Anil Maheshwari, MD

11/09/2023

Are you worried that you're not getting enough sleep?

You may have heard a lot of advice about how important is for our . Experts have repeatedly stated that we need to sleep 7-9 hours a night. Getting adequate sleep has been linked to improved , brain performance, , and . Not getting enough sleep is thought to contribute to and even .

Unfortunately, many of my patients are not able to get this many hours of sleep a night. And quite frankly, neither am I. This can lead to feelings of guilt about doing ourselves harm, even if we don’t feel tired or sleepy during the day and engage in other behaviors such as avoiding , regularly, , keeping our down, and managing to the best of our ability.

There is some good news. A new study published in the journal “Sleep” found that sleep regularity was a stronger predictor of lifespan than the quantity of sleep. Impressively, data was used from accelerometers being worn by 60, 977 participants with an average age of 62.8 years in the UK Biobank databank.

Going to bed and waking up at the same time regularly was found to decrease the risk of death by 20-48% overall. More specifically, a 16-39% lower risk of death from cancer and a 22-57% lower risk of death from a cardiac cause was found, depending on the level of regularity.

These are fairly impressive numbers, especially given the number of participants and how the data was collected - not from people’s recall (which can be erroneous) but by devices tracking their movement, which is much more precise.

So if you are worried that you aren’t able to get enough sleep, make sure that you at least keep the same schedule. However, you should see your doctor if you are getting less than 4 or more than 12 hours of sleep a night, notice gaps in your breathing at night, or are regularly feeling tired or sleepy during the day.

See the entire study here:
https://pubmed.ncbi.nlm.nih.gov/37738616/

11/09/2023

Today, the FDA approved Zepbound (tirzepatide) for chronic weight management in people with a BMI of 30 or greater or a BMI of 27 or greater with at least one related medical condition such as high blood pressure, diabetes, high cholesterol, fatty liver or sleep apnea.

Tirzepatide had already been approved as Mounjaro for diabetes type 2 management in both the US and Canada. Now we await Health Canada's decision regarding Zepbound for chronic weight management.

By the way, who comes up with names like Zepbound?!?

The FDA approved Zepbound (tirzepatide) for chronic weight management in adults with obesity or are overweight.

11/06/2023

I was on the Peak Human with Sanjeev Goel MD. We talked about what we can learn from the in order to increase both our and .

Things like:
What kind of should we be eating?
What kind of and should we be getting?
How much should we be drinking for ?
What kind of role do , and other social bonds play in our ?

And - at the risk of sounding like an infomercial - much, much more...

I have to say it was a lot of fun and I'm looking forward to doing more video/audio content!

Join Dr. Sanjeev Goel and Dr. Anil Maheshwari in this discussion as they explore the fascinating concept of Blue Zones and the secrets to longevity shared by...

09/21/2023

If you’re interested in having both a better (the period of life spent in good ) and a better (how long you live), you are going to want to learn about the Blue Zones.

These are areas in the world where people are healthier and live longer than in other parts of the world. Places like Okinawa (Japan), Sardinia (Italy), Ikaria (Greece), Nicoya (Costa Rica), and Loma Linda (California).

One of the best introductions to the is the Netflix series, "Live to 100: Secrets of the Blue Zones." Check it out! If you've already started watching it, what do you think?

08/17/2023

It’s great to be teaching 1st year medical students again this fall at the McMaster Medicine Waterloo Regional Campus.

McMaster University Medical School

07/25/2023

Check out my latest blog entry: Why is it so hard to remember to take a pill (and what you can do about it)?

When you see a health care provider, a vitamin or medicine is sometimes recommended or prescribed. Even if you buy the pill and you want to follow the medical advice, you may find it hard to remember to take it everyday. For example during annual physicals, I often advise daily vitamin D supplemen

07/05/2023

There are certainly a lot of positive studies coming out about weight loss medications in development. For example in a phase II trial, retatrutide, a triple combination therapy lead to an AVERAGE of almost 25% weight loss in people who were able to tolerate the side effects at the highest dosage. This is fantastic news - we are at the level of weight loss seen with some types of bariatric surgery!

