Thursday, April 24, 2014

Dried Fruits

Most people I know love dried fruits. I sure do. They are incredibly delicious and are a relatively healthy alternative to candy. However, the are some problems.

The  population of the United States has consistently and significantly become more obese in the last 30 years. Those of us that attempt to remain healthy by exercising and eating better should know what we're consuming.

Many tout the benefits of eating dried fruits. There are some truths to this. There are also some misconceptions.


The benefits of fruits are well known. We know that they provide us with vitamins, minerals an other phytonutrients. The benefits of fiber and their antioxidant properties are also well known.

Now the bad news:
  • Portion control can easily become an issue. Water takes up much volume in fruits. Since water is eliminated from dried fruits, we tend to consume much more. It wouldn't be difficult to consume the equivalent of five, ten or more fruits! This of course leads to an excessive intake of calories.
  • Blood sugar levels can get out of control. Since we may have a tendency to consume too much, we may inadvertently increase our blood sugar levels; which in turn can create dangerous situations with people that have diabetes.
  • Dried fruits have naturally occurring sugars (fructose). When they are dehydrated, these sugars become highly concentrated.
  • Many people are completely unaware that many of these dried fruits also have some added sweeteners. Some are coated with sugars. Some are sprayed with corn syrup.
  • Dried fruits are incredibly sticky and adhere well to the teeth. It's bad enough that the sugars are highly concentrated, but when they remain on the tooth structure for extended periods, cavities develop.
  • Many dried fruits are sprayed with oils. If you are trying to avoid oils, you may unsuspectedly consume more oils than you desire. By the way, bananas are often deep fried.
  • Many fruits have sulfur or sulfites to preserve the bright colors. If you have an allergy to these, then you may have a potentially dangerous situation on your hands.

I'm certainly not suggesting that you avoid dried fruits. Just know what you're truly eating. Consume them in moderation. Also, brush or at least rinse really well within the first 15 minutes after consuming dried fruits to get the sugars off of your teeth.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Friday, April 18, 2014

Diabetes and Sleep Apnea

Last week I addressed the link between obesity and sleep apnea. This week I will throw diabetes into the discussion.

The American Academy of Sleep Medicine issued a statement last year concerning diabetes (and hypertension). Basically, practitioners that have patients suffering from diabetes type 2 are advised that they should also have their patients evaluated for sleep apnea.

There is an enormous body of research that shows the relationship between diabetes and sleep apnea. There are several other co-morbidities such as hypertension and obesity. In other words, conditions that are usually coexistent and contribute to death.

This chart is shows the connections of other conditions and sleep apnea.

People that suffer from sleep apnea are at significant risk for developing diabetes (or any of the other conditions) and vice versa. Attempting to  treat diabetes through medications and other therapies without also addressing sleep apnea will undermine a successful outcome.

This chart shows the percentage of other conditions in patients that suffer from sleep apnea.

Adequate sleep is necessary for proper regulation of many biochemicals such as insulin. Insulin allows transportation of glucose from the blood stream and into the cells.

Patients that do not exhibit proper glucose metabolism will retain more glucose (sugar) in the blood. This in turn will increase the fluid within the blood stream which will result in more frequent urinating in the middle of the night, thereby interfering with sleep.

Many patients that are diabetic are also obese. Refer to my previous blog on the link between obesity and sleep apnea. These conditions are all connected! One condition leads to the other.

My father passed away in 2001 from a stroke. He also suffered from diabetes and hypertension. I can recall nights when I was growing up that my father snored quite a bit. If we would have known then what we know now, he would probably still be alive.

If you or anyone you love suffers from any of the above conditions, I strongly urge you to visit your doctor.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Thursday, April 10, 2014

Obesity and Sleep Apnea

There has been an increased awareness amongst health care providers and the public in recent years concerning sleep apnea and obesity.

The obesity rate has risen steadily since the 70's. Back in the 70's the obesity rate was significantly lower than it is today. It  has gradually increased to it's present and alarming rate. The charts below demonstrate this trend.

These are the obesity rates in 2010. No distinction made between children, adolescents and adults.

Both sleep apnea and obesity have spiraled out of control and continue to do so.

Even though sleep apnea and obesity are two completely separate issues, they both exacerbate the other condition.

How obesity contributes to sleep apnea:

We know that there are many conditions that contribute to the severity of sleep apnea. Let's talk about how obesity exacerbates sleep apnea.

It's really quite simple. The more obese a person becomes, the larger their necks get. The problem with this is that the airway becomes severely restricted and therefore makes it difficult to breathe. As we all know, breathing is vital in maintaining life.

For a better understanding of sleep apnea, please refer to my previous blogs regarding this topic.

How sleep apnea contributes to obesity:

As I mentioned in previous blogs, hormones and other biochemical are regulated during sleep. In particular, during REM sleep. 

Two of these hormones are leptin and ghrelin. These two hormones are responsible for appetite and weight regulation. When these two hormones are not properly regulated, we tend to eat too much because our bodies are tricked into believing that we are hungry when we shouldn't be. This is one way sleep apnea contributes to obesity.

Another way sleep apnea contributes to obesity is from low energy levels. When we don't get adequate sleep and proper oxygenation, we tend to feel exhausted throughout the day. This makes losing weight much more difficult because we can't find the energy to be active or to work out.

Latest developments:

In the past, physicians and other healthcare providers suggested weight loss to their patients. We were concerned with people's feelings and didn't want to offend them by telling our patients they were fat and needed to do something about it. We now know that we need to address obesity much more aggressively. Obesity is a disease. We need to treat it as a disease process. Both sleep apnea and obesity significantly reduce life expectancy.

Michelle Obama has even chimed in on the subject with the "Let's Move" campaign. There are other public awareness campaigns to get the information out. Hopefully we can reverse this alarming trend in obesity rates.

If you are obese and/or suffer from sleep apnea, visit your healthcare provider to discuss the appropriate methods to address your concerns. It could save your life!

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Thursday, April 3, 2014

Radio Interview on Sleep Apnea, Bad Breath and Other Topics

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This week we'll do something different. I attached a radio interview that was aired earlier this week. We discussed several topics. We mostly discussed sleep apnea and bad breath. We also discussed a couple of other topics. Please excuse the sound quality. The host's sound is fine. My sound is not quite as good.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit