  increased awareness about children's use of cell phones at night.
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  The study was presented at the American Academy of Child and Adolescent Psychiatry meeting in
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  October, drawing considerable media interest.
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  Leading the research is Doctor Abhishek Reddy, an associate professor at Virginia Tech
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  Carilion School of Medicine and a child and adolescent psychiatrist at Carilion Clinic in
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  Roanoke, Virginia.
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  Doctor Reddy noted an increase in overdose attempts among children, which spurred him and
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  his team to investigate further.
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  The researchers reviewed six months of data on overdose suicide attempts among 51 children
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  aged 12 to 17.
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  They found that 64.7 percent of these overdoses occurred during nighttime hours, and 74.5
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  percent of the children had engaged in screen use immediately prior to the overdose.
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  Notably, 26 of these overdoses involved prescription medications.
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  Doctor Reddy explained that, while they anticipated more overdoses in the evening, the
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  findings were striking: two-thirds of the overdoses happened between 8 p.m.
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  and 6 a.m., with three-fourths of the children using screens right before the overdose.
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  He emphasized that while this is a strong coincidence, it does not establish causation,
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  yet it highlights a significant time relationship.
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  He pointed out that poor sleep exacerbates mental health issues such as depression,
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  suicidality, anxiety, and attention deficit-hyperactivity disorder.
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  This is compounded by the combination of poor sleep, screen exposure, and access to
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  over-the-counter or prescription pills, which were involved in many of these overdoses.
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  The link between sleep and suicide risk has been explored in both adults and children.
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  Doctor Joel Stoddard, a child and adolescent psychiatrist at Children's Hospital Colorado,
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  noted a well-established relationship between nighttime and suicide attempts among youth, as
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  well as across different age groups.
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  He and his colleagues have been translating the known association between sleep and suicidal
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  thoughts and behaviors in adults to children.
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  Doctor Stoddard remarked that while Doctor Reddy's research initiates an important
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  discussion, it does not introduce new insights.
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  Key questions remain, such as whether adolescents are simply on their screens at
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  night due to not sleeping, if screens distract them from emotional distress, or if they use
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  devices to seek help or engage in preparatory behavior.
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  Additionally, whether they were communicating with others or receiving distressing news
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  remains to be understood.
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  Ultimately, Doctor Stoddard emphasized the need to understand the relationship between sleep,
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  suicidal thoughts and behavior, the timing of suicidal behavior, and screen use.
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  Doctor Reddy underscored the importance of establishing a good sleep routine for
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  teenagers, ensuring they get eight to nine hours of sleep, avoiding screens at bedtime,
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  and limiting access to both over-the-counter and prescription pills.
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  Reddy highlighted the importance of addressing these issues, particularly for children
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  experiencing mental health crises, bullying, or stressful events.
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  He also noted that both children and adults tend to ruminate more on nighttime triggers.
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  Numerous studies indicate that poor sleep can negatively impact mental health, while screen
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  use at night can disturb sleep and consequently mental health.
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  Doctor Reddy concluded by emphasizing the importance of providing parents with strong,
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  actionable advice or take-home messages from this study.
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  These insights are crucial for helping parents manage their children's screen use and sleep
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  habits, especially during challenging times.
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  Our final topic today focuses on a crucial nutrient that many Canadians might be
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  lacking—vitamin D.
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  Health Canada is taking steps to address this deficiency by requiring milk and margarine
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  producers to enhance their products with additional vitamin D.
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  This regulation, which came into effect at the end of 2025, mandates that cow's milk, goat's
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  milk, and margarine contain more than double the previous amounts of this essential
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  nutrient.
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  Vitamin D, often called the "sunshine" vitamin, is vital for our health.
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  It helps the body absorb calcium, strengthening our bones and teeth.
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  However, due to Canada's high latitude, many Canadians do not get enough sunlight for a
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  significant part of the year, which affects the natural production of vitamin D in our bodies.
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  According to Health Canada, one in five Canadians are not getting enough vitamin D,
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  which is concerning given its role in preventing conditions like multiple sclerosis.
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  Brenda Hartman, a nutritional sciences professor at Western University, notes that
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  Canadians don't produce vitamin D from the sun for about six to eight months of the year.
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  This lack of sunlight, especially during the winter months when the sun's angle is low,
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  increases the risk of vitamin D deficiency.
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  Health Canada's new regulation aims to ensure that more Canadians meet their recommended
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  daily dose of vitamin D through fortified foods like milk and margarine.
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  Under this regulation, the amount of vitamin D in cow's milk has increased from approximately
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  2.3 micrograms to five micrograms per cup.
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  Margarine now contains about 13 micrograms of vitamin D per 50 grams, or roughly three
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  tablespoons.
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  This approach aims to make vitamin D more accessible to the entire population, according
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  to Mary L’Abbé, director of the World Health Organization's Collaborating Centre on
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  Nutrition Policy.
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  In addition to fortified foods, other sources of vitamin D include egg yolks, fatty fish, and
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  supplements like pills or drops.
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  Health Canada suggests that older adults, who require about 20 micrograms of vitamin D per
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  day, may benefit from supplements to meet their needs.
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  A typical vitamin D supplement can provide 25 micrograms, or 1,000 international units, of
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  the vitamin.
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  While it is possible to consume too much vitamin D, it's rare and usually occurs over a
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  long period.
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  Health Canada advises that adults should not exceed 100 micrograms per day, equivalent to
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  4,000 international units, to avoid adverse health effects such as calcium buildup, which
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  can weaken bones and damage kidneys or the heart.
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  The new fortification strategy by Health Canada not only addresses the current deficiency but
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  also ensures that as more people switch to non-dairy beverages, they still receive
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  adequate vitamin D.
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  Plant-based drinks are allowed to include vitamin D, although it's not mandatory.
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  This regulation is part of a broader food fortification strategy to improve public
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  health.
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  As we wrap up today’s episode, remember that small changes in our diet, exercise, and sleep
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  can have lasting impacts on our health.
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  Whether it’s incorporating more vitamin D into your routine or taking part in initiatives like
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  Dry January, every little bit helps in building a healthier lifestyle.
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  Thank you for joining me, Dr.
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  Chi-Ming Chow, on Morning Medical.
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  Until next time, stay healthy and informed.