A drug for sleep apnea; spiritual care; Gen Z’s health concerns: Upstate Medical University’s HealthLink on Air for Sunday, Dec. 15, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a sleep specialist tells about a medication that treats obstructive sleep apnea.

Antonio Culebras, MD: ... One half of patients, 50% of patients, came down to the point of no more need for a CPAP. That's fantastic. ...

Host Amber Smith: A reverend discusses the role of spiritual care in a hospital.

Rev. Terry Culbertson: ... Most of us have an amalgamation of both. We might perhaps belong to a faith community, but we might also practice a spiritual practice like yoga. ...

Host Amber Smith: And a doctor of family medicine talks about the health concerns of Generation Z.

Kaushal Nanavati, MD: ... In general, the trend is that they're making decisions to try to promote their health proactively better than generations that have come before them. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll explore the role of spiritual care in a hospital. Then we'll hear about Generation Z, born between 1997 and 2012, and their health concerns. But first, a medication has been shown to treat obstructive sleep apnea.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

A drug that's been used for diabetes and for obesity has been shown scientifically to improve obstructive sleep apnea. Here to tell us about it is Dr. Antonio Culebras. He's a professor of neurology who specializes in sleep medicine, and he started the first sleep center in Syracuse in 1978 at the Veterans Affairs Medical Center.

Welcome back to "HealthLink on Air," Dr. Culebras.

Antonio Culebras, MD: Thank you. My pleasure.

Host Amber Smith: Now, this medication was studied by an international team of researchers who published in the New England Journal of Medicine recently about its use to treat sleep apnea when people stop breathing while they're sleeping. What is this drug and what can you tell us about it?

Antonio Culebras, MD: Yes, indeed. It was an article, a scientific article, that appeared in the New England Journal of Medicine just a couple of weeks ago. And it is a major successful event, the fact that there is a medication that reduces not only obesity but reduces sleep apnea significantly.

Just a reminder that there are 900 million people worldwide who suffer sleep apnea. Of course here in the United States is also a significant number of people who suffer sleep apnea. Most of them, if it isa large or a significantsleep apnea problem, are treated with CPAP, (continuous positive airway pressure). But CPAP is uncomfortable, and, after one or two years, 50% of people drop their CPAP therapy.

There are some interventions and surgical interventions that are successful, but they are costly, and of course there are complications and so forth. So we are really left with a large number of sleep apnea patients who remain untreated, without control. And sleep apnea is a significant risk factor for cardiovascular and cerebrovascular events, for worsening of diabetes, for a variety of neurological problems, and so on and so on. So the fact that now we may have a pharmaceutical agent to improve sleep apnea by the way of weight loss in patients who are obese is a significant advancement.

Host Amber Smith: Now you mentioned CPAP, that continuous positive airway pressure. That's that mask that people wear at night, and they're hooked up to a machine. Are you saying that a medication like this might replace the need for CPAP?

Antonio Culebras, MD: It might. It might because this particular scientific research has shown that half of the persons who were obese and had sleep apnea reduced their weight such that their sleep apnea came down to a level that did not require CPAP any longer. One half of them. That is very, very significant.

Host Amber Smith: So how does this drug do that? Can you explain to us how it works?

Antonio Culebras, MD: This drug, by the name of tirzepatide, has been available for patients who are obese and have diabetes, but it had not been shown that by reducing weight would also improve sleep apnea, although the suspicion was high.

Over a period of two years, there were two trials. Trial No. 1, patients who were not using PAP (positive airway pressure) devices. And trial No. 2, patients who were using PAP devices. And, the structure of the trial was that half of the patients received the medication, tirzepatide, and the other half did not receive the medication.

Host Amber Smith: From what I understand, the research included two double-blind randomized controlled trials -- that's the gold standard -- involving men and women with moderate to severe sleep apnea and obesity. Half got the medication during the trial and the other half received a placebo or a fake medication. Is that right?

Antonio Culebras, MD: That is correct.There were 235 participants in trial No. 1. And there were a similar number of participants in trial No. 2.

Host Amber Smith: And they looked at some people that used CPAP and some people who don't use CPAP. Why did they look at both groups?

