A very common question at appointments lately is “I think my hormones are out of balance-can I get them tested?”  While society may tell you that an imbalance is the cause for everything from weight gain to mood change to almost any other symptom, it’s not likely the culprit for women with normal cycles, and here’s why:  the amount of sex hormones fluctuates markedly over the course of a menstrual cycle, and in fact, if they didn’t, there would be markedly dysfunctional cycles.  Here I’ll review what happens during the menstrual cycle as well as each hormone involved, how it changes over the course of a menstrual cycle, and also what it does.

What is the menstrual cycle?  The menstrual cycle starts on the first day of bleeding during the period and lasts until the first day of bleeding during the next cycle.  The lining of the uterus is shed and then begins to thicken again in case pregnancy occurs.  Ovulation generally occurs around the midpoint of the cycle (about 2 weeks before the start of the next cycle) in response to hormonal changes, and while the ovum (egg) is present, fertilization and pregnancy may occur.  If there is no pregnancy, then the cycle starts over again.  The length of the cycle can be calculated by using day 1 as the first day of bleeding and then counting days until bleeding starts again.  Typical ranges can be from 24-38 days.  Now that the cycle has been explained, we can move on to the important part – the hormones.
​

1. FSH and LH – think of FSH as the director of a cycle.  Follicle stimulating hormone (FSH) comes from the pituitary gland in the brain and is responsible for the growth of an egg during the menstrual cycle until ovulation is triggered by luteinizing hormone (LH).  FSH is highest just before ovulation and then decreases following the release of an egg until it’s time for the next menstrual cycle.  In menopausal women, levels are consistently very high because the pituitary gland wants to stimulate release of eggs from ovaries that are no longer responding.
2. Progesterone – this hormone is released from the corpus luteum (a cyst formed on the ovary each month).  It increases in the second half of the cycle in order to support a pregnancy should it occur, but if there’s no pregnancy, the corpus luteum goes away and the decreased progesterone triggers a menstrual cycle.  High progesterone levels in the second half of the menstrual cycle are responsible for many of the PMS symptoms experienced by women including acne, mood change, headache, breast tenderness, and everyone’s favorite-bloating.
3. Estrogen – estrogen is produced by the dominant follicle in the ovary and increases as the size of the follicle increases over the first half of the cycle.  Increased estrogen thickens the lining of the uterus in preparation for possible implantation of the pregnancy.  Once estrogen levels are high enough, then the LH surge triggers ovulation and the second half of the menstrual cycle begins.  The decrease in estrogen in the latter part of the menstrual cycle stops the thickening of the uterine lining and works with the decreased progesterone levels to allow the menstrual cycle to start over if there hasn’t been a pregnancy.  Persistently high estrogen levels, such as those caused by estrogen production in adipose tissue in women with PCOS, cause continued growth of the uterine lining.  Continually elevated estrogen can ultimately result in unpredictable menstrual cycles as triggers for bleeding can be suppressed, and these cycles can often be very painful and heavy as several months worth of endometrial lining can be passed at the same time.  Over a long enough time, this type of bleeding can even result in endometrial (uterine) cancer.
4. Testosterone – testosterone, while generally thought of as a male hormone, is present in women, although in much smaller amounts.  Testosterone is a driver for libido and plays a role in developing/maintaining muscle mass and bone density.  There is a slight increase around the time of ovulation (in order to encourage procreation), but otherwise levels are pretty stable.  If testosterone levels get too high, women can experience acne, facial/body hair growth, deepened voice, male pattern baldness, heart disease and increased clitoral size.  While some of those effects are temporary, many of them may be permanent.

Given the natural course of hormonal change during the menstrual cycle, a single hormone test may be misleading.  For instance, progesterone levels prior to ovulation will be lower, but by adding supplemental progesterone to “correct” this imbalance, a woman might then live in a constant state of PMS.  Unopposed estrogen in a woman with a uterus will likely lead to irregular bleeding and could cause endometrial cancer.  Testosterone supplementation at high enough levels could cause permanent hair loss (from the scalp) or permanent hair growth (on the face and body) among other issues.  Many times the good intentions to supplement a natural fluctuation in sex hormones will likely make symptoms worse rather than better, and in turn, this could result in further unnecessary tests and procedures.  For nearly all premenopausal women, the better bet may be some sort of contraception-based hormone management.  That being said, be sure to review your full health history with your provider before starting any hormonal therapy, contraception-based or otherwise, to ensure it’s a safe and medically-appropriate treatment option for your specific symptoms. 

