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Sundowning: How to help your loved one

Have you heard of Sundowner’s Syndrome? Sometimes it’s called Sundowning, and it’s usually associated with people who have Dementia or Alzheimer’s. For those people, sundowning can be a time of increased memory loss, confusion, agitation or even anger. For the family members who care for them, it can be a painful and exhausting experience.

What causes Sundowning?

  • Too much activity towards the end of the day can trigger sundowning. Even shift changes can lead to anxiety and confusion for those in a memory care facility.
  • Fatigue is also a common factor. Perhaps they are tired from the activities of the day, or even the sudden lack of activity after dinner can be a contributor.
  • Too much sleeping during the day and inactivity can also disrupt a good night’s sleep.
  • When the sun goes down, shadows may increase and the amount of available light makes already challenged vision that much more difficult to see.
  • Hormonal imbalances can cause disruption in the internal biological clock. This imbalance can lead to confusion between waking and sleeping hours.
  • Even wintertime and its shorter days can make sundowning worse for some people. This is also an indicator that the syndrome may have something to do with Seasonal Affective Disorder, a common type of depression caused by lack of exposure to natural sunlight.

How can you help reduce Sundowning symptoms?

  • Sticking to the same schedule every day can help your loved one feel more calm and oriented. If a routine much change, try to adjust them gradually and with as small of an impact as possible.
  • Adjusting the lighting in their room or home could also help with sleep and wake cycles if their circadian rhythm gets out of sync. According to the a research review published in Psychiatric Investigation, some studies suggest light therapy to reduce agitation and confusion in people with dementia.Placing a full-spectrum fluorescent light a few feet away from your loved one for a couple of hours each morning could help with sundowning symptoms. Even brightening the lights may help. when they feel confused or agitated.
  • Walking in the park and other activities during the day might improve their sleep at night and reduce sundowning symptoms.
  • Consuming large meals, caffeine, and alcohol can also interrupt the sleep patterns of someone with Sundowning symptoms. Limiting evening food to a healthy snack or a light meal might help them rest easier, too.
  • Encouraging evening activities that aren’t too stressful can help reduce confusion and irritability. If they have mid-stage or advanced dementia, watching television or reading a book could be too difficult. Try playing soft music to calm and soothe them. Snuggle time with a family pet could also help reduce stress.
  • If a loved one has moved into a hospital or assisted living facility, furnishing their space with some of their treasures like a favorite blanket, and family photos, can help ease the transition and help with sundowning symptoms.
  • Medication may be helpful in some cases of sundowning, especially when it’s associated with depression or sleep disorders. Consulting a physician is important since some medications may actually disrupt sleep patterns that can make symptoms worse.

Looking for patterns of sundowning in your loved one can help you identify the triggers.Track behaviors and activities with a journal or smartphone app to learn what makes symptoms worse or better. Once you know which activities or environments are triggers, it’s easier to avoid those situations and events.

Managing a loved one’s symptoms can be exhausting for the caregiver, so it’s important to take good care of yourself. Be sure to eat a well, get regular exercise, and get plenty of sleep every nights. It’s okay to rely on other family members or seek respite care so you can take regular breaks.

Radon: Should you test for it?

In the United States, 15,000 – 22,000 people die from radon-related lung cancer every year (compared to 160,000 lung cancer deaths from smoking).

How are people exposed to Radon?

Normal decay of the elements uranium, thorium and radium found in rocks and soil causes radioactive gas, Radon, to be released into the air. Radon is an invisible, odorless, tasteless gas that seeps up through the ground and diffuses into the air. In a few areas, depending on local geology, radon dissolves into groundwater and can be released into the air when the water is used. Radon gas usually exists at very low levels outdoors. However, in areas without adequate ventilation, such as underground mines, radon can accumulate to levels that substantially increase the risk of lung cancer.

For those of us to don’t work in a mine, exposure to radon gas can happen in our homes or even the workplace.

Radon can enter your home through:

  • Cracks in foundation walls and floors
  • Gaps in flooring
  • Warm air rising indoors
  • Spaces around pipes entering the foundation
  • Wind blowing outdoors
  • Fireplaces and furnaces
  • Open areas inside the walls
  • Exterior air vents
  • Water — usually well water
  • Construction joints — where concrete stops and starts again

Radon is a common problem in homes throughout the country — as many as one in 15 U.S. homes has high levels of radon, according to the EPA. But certain geographic regions are more likely to be affected. In general, the Northeast, southern Appalachia, the Midwest, and northern plains areas tend to have levels over the recommended limit of 4 picocuries per liter (pCi/L) of air, while coastal areas tend to have lower levels. Newer homes may also have higher levels of radon due to better porosity in soil around the house, which can make it easier for radon gas to flow in.