Antonio Culebras, MD: Because in the real world, half of the patients who have significant sleep apnea do not use their CPAP, are not compliant with the CPAP. And, the trial looked at that and also whether there was any additional effect of the CPAP on the activity or the effect of this medication.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with sleep expert, Dr. Antonio Culebras, a professor of neurology at Upstate, about a medication that may help for obstructive sleep apnea.

So in general, what were the findings?

Antonio Culebras, MD: Well, the inclusion criteria were to have moderate to severe sleep apnea. That is more than 15 events per hour of sleep. And also to be obese with a body mass index of 30 or higher. Now patients with diabetes were excluded, because in the past this medication had already been tested for patients who were obese with diabetes. And actually it is an indication right now for prescription of this medication.

Now in trial No. 1, the average apnea hypopnea index -- that is the number of respiratory events per hour of sleep -- was 51 per hour, which is high. And the average BMI (body mass index) was 39, which is high. In trial No. 1 after 52 weeks of receiving medication subcutaneously once per week, there was a reduction in respiratory events from the 51 that I mentioned before to 25 per hour with tirzepatide. Whereas with placebo, there was only five events per hour reduction.

Now, placebo patients also had minimal improvement because they ate a diet prescribed by the study. And they had also some physical activity. So that resulted in a minor loss of body weight.

In trial No. 2, where patients had access to the PAP device, they started with 49 events per hour of sleep, and the reduction with tirzepatide was down to 29 events per hour. BMI also was reduced significantly. So compared with placebo, these are very, very interesting results.

So let me mention that one half of the patients who were taking tirzepatide lost a lot of weight, and their apnea hypopnea index dropped to levels where the CPAP is no longer needed. One half of patients, 50% of patients, came down to the point of no more need for a CPAP. That's fantastic because as I said before, many patients with sleep apnea do not like their CPAP, are not compliant with their CPAP, and they drop the use of the CPAP after at least one year of using it. So now we have a pharmaceutical intervention that is effective.

Host Amber Smith: Now, the study was paid for by the drug maker Eli Lilly. Can we trust the results?

Antonio Culebras, MD: Yes. The results were obtained in the trial that covered nine countries in all continents. And, Eli is a very well-known pharmaceutical company. And, these results are to be trusted. Of course, confirmation is needed later. Now they are trusted to the point that the pharmaceutical company has requested a fast-track pathway to approve this drug to be sold in pharmacies with an indication of sleep apnea, and that may occur before the end of this year.

Host Amber Smith: Interesting.

Antonio Culebras, MD: It is quite possible that starting in January, I should be able to prescribe this medication with the indication of sleep apnea.

Host Amber Smith: So let me ask you, were there any side effects from the medication in the trials?

Antonio Culebras, MD: Yes, there were some side effects, but they were modest. Mostly gastrointestinal issues. But they tended to disappear over time. There were two cases of acute pancreatitis, but every single research project has an occasional serious event. So overall I think that the side effects were quite acceptable.

Host Amber Smith: So do you think, there's other drugs that are being used like for weight loss and diabetes -- semaglutide, Wegovy and Ozempic -- do you think that drug would have the same effect as tirzepatide?

Antonio Culebras, MD: It is very likely that any other drug that causes significant weight loss will have an effect on sleep apnea. What is important here is that if the pharmaceutical company gets from the FDA (Food and Drug Administration),, an indication for obstructive sleep apnea and obesity, then I would be able to prescribe the medication. Right now, I cannot prescribe the medication. And, if a medication is prescribed without FDA approval, the insurance company will not accept it. And, as I said before, this is a very expensive drug, $12,000 or more per year. So it is very important to get that FDA approval, which I hope will occur sometime in January.

Host Amber Smith: Now, since this is a medication that maybe people are already using for diabetes or weight loss, do you think there may be people out there taking it who've already seen an improvement in their sleep apnea, and maybe they don't even know to credit the medication?

Antonio Culebras, MD: Most likely. Most likely. There are anecdotal reports of people using the weight-losing medications for other conditions like obesity and diabetes, who have found an improvement, who have noticed an improvement in their sleep apnea. But those are anecdotal reports. By that I mean that they were not measured properly, scientifically, but now we have scientific proof.

Host Amber Smith: Well, and it's really nice of you to make time to share this information with us. Thank you.

Antonio Culebras, MD: My pleasure.