Dr. Nick  

There are lots of people out there that are worried about not taking enough Vitamin D supplements.  Its more popular than most supplements out there including fish oil, probiotics, and antioxidants. 

​What is all the hype all about and is it real?  Originally, we were told that Vitamin D helps prevent thinning of the bones.  More recently is has been touted to be a panacea for just about everything.  It helps boost the immune system and mood, helps with muscle weakness, fatigue, prevents cancer/heart disease/diabetes and even helps slow down the aging process.  So whenever one supplement does all this, I think we should be a little skeptical. 

What does Vitamin D do?   It helps your intestines absorb calcium.  Without Vitamin d, your intestines can only absorb 10% of calcium from the diet; with it your body can absorb about 40%.  Your body needs calcium to make your bones strong.  Without enough calcium, your bones will start to thin, soften and can bow outward (known as Rickets in children) and can increase fractures in older adults. 

Many vitamins must be consumed from different types of foods because your body can’t make it.  Not Vitamin D.  Vitamin D is made in our skin when exposed to sunlight and then converted in the liver and kidneys to usable forms.  Vitamin D is found in certain specific foods as well.  Since certain states have long winters and less exposure to sunlight, the federal government has required that Vitamin D be fortified in certain foods like milk, yogurt and orange juice to prevent diseases like Rickets.  This disease is pretty much nonexistent in modern times because of fortified foods. 

So why did experts think Vitamin D was so useful for so many things.  Researchers did observational studies where they looked at people who took supplemental Vitamin D and found that they were less likely to have certain cancers, hypercholesterolemia, hypertension, heart disease, fractures and a myriad of other chronic illnesses that are common in our modern world. 

I thought Vitamin D was just supposed to help with bone health, so how did it help with everything else?  In these observational studies, the individuals decided whether they took additional Vitamin D or not.  The people that were more likely to take theses supplements were more likely to be healthy, i.e. exercise regularly, eat healthily, and thus less prone to chronic diseases like heart disease and diabetes.  When randomized controlled trials with Vitamin D were done (the researchers picked who got Vitamin D and who got a sugar pill), the results were quite different. Most of those studies did not show any benefit in the group that received Vitamin D supplementation.  Some even found that Vitamin D supplementation may cause more harm: high levels of Vitamin D could cause weakness (and increase falls causing fractures), vomiting, and kidney stones. 

So, what does all this mean?  First, Vitamin D is not a cure all despite what celebrities may tell you.  Second, the most important way to stay healthy is to get your vitamins and minerals from actual food and not from supplements.  Third, get some sunshine (just not too much!*) and stay active outside.  This will boost your levels of Vitamin D and provide way more benefit than you realize.  Talk to your provider and decide whether you need Vitamin D blood level testing.  Remember 97% of people in the US have adequate levels of Vitamin D (from the sun and fortified foods) when the Institute of Medicine and US Preventative Services Task Force determined that blood levels above 20 nanograms are adequate.  However, more than 50% of individuals were noted to have inadequate levels when certain commercial labs changed the necessary level to >30 nanograms to have an adequate amount of Vitamin D.  Hope this helps to clear up the craze surrounding Vitamin D.  It would be awesome if a single supplement in pill form helped cure everything, but for better or worse, the old adage still holds-if you want to be healthy, balanced diet and regular exercise trump supplements**.  Have a good summer and get your vitamin D the old-fashioned way, by enjoying that Idaho sunshine while it lasts!

 Dr. Pam

*Too much sunshine, particularly without the use of sunscreen, could increase your risk of skin cancer.
**Be sure to talk to your provider before discontinuing any recommended treatments.