But elevated levels of radon can be found in any state and in any home. Often, next-door neighbors can have vastly different radon readings — one safe and the other not.

Typically, we are exposed to radon through the air we breathe and the water we drink. Radon that exists in the ground, groundwater and some natural building materials enters living and work spaces and causes exposure. Although high concentrations of radon in groundwater may contribute to radon exposure through ingestion, the inhalation of radon released from water is usually more important.

In comparison with levels in outdoor air, people who work in confined air spaces, such as mines and below-grade areas of buildings, are exposed to elevated concentrations of radon. Exhalation of radon from ordinary rock and soils and from radon-rich water can cause significant radon concentrations in tunnels, power stations, caves, public baths, and spas. The average radon concentrations in houses are generally much lower than the average radon concentrations in underground ore mines.

How do you know if you are at risk of exposure?

Since you cannot see or smell radon, special equipment is needed to detect it. Testing is the only way to know if a person’s home has elevated radon levels.Indoor radon levels are affected by the soil composition under and around the house, and the ease with which radon enters the house. Homes that are next door to each other can have different indoor radon levels, making a neighbor’s test result a poor predictor of radon risk. In addition, rain or snow, barometric pressure, and other influences can cause radon levels to vary from month to month or day to day, which is why both short- and long-term tests are available.

Short-term detectors measure radon levels for 2 days to 90 days, depending on the device. Long-term tests determine the average concentration for more than 90 days. Because radon levels can vary from day to day and month to month, a long-term test is a better indicator of the average radon level. Both tests are relatively easy to use and inexpensive.

When you’re ready to test your home, contact your state radon office for information on locating qualified test kits or qualified radon testers.

While it is not required by law in NC that radon testers and mitigators have any certifications, the NC Radon Program highly recommends hiring a trained professional.The NC Radon Program cannot endorse any particular certification company or individual, so they recommend researching the individual’s qualifications and asking for references.

Below are links to the three organizations that provide radon testing certifications.

National Radon Proficiency Program

National Radon Safety Board

▪Inspector Nation

You also can order do-it-yourself test kits and obtain information at https://sosradon.org/.

The U.S. Environmental Protection Agency (EPA) recommends taking action to reduce radon in homes that have a radon level at or above 4 picocuries per liter (pCi/L) of air. About 1 in 15 U.S. homes is estimated to have radon levels at or above this EPA action level. Scientists estimate that lung cancer deaths could be reduced by 2 to 4 percent, or about 5,000 deaths, by lowering radon levels in homes exceeding the EPA’s action level.

Put Your Best Fork Forward

March is National Nutrition Month and this year’s theme is “Put Your Best Fork Forward”. The campaign strives to help people make small changes in eating habits over time rather than a complete change overnight that may be more difficult to maintain.

A variety of foods is important to diet, because no one food or food group provides all of the nutrients our bodies need to grow and stay healthy. There are 6 nutrients: water, protein, carbohydrate, fat, vitamins and minerals.  Most foods and drinks provide some or all of those, only in different amounts.

For example, bell peppers are a good source of vitamin C, whereas yogurt and cheese provide higher amounts of calcium.  Nuts and seeds are good sources of minerals, like magnesium and zinc, but they also contribute protein and healthy fats.  Bananas are known for being a good source of potassium, a mineral many Americans don’t get enough of.  Asparagus is too, but it also provides a good amount of a B vitamin, called folate, which is important for women of childbearing age.

There is some overlap, too.  For instance, fruits, vegetables, and whole grains are all great sources of dietary fiber.  And foods, like fish and chicken, provide protein, but fish are also good sources of heart healthy fats called omega-3s.  Fatty types of fish are one of the few food sources of vitamin D – another nutrient many people are lacking.  (Eggs are also a good source of protein and vitamin D.)

All vegetables are important, and it is recommended that we eat some every day.  Children have smaller requirements, 1 to 1-1 /2 cups per day, girls and boys up to the age of 18 should eat 2 to 3 cups daily and the amount for most adults is the same (2 to 3 cups every day).

Surveys in the U.S. indicate that most people, no matter their age, fall short, and the most commonly eaten vegetables are potatoes and tomatoes.  These 2 vegetables aren’t bad, but a lot of times they are made with added sugars, salt, and fat.

Plus, if those are the only 2 vegetables eaten regularly, then we’re missing out on the nutrients the other subgroups of vegetables provide.

Dark green vegetables, for example, are a great source of vitamin K, which is important for blood clotting and bone health.  (Some people need to monitor their vitamin K intake when taking certain medications, like blood thinners.)

Red and orange veggies provide nutrients that help keep our eyes healthy.

Beans and peas are not only considered vegetables, but they can also be good sources of plant-based protein.  This is especially important for people who follow vegetarian or vegan diets.