Host Amber Smith: My guest has been Dr. Antonio Culebras. He's a professor of neurology who specializes in sleep medicine at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Why hospitals offer spiritual care -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

The World Health Organization identifies four dimensions of well-being: physical, social, mental and spiritual. Today, I am talking about spiritual care with the Rev. Terry Culbertson. She's a clinical assistant professor who directs spiritual care at Upstate.

Welcome to "HealthLink on Air," Rev. Culbertson.

Rev. Terry Culbertson: Thank you so much, Amber.

Host Amber Smith: Can you start by defining what spiritual care is?

Rev. Terry Culbertson: Yes. I really love this definition by Dr. Christina Puchalski. She is the director of George Washington Institute for Spirituality and Health (in Washington, D.C.), and she says, "Spirituality is that which allows a person to experience transcendent meaning in life."

And it can be expressed in a variety of ways, like a relationship with God. It could be in nature, it could be art, music, could be family, could be community. Whatever beliefs or values give a person a sense of meaning and purpose in life.

Host Amber Smith: A traditional religion.

Rev. Terry Culbertson: Uh-huh, exactly. And it's interesting that the Pew Forum (a research center), does what's called a "changing landscape of religion" analysis every couple years, and what they've discovered in America is this incredible dynamic changing of religious and spiritual practice. Most of us have an amalgamation of both. We might perhaps belong to a faith community, but we might also practice a spiritual practice like yoga or mindfulness.

It's more than a third of the country, they say, now does this. It's definitely increasing in America as things shift and change.

Host Amber Smith: Now, what is a chaplain, then?

Rev. Terry Culbertson: A chaplain is someone who ministers in a specialized setting. That is an incredibly broad definition.

There are a variety of interesting chaplaincies. There's racetrack chaplains, believe it or not. There are cruise ship chaplains. There are airport chaplains. There are nursing home, of course, jail chaplains, hospital chaplains, long-term care, all those kinds of things. So the qualifications to minister in those places varies according to the setting.

Host Amber Smith: So for hospital, is there additional training on top of spiritual care or ministering training that has to do with being in a hospital?

Rev. Terry Culbertson: It's interesting, of all the hospitals in this country, I think they say it's about 65% have chaplains. Hospitals vary also in terms of what they require.

Some of the regulatory agencies, the Centers for Medicare and Medicaid, what's called the Joint Commission, or DNV,they might require something spiritual, but they will not tell the hospital what that looks like. Now, Upstate is different. We are an academic medical center, Level 1 trauma center, and we embrace the highest standard for chaplaincy in hospitals, which is board certification, and there are only three organizations in the country that we recognize: Association for Professional Chaplains, National Association of Catholic Chaplains, National Association of Jewish Chaplains. So the gold standard is, Amber, a high bar indeed, and I could describe the qualifications if you'd like.

Host Amber Smith: I'm curious, does it require some certain training and background or experience?

Rev. Terry Culbertson: Absolutely. One of the biggest things it requires is what's called clinical pastoral education through the Association for Clinical Pastoral Education. So it's a Department of Education-accredited training program.

There's about 300 in the country, and we're the only one in Central New York. It's a big deal. And so we offer this training, what's called units of training, which are 400 hours each. The main experience of these training units is direct encounters with suffering persons, so at the bedside, in the emergency department and traumas, end of life, all those things, and students learn from those encounters, under supervision, with some educational theory and the opportunities to learn the skill. So it's a big, big deal. So you have to have 1,600 hours of this to become board certified, which is a lot.

Host Amber Smith: So this takes some real dedication.

Rev. Terry Culbertson: It sure does, and I've got to say, we have over 160 graduates in our program; we had a reunion this year, 20th year. And people have come from the Southern Tier, they've come from Canada. Some of them work full time, but they're called to this kind of work and come to train alongside of us, and it's very powerful indeed.

Host Amber Smith: So once you are a chaplain, what are the duties of a chaplain in a hospital like Upstate?

Rev. Terry Culbertson: You get everything from -- well, I should say it's like a box of chocolates, right?

Many of our folks, as one enters into clinical training, develop specialties, for example, pediatrics or psychiatry or neurology or cardiology, and they work alongside the interdisciplinary staff because we don't just confine our work to our own discipline, but we are cooperatively multidisciplinary, at the table with the rounds, at the bedside with nurses and physicians, providing holistic care.