As screen time increases, we’ve begun to see a number of health concerns ranging from headache and eye strain to posture issues and obesity to increased anxiety and loss of interpersonal social skills.  Some of the correlation can be more self-explanatory, i.e. hours a day craning your neck to look at your phone can hurt your neck, but some potentially negative health effects, such as those caused by blue light, may be more subtle.  Here we take a look at blue light and how it can affect your health.
​
What is blue light?  Taking you back to grade school, a rainbow shows the different colors that make up white light, ranging from red at one end all the way to violet at the other.  Red has a longer wavelength and is less easily scattered whereas blue has a shorter one and is more easily scattered.  That’s why the sky generally appears blue.
Ok, but what does it do?  Blue light is awesome during the daytime because it can boost attention, mood and reaction times.  It’s not so great at bedtime.  Prior to electronic screens, humans essentially evolved to be dependent on the sun for this type of stimulation, and it’s why for however long humans have been around, people tend to be more focused during the day and sleep at night.  Now, with the advent of tablets and cell phones, some people can’t even get out of bed until they get their electronic fix and the blue light that wakes them up.

Um, is that a problem?  It may not be the end of the world to play on your phone a minute or two before getting up, but not being able to sleep at night due to screen time definitely isn’t a good thing.  Blue light decreases melatonin levels, which are responsible for your circadian rhythm, meaning that falling asleep can be harder.  In some cases much harder.  Given that just over 2/3 of the U.S. has trouble sleeping at least one night a week, it’s not unreasonable to think that there may be a correlation, especially as this is nearly an identical number to those in the U.S. with a smart phone.  Those sleep struggles can lead to obesity, heart disease, decreased libido, inhibited immune system, and even contribute to some types of cancer.

Yeah, but I’m not getting rid of my smart phone, so what can I do?  In an ideal world, stopping screen time for at least a few hours before bed is a good idea.  In a practical world, screen settings with warm light or blue light-filtering glasses/screen protectors may provide some benefit.  While some studies suggest these measures can help prevent some of the melatonin decrease associated with sleep disturbances, the data is mixed, so it’s unclear if these measures really make things better or just make us feel better about trying to do something.  The bottom line is that light is good during the day, and sleep is good at night 😊

Dr. Nick

Antibiotics are one of the great advances in medicine.  They have allowed us to treat infections and do surgeries like cesarean sections that would most likely have resulted in death from infection in the past. That being said, there are definitely times when antibiotics can be helpful, but there are also situations in which they aren’t.  To help explain the difference, here’s a quick overview.

First, what do Antibiotics treat?  Germs consist of bacteria and viruses.  Bacteria are living organisms that exist as single cells.  Bacteria are everywhere.  Some cause disease, some do not, and some are even beneficial like the ones that line your intestines and help with breakdown of food.  Viruses are not alive and invade our cells and use them to replicate.  Viruses are generally harmful.  Antibiotics only work against bacteria because they are living organisms.  They do not work against viruses. 

Antibiotics are great at treating bacterial infections that can cause pneumonia, ear infections, or sinus infections, and they can prevent infections during surgery.  However, if these infections are caused by viruses like the common cold or the flu, antibiotics will not help and are only likely to stir up all sorts of issues:

1. First, antibiotics can have lots of side effects!  The most common side effects of antibiotics include vomiting, nausea, diarrhea, bloating, and abdominal pain.  Notice how the most common symptoms are GI related.  The reason for this is there are lots of bacteria in your intestines- some are good and help with the breakdown of food and some are bad.  In the process of killing bad bacteria, antibiotics may inadvertently kill some good bacteria in the stomach as well, and this is what causes these side effects.  Other symptoms include hives (a scaly itchy rash), coughing, and wheezing.  In fact, some individuals even have trouble breathing (this is an emergency that requires an urgent visit to the ER). 
2. The overuse of antibiotics to treat things like the common cold have led to antibiotic resistance.  As bacteria get exposed to antibiotics, they find a way to thwart the effects of the antibiotics on their cells.  This is how they become superbugs.  They find ways to combat the effect of antibiotics and survive despite being bombarded by different types of antibiotics.  What many physicians are worried about is as more bacteria become resistant, we will run out of antibiotics to treat common bacterial infections because they will be resistant to all the antibiotics currently available. 
3. Another side effect of antibiotics is a common complaint from patients to their gynecologist- vaginal yeast infections.  Antibiotics cause yeast infections in the vagina for the same reason they cause GI side effects.  There are many good bacteria in the vagina. Antibiotics can kill off these beneficial bacteria and cause an overgrowth of yeast in the vagina causing a cottage cheese like discharge and severe itching.  Alternatively, they may also contribute to bacterial vaginosis. 
4. Using antibiotics can cause other infections like clostridium difficile (c. diff).  C. Diff is a bacterium that can cause symptoms that range from diarrhea to a life-threatening inflammation of the colon.  When you take antibiotics to treat an infection, it can destroy some of the normal, beneficial bacteria in the intestines and cause an overgrowth of c. diff. 

