Your brain’s nightly cleanse

Because of improved imaging techniques, scientists are learning new things about how our brains work. They’ve known that brains generate waste but didn’t know, until recently, how the waste was removed. (In the rest of our bodies, garbage removal is handled by the lymphatic system.) As our brains work throughout the day, they generate waste—excess proteins and other molecules that can be toxic if not removed. Among those proteins are amyloid beta and tau, key drivers of Alzheimer’s disease.

It’s only been since 2012 that scientists have discovered a circulatory system in the brain, one in which cerebrospinal fluid flows from the spinal cord into the brain. In the brain, the cerebrospinal fluid mixes with other fluids in the spaces around the brain’s cells, collects the waste, then leaves the brain, taking the garbage with it.

In 2013, scientists learned that this brainwashing was most active and efficient during sleep, suggesting that the garbage collection process is one of the critical functions of sleep. The electrical waves that sweep through the brain during sleep propel cerebrospinal fluid in and out of the brain. The brain is not less active during sleep; it’s differently active.

The discovery that waste clearance is an essential function of human sleep suggests that a dysfunction in this cleansing system is a likely cause of many neurological and psychiatric disorders. It’s long been known that accumulation of amyloid and tau proteins leads to Alzheimer’s, but the link between sleep and a faulty waste-clearance process was not obvious. One clue is the fact that conditions such as traumatic brain injury, which is associated with Alzheimer’s, interfere with waste clearance.

None of this is to say you should worry about your sleep! Just be grateful that it’s being put to good use.

Telehealth abortions

In last week’s blog, I wrote about the rise in telehealth: accessing healthcare organizations remotely by using an electronic device. Since the Supreme Court decided, in 2022, that abortion was no longer part of the constitutional right to privacy, women are increasingly using telehealth to obtain “morning after” pills. That’s because abortion policy is now up to the states.

States, of course, responded to the Supreme Court’s decision in different ways. As of June 30, 2025, 16 states have total or near-total abortion bans, 11 of which criminalize the act of providing an abortion except to save a patient’s life. Other states have enacted “interstate shield laws” that protect clinicians within their borders as well as the abortion-seeking patients. Women who live in states where abortion is banned can use telehealth to get their “morning after” pills in states where it is not.

Because telehealth abortions are increasing, the power of shield laws to protect clinicians from out-of-state prosecution is being tested. In fact, both Texas and Louisiana have filed lawsuits against New York-based Maggie Carpenter—a telehealth abortion provider. New York’s shield laws are protecting her. But it’s possible that if Carpenter were to travel to Texas or Louisiana, she could be prosecuted.

Despite efforts to outlaw abortions, abortion rates have increased since June 24, 2022. Telehealth accounted for 25 percent of abortions as of December 2024—up from 4 percent before the Supreme Court’s decision. Nearly all women who live in states that ban abortions are getting their mifepristone pills in states with the shield laws.

As noted in the Journal of the American Medical Association, where I got this information, “…although abortion care is a fundamental aspect of evidence-based reproductive medicine, the legal environment in the US after Dobbs contains more risks in providing the standard of medical care.” For sure.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Bypassing traditional health care

 A recent issue of the Journal of the American Medical Association notes that primary care is diminishing. “In 2024, more than 1200 positions in family medicine, nearly 1000 in internal medicine, and more than 500 in pediatrics went unfilled.” At the same time, they add, we now have “an emerging direct-to-consumer health care market that bypasses traditional health care organizations.” One of these organizations—no surprise—is Amazon’s One Medical, which “integrates telehealth, primary care, and pharmacy services into its Prime membership,” as described on their web site. You either pay $9.00 a month, $99 a year with Prime membership, or $199 a year without Prime membership. “Telehealth” is virtual health care. You visit a health care person using your computer or phone. Here's an example of how you'd make an appointment.