So the training: One might develop those specialties, like I mentioned, but we're also more generalist. For example, this morning I had a call about 5 a.m. for a death in the medical intensive care. And we get a lot of those kind of calls. End of life, families need support, very challenging and difficult situations, and organ donation, for example, making health care decisions and looking at the moral issues and the values of that person and that family.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with the Rev. Terry Culbertson, who oversees spiritual care at Upstate.

I know this year's Spiritual Care Week has the theme of "chaplain beyond religious roles." Can you explain what that's about?

Rev. Terry Culbertson: Actually, I think a great example is, this morning I got a request to do an invocation blessing for our new Biobehavioral Health Unit located on the Hutchings campus (near the hospital).

So chaplains, we do direct care at the bedside. We do, certainly, family care. We do something that might be a little surprising to people; we do a lot of staff support. Staff deal with such hard things, and that's staff in all traditions, like environmental, security, nursing, respiratory, physical therapy. And so one of the great gifts we find is we are an informal sense of support right at the bedside with them and do some supportive care, especially after traumatic situations where there might need to be some debriefing or some defusing. But my example of doing a blessing for that building is a great honor and one of the unusual things we do.

We also do things like an annual memorial service for all the families of patients that have died here, because we consider those relationships so essential, and that we cared for each other, and we're changed by each other. So that's an annual event that we do as well.

We do educational things, teaching with, for example, respiratory students. We did a simulation reenactment this summer with, the new respiratory students, at a bedside of a simulated manikin while they extubated (disconnected from a ventilator) the manikin. And so that's kind of unusual.

The other thing that was quite remarkable this summer, we have this anatomical gifts program here, where people donate their bodies to science for the medical students, and I was privileged to go out and offer a service over the remains of some of these people out in the community, where we have a burial site. So you never know what you're going to get.

Host Amber Smith: It sounds like your job is different every day.

Yeah. Hour by hour. (chuckles) Well, serious illness or hospitalization can lead to spiritual distress. Are there symptoms? How would you know, or how would the bedside nurse know that someone is in spiritual distress?

Rev. Terry Culbertson: Maybe first thinking, what does that mean? There's a variety of definitions from spiritual injuries, spiritual distress, spiritual pain. But distress implies that whatever you believe or hold most dear, gives you meaning, is not working for you in the context of whatever you're encountering in your life.

So somebody faced with a new diagnosis, say, cancer, who had a belief in a benevolent God that "If I'm faithful enough, I will never have anything go wrong in my life," could experience extreme spiritual distress by wondering: Where is God in this?

There's also spiritual despair. So distress would be "I can't make sense of it, but I'm trying." Well, despair would be what we call a broken ontology, broken meaning of life. And what can come from that brokenness is, in the conversation with a chaplain, is new meaning to emerge. And we do see that happen even at the end of life.

We had one today where hope was expressed that "I'm not going to get better. But I do hope that I'll have a peaceful death. I do hope I'll be reunited with my loved ones." Hope can be transformative, but it might change over time. So that's one symptom, the question of struggle with guilt, struggle with purpose of life, all the things that we hold so dear, our identities, who we are, those are the things that often get challenged with suffering.

Host Amber Smith: Is spiritual care part of the medical record?

Rev. Terry Culbertson: Yes. So we are very grateful to be part of medical documentation, and we do hear providers read our notes. We use a spiritual assessment model where we assess what are the spiritual needs, hopes and resources, because we do not see people as a big bag of needs, but elicit the resources they have within them and then assess what interventions might assist them in, strengthening their spirituality or their practice faith-wise.

And sometimes it can be very simple. Some people just, "I just need you to come and pray with me." "I need to hold my rosary." "I need a Quran."

But oftentimes it's got more complexity to it, where you have a variety of beliefs in the room. I had one yesterday, an end of life, and the dying person couldn't speak for herself, but her family had a variety of beliefs -- no faith, faith, spirituality related to their nature to how they conceive of God. And to help them gather at the bedside to make their goodbyes was profound.

Host Amber Smith: And so it's your role to bring all of those beliefs together?

Rev. Terry Culbertson: Yes. Or at least to elicit them and to acknowledge them.