We don’t need to eat all of these sub-groups each and every day, instead it’s recommended that we include several servings every week.











Here are some tips to getting a variety of foods into your diet each week:

Vegetable Variety:

  • Plan meals to include different colored vegetables throughout the week.
  • Remember to choose vegetables from each of those subgroups (i.e., dark green, red and orange, beans and peas, starchy, and other)
  • Experiment with different vegetables when preparing healthy soups and salads.
  • Make a point to buy different vegetables, depending on what is in season.  Chances are they will be more affordable, too.

Fruit Variety

  • Pack a variety of different colored fruits as snacks.
  • Whole fruits, such as apples, bananas, and oranges are really convenient, but individually packaged and already cut up fruit works, too.  Just be sure to look for ones with 100% fruit juice and no added sugars.
  • Try new recipes that call for fruits, such as a mixed salad with sliced apples or pears.  You can also add fruit, like berries and bananas, to oatmeal, muffins and even pancake batter.
  • Enjoy fruit in place of sweets for dessert more often.

Increase Whole Grain use in your diet:

  • Try preparing a whole grain that is new to you, such as brown rice instead of white.
  • You can also experiment with other grains, like wild rice or quinoa.
  • Switch to a whole grain bread or wrap for sandwiches – there are so many different varieties available today to choose from.  Just be sure to look for a whole grain flour of some type listed as the first ingredient (as opposed to an enriched one).
  • Another option is to look for ready-to-eat cereals, and even snacks, that are made with whole grain flours.
  • You can also add whole grain flour to muffins, quick breads, and batters to make pancakes or waffles.  (Up to half of the amount of flour that is called for in a recipe can be substituted with a whole grain flour.  The amount of leavening may need to be adjusted, though.)

Vary your Proteins:

  • Substitute plant-based proteins in recipes, such as a mixture of beans in chili.
  • You can make the recipes without any meat or substitute some of the beans in place of some of the meat, if you’d like.
  • Another option is to try meatless dishes when you eat out.
  • Many different cuisines offer foods made with beans and lentils.

Dairy Variety:

  • Sweeten plain low-fat yogurt with different types of fruits or whole grain cereals.
  • This combination makes for a tasty treat, and if you portion it out in advance, then it becomes a convenient breakfast on-the-go or a healthy snack.
  • You can also make smoothies with fruit and fat-free milk or yogurt on other days.

We don’t like to talk about fat, but it’s actually an important nutrient that is required for various body processes and helps us absorb certain vitamins.  However, some fats are considered to be healthier than others.

Plant-based fats that are liquid at room temperature, like vegetable oils, are the sources of fat that we want to include more often. These types of fats are called unsaturated fats.  

Saturated fats are solid at room temperature and are found in fatty meats and higher fat dairy products.

Trans fats may be found in snacks, already prepared foods, baked goods, and some margarines.  You can check the label for grams of trans fat or check the ingredients list for “partially hydrogenated oils”.

We should limit saturated fats and trans fat by:

  • Choosing low-fat and fat-free milk and dairy products.
  • Eating lean sources of protein foods.
  • Including more plant-based oils in place of solid fats.
  • Limiting sweet desserts and snacks.

The changes you decide to make can focus on one food group or even one meal at a time.

It’s important to remember that everything you eat and drink matters.  Starting with small changes can help you develop healthier habits that last.

To help you get started, try making 1 or 2 small goals at first.

The more specific they are, the better.  For example, rather than saying, “I’m going to start eating more fruit”.  It’s better to set a goal such as “I will eat fruit 3 days this week as a snack in the afternoon”.

Other examples include: “I will try one new recipe this week that uses a whole grain” or “I will drink low-fat milk or water with dinner every day this week”.

Remember, eating right doesn’t have to be complicated. Just take some simple steps and plan ahead. Little changes will go a long way in how you look and feel.


Source: Academy of Nutrition and Dietetics


Stevia vs. Sugar and other artificial sweeteners

I’m sure you’ve all seen the numerous sweeteners that are lined up on the grocery aisle, not to mention the rainbow of packets on restaurant tables. You’ve got the yellow ones, the blue ones, the pink ones, but it’s the white ones that must be the worst, right? Not so fast.

We may still have more questions than answers, but here’s what we have found through various sources about the latest sweetener on the market — Stevia.

Stevia is a leafy green plant that is native to South America. Through processing, two sweet compounds are isolated from the leaves: Stevioside and Rebaudioside A. These two compounds are hundreds of times sweeter than sugar. Most of the studies and products on the market use stevioside, which is on the isolated sweet compounds.