As excited as I am about these medications leveling the playing field for patients who struggle with their genetics and environment and giving them a chance to lose weight and keep it off, I am very concerned about muscle loss.

Based upon the DEXA scan results of patients in the Weight and Lifestyle Management Program at Cleveland Clinic Canada, we have found that people can lose anywhere from 0% to >40% of their weight from muscle mass. That’s a lot of variability!

Our preliminary data points towards several factors protecting against muscle loss:

1) Following up with a certified bariatric educator regularly.
2) Obtaining adequate protein intake.
3) Increasing activity and exercise levels.

Those that are able to implement these three steps are able to maintain more muscle mass than those who are not, regardless of whether or not they use a weight loss medication.

In our program, those taking anti-obesity agents such as liraglutide, semaglutide and bupropion/naltrexone do lose greater amounts of weight on average than those not taking medications. As more agents become available in the near future, we will need to continue to make sure we best guide patients on how to retain as much muscle mass as possible.

Learn more about retatrutide here:
https://www.nejm.org/doi/full/10.1056/NEJMoa2301972

Original Article from The New England Journal of Medicine — Triple–Hormone-Receptor Agonist Retatrutide for Obesity — A Phase 2 Trial

07/04/2023

Happy 🇺🇸 Fourth of July 🇺🇸 to all my American friends and colleagues!

06/23/2023

Do medications lead to more loss than other types of treatment?

You may have seen some of the press surrounding and ( ) causing a higher-than-expected amount of muscle loss when used for weight loss. In the STEP 1 semaglutide study, those research subjects selected to have DEXA scans (one of the best ways to determine body composition) lost an average of 38.6% of their weight from muscle mass.

This seems concerning since muscle loss lowers your metabolic rate more than fat loss. However, it is important to put this into context:

1) ANY weight loss, wether from surgery, through medications, a diet plan or lifestyle changes can lead to muscle loss. For example, in the look AHEAD study 1,019 people underwent intensive lifestyle changes alone that lead to about 33% of weight loss coming from muscle loss on DEXA scans.

2) And when you take a closer look at the data in the semaglutide study, it is interesting to note that those patients on a placebo actually lost 57% of their weight from muscle loss - which is more than those on the medication.

3) The number of participants tested with a DEXA was only 140 out of the total of 1,961 patients enrolled in the study and the small sample size likely affected the results in both groups.

4) In the SURMOUNT-1 study done with another diabetes/weight loss drug called ( ), 24.3% of weight loss came from muscle mass loss in the medication group versus 24.1% in the placebo group. This study also did DEXA scans on a limited number of patients - 160 out of the 2,539 study participants. This medication works in a similar way as semaglutide so it is unusual to see such a different result.

Bottom line: Muscle loss is common with any weight loss method and not likely to be increased when weight loss medications are used. If all 3,500+ patients in both studies were tested, we would have more accurate results - for both medication groups and both placebo groups.

06/14/2023

Are you worried about getting because of your family history?

Good news - a recent study in the British Journal of Sports Medicine found that can greatly reduce your risk. The study looked at how physical activity and genetic risk factors affect the risk of developing diabetes. Researchers studied over 59,000 participants and found that engaging in moderate-to-vigorous-intensity physical activity (MVPA) lowered the risk of developing diabetes.

Even after considering genetic risk factors, participants who engaged in more MVPA had a significantly lower risk of diabetes compared to those who were less active. And this risk was dose dependent.

Compared to those who did not engage in MVPA, people who engaged in approximately:
5-30 minutes a day had only a 63% chance of getting diabetes
30-60 minutes a day had a 41% chance of developing diabetes
> 60 minutes a day had only a 26% chance of developing diabetes

Even people with a higher genetic risk for diabetes benefited from being physically active. In fact, the greater a patient's risk, the more that MVPA seemed to reduce it.