Host Amber Smith: So any patient who's hospitalized? What about a patient in the emergency department? Can they request spiritual care as well?

Rev. Terry Culbertson: Yes. We really try to round in the emergency. In our clinical pastoral training program. Each intern spends one evening a week in the ED, we call it the ED (emergency department), carrying trauma. And as some of you may know, our emergency room is incredibly busy. People are lining the hallways, people are coming through. There's small things, very big things. There's scared people, angry people. We get called there every single day, for all the traumas. We come down for codes, we come down for strokes, and we come down to provide support and comfort as well, so people know that they're not alone. And sometimes it's that basic, just "Hold my hand and tell me that I'm still here, and I'm still a person of worth."

Host Amber Smith: Let me ask you, are there adequate numbers of people who are going into the profession of spiritual care?

Rev. Terry Culbertson: Actually, the number of people going into ministry is shrinking in this country. I think it has to do with the shrinking population as well as the changing landscape of denominationalism.

Those who are Roman Catholic may be aware, obviously, the number of priests in this diocese has considerably lessened. Some traditions are growing some, but I think going into chaplaincy is such a specialized thing in terms of calling.

What we're seeing is more what I would call non-ordained people. We have a number here in our department who are not ordained like I am, but are clinically trained, theologically educated, and provide an incredible service to the patients, and I think that's the cutting edge of chaplaincy.

We have had a few younger people come in. We actually have quite a spectrum. I think our youngest student was 22, and our oldest might have been, like, 79. I actually think it's a great profession for all ages. We bring our wisdom, we bring our life experience. We bring maybe another career that we've learned from the discipline of being responsible, maybe having raised children, which I think is one of the greatest learning opportunities.

We certainly welcome people to inquire, and a lot of times people come alongside of us, and they volunteer for a while and see if this is really what they're meant to do, because it's not for everybody.

Host Amber Smith: But it sounds like you would recommend becoming a chaplain. To some people this might be a good profession.

Rev. Terry Culbertson: Absolutely. The one thing that is different being a chaplain from being, say, a clergyperson or, say, a priest, is we minister to all traditions and no traditions. So we cannot impose our faith or our religion on others. All of us in the department are ordained or endorsed by some tradition. We have to be located somewhere, in our faith walk, but we cannot impose that on others.

So you have to have an open heart and an open soul and, really see what you can learn from someone else.

Host Amber Smith: Well, Rev. Culbertson, thank you so much for making time for this interview.

Rev. Terry Culbertson: Thank you, too.

Host Amber Smith: My guest has been the Rev. Terry Culbertson, director of spiritual care at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," what's on the mind of Gen Z when they go to the doctor? From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Doctors of family medicine treat patients of all ages, but today I am focusing on young adults in their 20s who've graduated from pediatric care, and they're out on their own. I'm talking about Gen Z patients, born between 1997 and 2012, with Dr. Kaushal Nanavati. He's a doctor of family medicine at Upstate and also the director of integrative medicine, and he has some observations about this patient population.

Welcome back to "HealthLink on Air," Dr. Nanavati.

Kaushal Nanavati, MD: Thank you, Amber. Great to be back.

Host Amber Smith: This is going to be very general, understanding that people are individuals, but there are sometimes trends that you can see in certain patient populations.

Are these young adults more or less health-minded than their parents, do you think?

Kaushal Nanavati, MD: It's a fascinating topic. In general, they're more health-minded, they're more health-conscious. They're looking to make choices that are healthier.

And at the same time, we also know that in some ways, physical activity-wise, and even in terms of weight, overweight, et cetera, diabetes, some of these chronic conditions, we're also seeing some more of these conditions in this generation, including some cancers, in this generation compared to others.

So it's kind of a mixed data set, but, in general, the trend is that they're making decisions to try to promote their health proactively better than generations that have come before them.

I think millennials have kind of paved the way for Gen Z in some ways, as well.

Host Amber Smith: So they're trying to do right with their health, but you do see some things that they're not doing, they're not getting right.

Kaushal Nanavati, MD: Right. And again, that has to do with generational shifts. That has to do with the way in which we engage with the world, lifestyles and focus as well.

Host Amber Smith: So how do you talk with this patient about diet and nutrition?