Not only is stevioside naturally sweet, research has shown that it also has some health benefits. In one particular study, a randomized, double-blind, placebo-controlled trial of 174 patients took either 500 mg of stevioside or placebo, 3 times per day. These were the results after two years in the group taking stevioside:

  • Systolic blood pressure: went from 150 to 140 mmHg.
  • Diastolic blood pressure: went from 95 down to 89 mmHg.

In this study, the stevioside group also had a lower risk of Left Ventricular Hypertrophy, an enlarging of the heart that can be caused by elevated blood pressure. The stevioside group also had improved quality of life.

Stevia has also been studied in diabetic patients with impressive results. In one of the studies, type 2 diabetic patients took either 1 gram of stevioside with a meal, or 1 gram of maize starch.

The group taking stevioside had a reduction in blood sugar by about 18%.

Another study compared sucrose (regular sugar), aspartame and stevia. It found that stevia lowered both blood sugar and insulin levels after a meal, compared to the other two sweeteners.

Stevioside was found to be nontoxic in acute toxicity studies in a variety of laboratory animals and no major contraindications, warnings, or adverse reactions have been documented.

And, in 2008, the FDA declared that stevia was safe in foods and beverages. The U.S. may see numerous companies incorporate it into their products since there is considerable consumer interest in natural, low-, or no-calorie sweeteners.

Since stevia comes from an herb and not a chemical, it’s the safest option out there if you want to avoid sugar completely. Though coconut sugar, maple syrup, agave, molasses, and cane syrup may be more natural, they all still raise the glycemic index number. Stevia on the other hand, (in a very pure form) does not raise the glycemic index and has been helpful for those dealing with high blood sugar that don’t want to turn to artificial sweeteners.

If you want to purchase stevia and want the purest product possible, always buy a powdered product that is 100 percent pure stevia extract (not stevia powder, which indicates it is a blend and not pure extract.)  It isn’t cheap to say the least, and it is hard to find in stores. However, it does taste the best and is the cleanest option possible. Another good choice is to choose pure liquid stevia and choose alcohol-free versions if possible. This will ensure the product won’t cause any glycemic or digestive issues or trigger any possible reactions.

According to Prevention magazine, these are the top five Stevia sweeteners on the market (starting with number 5):

5. Stevia in the Raw Zero Calorie Sweetener


3. NOW Foods Organic Better Stevia Extract Powder

2. SweetLeaf Natural Stevia Sweetener

1. NuNaturals NuStevia White Stevia Powder

You can add it to your smoothie, yogurt, tea, coffee and other beverages. It is also a good sugar substitute for baking. When it comes to baking with stevia, many people mix it with erythritol, another natural low-calorie sweetener that is much bulkier.

However, after much research, most all of the above mentioned stevia sweetener brands are chemically processed and may contain additives that remove the aftertaste of pure Stevia.

The best advice is to read all labels for content on the products you’ll find in the grocery store. If you are trying to lose weight, reducing all sweeteners in your diet is the best way to go. Artificial sweeteners are 30 to 300 times sweeter than sugar which could increase your sugar cravings. This can lead to naturally sweet, whole foods like apples being not sweet enough to some people.

One particular study that followed thousands of residents of San Antonio for 10 years found those who drank more than 21 servings of diet drinks a week were at twice the risk of becoming overweight or obese, and the more diet soda people drank, the greater the risk.

“Until we know more, we should use nonnutritive sweeteners in moderation. It should be a treat to have a diet soda, not something you drink all day long,” said M. Yanina Pepino, an assistant professor at Washington University School of Medicine’s Center for Human Nutrition.

“Table sugar and modified sugars could be less safe than sweeteners if you consider that they increase calorie intake and increase blood sugar levels,” Dr. Kumar says. “For someone trying to control blood sugar and/or lose weight, sweeteners can have a role as a sugar replacement.” Ultimately, though, if you can stomach it, NO soda of any kind is your best bet, especially with the science still out on artificial sweeteners and their link with obesity.

So which one is better?

Conventional wisdom still holds; moderation is key both with artificial sweeteners and natural sugars. For someone looking to lose weight, artificial sweeteners are probably your best bet.

But for overall health, table sugar or natural sugar is the way to go — just not too much of it! “Artificial sweeteners have recent medical studies showing safety, but table sugar has centuries of chemical safety data,” adds Dr. Kumar. “We have a lot of long-term safety data for table sugar, but it should be used in moderation.” Try and avoid modified sugars such as high fructose corn syrup and agave nectar; they’re the worst category overall.

You might as well reach for the table sugar for your coffee. One white packet only has 15 calories, and if the rest of your diet is pretty free of added sugars, it shouldn’t be a problem. The USDA recommends no more than 25g of added sugar a day; one packet of sugar is about 4g.

Just make sure you’re reading your labels carefully; calories still count at the end of the day, and aspartame, sucralose, or stevia aren’t an excuse to have a sugar-free free-for-all.