Bottom Line:
If you want to lower your risk of diabetes without medications, aim for moderate-to-vigorous-intensity activities like brisk walking, jogging, or dancing. The more active you are, the better your chances of preventing diabetes, even if you have a family history or genetic risk for the .

Full study here:
https://bjsm.bmj.com/content/early/2023/06/05/bjsports-2022-106653

Objective Although 30 min/day of moderate-intensity physical activity is suggested for preventing type 2 diabetes (T2D), the current recommendations exclusively rely on self-reports and rarely consider the genetic risk. We examined the prospective dose-response relationships between total/intensity-...

06/10/2023

The Washington Post recently had a good article about how many we actually need and the history of how 10,000 steps was chosen as a target. Here are my seven tips about using , Fitbits or smart watches that count your steps.

1. While step counting by these gadgets isn't 100% accurate, it is accurate enough (if you keep the device on you, including in your purse or pocket if you are using a phone to track steps). So use your device to get an objective measure of how active you are being and whether you are doing better, worse or the same as yesterday. It can be great way to figure out if you need to take different actions.

2. Pair these devices with brisk (zone 2 cardio) walks. This means walk a bit faster than normal where you are able to speak but not hold long conversations. This is where you will get the most benefit for your general health. You will both be more likely to increase your step count while also doing the type of activity that is good for your heart.

3. Don't try to increase your steps too quickly or you can end up in pain or even injured. If you are looking to walk more, do it slowly - increase by 500-1,000 steps per week until you get to your goal. You will find it easier to reach each new level, feel good and want to do more the next week. Not to mention your body will thank you for not going overboard.

4. 10,000 steps will not help you to lose weight but activity and exercise are a great way to get healthy. I still recommend being as active as possible but if you are expecting to move the needle on the scale, focus on the calorie intake side.

5. Increased activity as measured by steps will help you to lower your blood glucose, especially if you have high blood glucose levels (pre-diabetes or diabetes). Activity after eating is especially useful. If you go for even a 10 minute after each meal, you will see your blood sugars drop significantly. Try using a continuous glucose monitor such as FreeStyle Libre or Dexcom to find out how activity affects your blood sugar.

6. Focus on finding an activity that you enjoy, because that is more likely to continue long term. Try with a friend or loved one or join a walking club. Walk during the cooler part of the day in the summers. Avoid icy sidewalks in the winter. Walk in nature to boost your mood. Listen to your favorite music, podcast or audiobook. Cactch up with a friend on the phone.

7. Step counting isn't for everyone. If it makes you anxious or you start revolving your life around the number of steps you are getting, it might not be for you. There are plenty of other ways to measure healthy behavior. Try a habit tracker app to build new healthy habits. Join a gym or sign up (and go) to your favorite exercise classes.

Bottom line? Experiment and use what works for you.

https://www.washingtonpost.com/wellness/2023/06/07/counting-10000-steps-new-goals/

Think you need 10,000 steps? Scientists have come up with evidence-based recommendations about step-count goals that might be lower than you would expect.

05/29/2023

Today’s post is bittersweet. After 14 years as a family doctor at Grandview Medical Centre I am choosing to focus on my true passion: Preventative medicine including weight loss. To those of you who know me well, this isn't a huge surprise. My Facebook, Twitter and LinkedIn posts tend to focus on these issues.

One of my concerns about leaving Grandview was making sure that I had someone to take care of the people I had gotten to know over the past 14 years. I’m happy to say that Dr. Vinny Khullar is taking over my practice. Some of you may have already met her while she has been a locum for me. You should have received a letter describing the transition process.

I already miss so many of my patients - I was honoured to get to know so many of you so well. And it has been incredible working with so many wonderful people in Cambridge - at Grandview, Cambridge Memorial Hospital and with the Cambridge Ontario Health Team. It’s been truly amazing to be a part of such a great community for so many years.