Kaushal Nanavati, MD: So the thing is, they're actually more inclined to make health-conscious choices in terms of nutrition. Things like plant-based eating, aren't an unknown enigma to them. They understand what that means.

The choices they make in terms of what they do to take care of their own nutrition, they have more insight and are more amenable to making some changes. And again, some of this, obviously it's a broad population that we're talking about, so there are more with more knowledge, and making some better decisions, and that enables us in a health system to then be able to support that much more easily.

I can tell you that even at our own medical school, students coming in from class year to class year, over time, we can see that interest in nutrition, that interest in plant-based eating. In fact, we have students right now who are working with our health system to continue to improve the nutritional offerings for our employees and our staff and those who visit our system as well as for patients, which I find to be fascinating, especially having been in health care for a time frame that I've been in.

Host Amber Smith: Are the Gen Z patients, are they apt to take vitamins and supplements?

Kaushal Nanavati, MD: I think there's curiosity. I think there are people who sometimes will do more. They feel like there's more information that's accessible to them online and content. and I'm always very cautious about this because frankly, "let food be thy medicine" should still be the principle for all of us.

So when you think about nutrients, when you think about nutrition, think about where you get your vitamin base, primarily it should be from whole foods and how we pair them. Understanding fiber and healthy fat and healthy protein, things like pickled vegetables versus raw versus cooked. This is all the information that's important to be shared.

I think "pillification," whether it's supplements or medications, it still becomes a formulary. And when people start using supplements in bulk or beyond recommended levels, we have to be very careful of the impact on the body, the liver, the kidneys, the organs of the body, and sometimes these supplements can interfere and/or interact or enhance the effect of medications they may be taking, which could lead to potential toxicity or blunting the effect of something that may be vital for their body and their health.

Host Amber Smith: What's their general feeling about alcohol use?

Kaushal Nanavati, MD: In general, they're using it less, marijuana less, and that's what some of the data bears out. At the same time, there are pockets where you may find that it's different. And I think with the current transition, the things that we have to help people be more aware of is that there are different ways of utilizing different things. So when it comes to marijuana, there are multiple factors and components, CBD, THC, et cetera, and some things in certain forms, like the essential oil versus smoking, have a different effect, different impact on the body, may have different health consequences as well.

This generation, more than others, is more open to learning this type of thing and has access to more information, which I think, because they're young, we still have to wait to see health consequences over time.

So we don't know what the impact will be fully yet, but the trend seems to be that, in general, they're making decisions that promote their health moreso than generations in the past have, and maybe because they have more access to better information.

Host Amber Smith: So, is this generation more into integrative medicine, like yoga or massage therapy?

Are they likely to try some of these things that are on kind of the fringes of medicine?

Kaushal Nanavati, MD: So I think in terms of the complimentary approaches, in general, they have more access. But again, there are factors, in terms of who's utilizing. Historically it's been women more than men. Historically it's been people with higher education. So even in this generation, some of those trends seem to be bearing out, and so access, I think, is still an important factor, but knowledge is more readily available. And then, I think they're wiser about asking questions. So I know in our practice, they tend to be more proactive with asking questions about things when they do come in.

I will say that this is also a generation that access is really important to them, so they tend to be more readily utilizing urgent cares and things like that, which, again, compared to two decades ago, there are more urgent cares around. And so what they sometimes don't recognize is the value of the continuity that you can get in a primary care setting, where somebody knows you over time and knows both the ups and downs, but also your history individually and in the context of your relations, generational history, which can influence and impact decision making, for the good of the person when the provider is aware of that. And so they tend to use urgent cares more, which is something that we'll have to see how that bears out in terms of the quality of health over time.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Kaushal Nanavati about Gen Z health practices. These are people born between 1997 and 2012. He's a doctor of family medicine and the director of integrative medicine at Upstate.

So let's talk about the chronic health conditions that you're seeing in this group: diabetes, heart disease, obesity? What else are you seeing sometimes?

Kaushal Nanavati, MD: There's data with certain types of cancers where the younger generations seem to be having a higher percentage, relatively speaking. And, you think, is it because we have better testing? Is it because we have better tools to detect? Are we screening more consistently, because they're accessing health care more consistently, whether it be primary care, urgent care, as we spoke about earlier? And the answer is, we don't know yet because they're young. What we do know, though, is that diabetes and even overweight seems to be more prevalent in this population.