A while back, my son mentioned having used this service, so I queried him about it, starting with asking him what prompted him to sign up with Amazon’s service. As he explained, his GP had retired, and he needed someone to refill a prescription. As he wrote, “I searched far and wide for a doctor (GP), and it was very difficult to find one. Appointment times were at least six months out. All I needed was a prescription, so I kept searching. I finally got a provider through Amazon medical. I actually dislike Amazon, but it was very easy to get an appointment with a nurse practitioner. And, she's awesome.” 

This nurse practitioner is now his go-to health care provider. She sent his prescription to his usual pharmacy and, when asked, referred him to a local gastroenterologist for a colonoscopy. Like conventional practices, telehealth companies ask for medical records if they’re needed. Visits are covered by your insurance.

I’m still a little mystified by the whole telehealth business. I searched the internet for such companies. There are plenty to choose from. I’m not sure if they all work like Amazon’s. One company, called Sesame, showed photos of their health care providers along with available appointment times, as shown in this photo. Looks easy!

When my GP retires, I’ll probably turn to a telehealth company.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Anemia

Anemia is defined as a low number of red blood cells. It shows up on your blood test as low hemoglobin, which is the main protein in your red blood cells that carries oxygen and delivers it throughout your body. If your hemoglobin is low enough, your tissues or organs may not get enough oxygen. Symptoms of anemia include tiredness, weakness, leg cramps, shortness of breath, pale skin, and cold hands and feet.

One study showed that anemia affects 12.5 percent of people over 60, and that the rate rises as you age. Another study, published in the Journal of the American Geriatric Society, showed that about one in five patients was anemic.

A friend of mine was hospitalized more than once with anemia, in her case caused by blood thinners that resulted in gastrointestinal bleeding. Transfusions were required. Other causes include hereditary conditions, vitamin B12 deficiency, lack of iron in your diet, bone marrow disorders, kidney failure, heart disease, and inflammatory bowel disease.

Remedies include over-the counter iron tablets—which often have unpleasant side effects—and intravenous iron infusions, which have been shown to be effective.

The World Health Organization defines 13 grams of hemoglobin per deciliter as normal for men and 12 for nonpregnant women. As luck would have it, I’d had a blood test prior to my spine surgery last year, so I looked up the results. Everything was normal (displayed in green) except my hemoglobin, which was high (displayed in red with warning sign). According to the Cleveland Clinic web site, above 16 is high for women. Mine was 16.1. Dehydration is one cause. That’s probably me. But other causes include kidney cancer and congenital heart disease. At any rate, I’m clearly not anemic and have none of the symptoms.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Best not to sleep for eight hours

I usually sleep about six or so hours a night, and it’s usually broken sleep. Lying awake for an hour or more in the middle of the night is no fun, but I don’t worry about it. Sometimes it’s even productive. I plan menus or think up book ideas. Sleep experts agree that eight hours of sleep is not optimal. Rather, it’s 6.5 to 7.4 hours. A study of 1.1 million people concluded that those who reported more than eight hours of sleep “experience increased mortality rates.” Scientists who have studied hunter-gatherer tribes in Bolivia, whose lifestyles remain the same as our forebears of two million years ago, found that they average less than 6.5 hours of sleep a night.

Nevertheless, the idea that you need eight hours of sleep persists. In 2024 there were more than 2,500 sleep-disorder centers in the U.S. accredited by the American Academy of Sleep Medicine. Aric Prather, the director of the behavioral-sleep-medicine research program at UC San Francisco says the wait time at his clinic is one year. “We have people coming into our insomnia clinic saying ‘I’m not sleeping eight hours’ when they’re 70 years of age. And the average sleep in that population is less than seven hours.” Making matters worse, fear of losing sleep causes sleep loss.

Thomas Wehr, age 83, once the chief of clinical psychobiology at the National Institute of Mental Health, says that humans aren’t necessarily meant to sleep in one long stretch but rather in two shorter ones. The night awakenings tend to happen as we’re exiting a REM (rapid eye movement) cycle, when our dreams are most intense. He says, “If you know you’re going to fall back asleep, and if you just relax and maybe think about your dreams, that helps a lot.” When I’m awake in the middle of the night, I don’t think about my dreams. I can’t remember them.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.