And that's something that is of concern because on the one hand, they do engage in physical activity, they do engage in, even are more amenable to, mind/body therapies, mindfulness therapies, those types of things. In terms of complementary approaches, as you mentioned, yoga, but is that across the spectrum of the population?

And generally people in their 20s and even 30s, and in this population, aren't necessarily as consistent with accessing health care, and that may be the issue. We know with colorectal cancer, there's a trend showing an increase. And so, there are many, many, national bodies looking at the "why," and whether it comes back to nutrition, whether it comes back to processed foods and those types of things. What's been accessible to them in school systems? For people who don't have access to healthy foods, what's accessible to them in their proximity, in their community? Now, all of these things are factors amongst many others, that make a big difference in what we're seeing.

So, while they're intending to be healthier, we're also finding more chronic conditions showing up earlier. And for that we have to be proactive, not only as a health system, but socially, politically, to have the right policies in place that improve access to healthy nutrition, that engender people having access to more physical activity opportunities and the education that goes along with that.

And stress plays a big role in a lot of this as well. And especially with what we've had and experiencing over, from 2019 onwards and a lot of the stresses in the world now. There's a lot of stress, some of which people can't control, but it's in their lives, and that can have an impact as well.

Host Amber Smith: So, do they come to the doctor's office with concerns about cancer or diabetes? Do they have a fear of something that they're trying to ask you to help them keep away?

Kaushal Nanavati, MD: Some do. I would say that the trend has been that they come in wanting to be proactive. So there's the "fear of," right? So when you're trying to prevent a problem, you're concerned about the potential of the problem.

And then there's the promotion of health, where you're proactively seeking to be healthier. And the mindset shift is, one is a proactive, and one is avoiding, fear-averse kind of a mindset. And so we're seeing more people coming in with a proactive mindset, which is, "What can I do to stay healthy?" versus "What can I do to avoid this problem?"

And that mindset engenders better health overall, mentally, emotionally, spiritually, physically, right, nutritionally, and so you embrace the journey with joy versus looking over your shoulder in case something's going to show up.

Host Amber Smith: So do you know what the projected lifespan is for someone, we're talking people that are from 12 to 27 at this point? Do you know what their projected lifespan is and if it's shorter or longer than their parents'?

Kaushal Nanavati, MD: So compared to baby boomers and even Gen X, Gen Zers have a higher life expectancy and even Generation Alpha. So, in general, we used to say baby boomers had a life expectancy around 70 or in their 70s, whereas Gen Z, the life expectancy is going to be over 85, potentially, and even higher, potentially. And, this is a fun statement, but it's also a fact, the longer you live, the longer you're projected to live. So, when you get to 65, the potential that you get to 75 is greater.

When you get to 75, the potential that you get to 80 is greater. And part of that is how you maintain health over time. And the healthier you age, the healthier you will age, right? And these statements, even, I'm chuckling when I say it, but it's good science, which is to say, "Build it well now. You're always building your foundation for the future." And this generation has a potential due to both advances in science, as well as improvements in knowledge and access to knowledge, that they can actually have a quality of life that extends well into their 60s, 70s, 80s as a generation.

And then we have pockets, and we have areas and people and subgroups that still struggle with getting access to good health care, to good nutrition, healthy nutrition and to be able to engage in self-care in a consistent manner. And socially, we had to continue to work on putting a spotlight on these subgroups, so that we can benefit them, so that overall, as a society, we advanced as a whole group.

Host Amber Smith: So, Generation Alpha, those are the people born after 2012, right?

Kaushal Nanavati, MD: Correct.

Host Amber Smith: And I should let listeners know, baby boomers are born between 1945 and 1964, Gen X from 1965 to 1980, and then the millennials were '81 to '96.

Looking into the future, what is the best advice you'd like to give your Gen Z patients, regarding their health?

Kaushal Nanavati, MD: In general terms, if you want to get very, very fundamental, but kind of the big rocks in place, you've heard me talk about what I call the "core four," optimizing nutrition, plant-based whole-food eating, thinking about fiber, healthy fat and healthy protein as being consistent parts of our nutrition.

Physical activity and what the data shows regarding aiming to get up to seven hours of moderate/intense physical activity.

Stress, focusing on things that you can do something about and continue to work on those things.

And then this idea that contentment and peace are dynamic in our lives.

But really, if we recognize that those are the ultimate goals in life, then we tend to reassess that periodically. Are we content, and are we at peace? And if we are, that's a great starting point to continue to build better, make today better than yesterday, and you'll look back on a life well lived. Save for tomorrow what you can do today, and you're going to look back on life unfulfilled,

Even more simply, living by "the sevens." Seven servings of vegetables a day. Seven hours of exercise a week. Seven hours of sleep a night; sleep is a very vital part, and when people are in an age range where they're trying to still build their life, oftentimes sleep becomes an afterthought.

In medicine, when we talk about our trainees, our students, our residents, but in the world of finance and investment banking and consulting, people that work shift work and nursing, there are life metrics that do truly make a difference, both in the quality and the potential quantity, moving forward. And so we have to recognize stress points in our life, be able to step back and focus on the fundamentals.

Host Amber Smith: Well, Dr. Nanavati, thank you so much for making time to tell us about this.

Kaushal Nanavati, MD: My pleasure. I really appreciate you having me on.

Host Amber Smith: My guest has been Dr. Kaushal Nanavati. He's a doctor of family medicine and the director of integrative medicine at Upstate.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from sleep expert Dr. Ioana Amzuta from Upstate Medical University. What can someone do to help get a good night's sleep?

Ioana Amzuta, MD: Basically retraining yourself to have better sleep hygiene: getting rid of all the distractions, getting rid of drinking coffee later in the evening, or any other caffeinated drinks, reducing the amount of alcohol and, even better, not having any alcoholic drinks in the evening hours, keeping the room at a low temperature, keeping the room quiet.

And again a big, big part of this is allowing yourself enough sleep time, so don't just go to bed at midnight if you know that you have to wake up at 6 o'clock in the morning. Allow yourself a time in bed of eight hours. And not in bed watching movies or checking social media, but actually sleeping and resting.

You have to keep your room on the colder side. The ideal room temperature should be around 65 degrees.

I recommend blinds or blackout curtains; especially if you are someone who is working shifts, and you have to achieve your sleep during the day, that becomes extremely important.

You shouldn't exercise just before going to bed, and the reason for that is because the exercise is going to increase your internal body temperature, so if you are exercising, try to stop exercising about two hours before going to sleep. And keep in mind that 30 minutes, minimum, of aerobic exercise daily will ensure a very good quality sleep.

Reading is a very good way of relaxing. But keep in mind that if you have a very bright light by your bed, so you can read, that's not a good idea. I truly encourage patients to keep the bed and the bedroom just for sleep. In other words, if you want to read in a different room, definitely do it. But then, when you go to bed, try to keep the bed only for sleep.

What will happen if you take a nap during the day? If you take a nap, by the time you go to bed in the night, you are not going to have such a powerful drive to fall asleep and stay asleep. For most people, I would say avoid naps during the day. Try to limit the nap to about 30 minutes to avoid that post-nap drowsiness.

For seniors, it is very important to get light exposure during the day. This will ensure that you have a healthy melatonin (a sleep-related hormone) production. And again, exercise is the best cure for having problems sleeping, so maintaining a healthy level of exercise, 30 minutes of aerobic exercise, five times a week, and in addition to that, some weight training, twice a week. That was proven to have amazing health benefits and improve the quality of sleep.

Host Amber Smith: You've been listening to sleep expert Dr. Ioana Amzuta from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Elaine Fowler Palencia is a poet from Champaign, Illinois, who has spent a lot of time in hospitals with her adult son, who has multiple disabilities. Her poem "In the ER Waiting Room, I Sit Reading" moves between observing her surroundings and seeing similarities in the James Baldwin book she is reading.

Steadfastness of walls and floor tiles

the patience of suffering

the confidence of uniforms

accidental clothing

tattoos

james baldwin

the shoes that brought us here

bought on such a different day

people who don't look a bit sick

people awaiting a death sentence

a woman silently choking

james baldwin

down a panic attack

the heaviness of time

air thick with the unknown

the politeness of hope

a tightness in the brain

james baldwin

whose every written word

cried Emergency

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," the value of memory tests for older adults.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

This is your host, Amber Smith, thanking you for listening.