There are lots of other theories out there as well that frequent antibiotic use in childhood may be a precursor to chronic diseases like asthma and obesity.  While the evidence for this is limited, we should be very wary of taking antibiotics when not necessary.  The best way to prevent these issues is by being a good steward of our current available antibiotics. 

In closing, here are a few quick tips for making the most of your antibiotics.

1. Please take antibiotics if your doctor encourages you to take antibiotics for illnesses or procedures.  Only take antibiotics that were prescribed by your doctor for you, take them as directed and do not skip doses in an effort to save them for later.   This often kills only the weak bacterial cells while leaving the stronger ones, which can cause your symptoms to return with a vengeance AND be harder to treat.
2. Trust your doctor if they feel your symptoms are more consistent with a viral illness and that antibiotics are not necessary. 
3. Consider probiotics foods while on antibiotics to help regenerate the beneficial bacteria of the gut.  This may help decrease the GI side effects, vaginal yeast infections and other issues caused by antibiotics. 

Dr. Pam

Were your plans to shed the baby weight upended by the COVID-19 crisis? If so, don’t panic: Weight gain is a perfectly normal response to major stressors, and it doesn’t have to be permanent. There are plenty of safe, healthy ways to get your body back on track. We’ve put together some tips you can use to help you feel like yourself again.
 
Focus on Nutrition
 
Your first step should be taking an honest look at your diet. Your primary goal should be hitting all of your nutritional needs. Stress-eating is rarely healthy eating. More often than not, when we’re stressed out, we turn to high-fat, high-sugar foods that don’t really do much for our bodies other than satisfy a craving. When we’re hitting our nutritional goals, however, we’re less likely to feel those cravings in the first place.
 
Moreover, our bodies will be able to work at their best when we meet our nutritional needs. This makes us more energized, sharper, and less likely to get sick. If you’re not sure what your nutritional needs are, you can always hire a nutritionist. These pros will help you figure out exactly what your body needs, and they’ll help you come up with a diet plan that will enable you to reach your goals safely. Other freelance workers, such as professional trainers or yoga instructors, may be good resources as well.
 
Switching to healthier snacks, focusing on portion sizes, and making sure you have a nutritionally complete diet will make a massive difference. Ask your nutritionist to help you figure out some healthy recipes you can make with shelf-stable pantry items, so you have ideas when you’re between essential grocery trips.


Get Moving
 
With gyms closed, many of us have fallen off of our workout routines. Unfortunately, this doesn’t just mean you might gain a little more or lose some muscle. Exercise is vitally important for every aspect of health, from immune function to emotional well-being. When we stop working out, we’re more likely to experience the kinds of stress and anxiety that lead to overeating, leading to a vicious cycle.
 
Find ways to exercise either in your home or around your neighborhood. Going for a run, bike ride or hike is a great way to burn some calories while getting some safe, socially-distanced time outside of the house. You can also check out exercise videos on YouTube or virtual workout classes if you don’t have any good place to workout outside. Remember to listen to your body, and only workout after you’ve had the all-clear from your doctor. Postpartum bodies may take some time to get back to their pre-pregnancy fitness level, so go easy on yourself if you’re not quite where you want to be yet.
 
Seek Mental Health Care
 
The postpartum period is a difficult one emotionally. Mix a massive physical feat, huge life change, enormous hormone dump, and sleep deprivation together, and you have a potent cocktail for acute mental health issues. Throw a pandemic into the equation, and the odds of developing some level of emotional problems go even higher. Remember to keep an eye out for signs of postpartum depression and anxiety, which can crop up anytime within the year following childbirth.
 
Even if you don’t think you have anything diagnosable going on, it may still be worth it to reach out to a mental health professional. Telehealth sessions are a great way to get some of the anxiety you might be feeling about the current situation off your chest. Moreover, they can give you coping mechanisms you can use to get through the tough times without turning to emotional eating.
 
Living in a postpartum body is tough in the best of times. You don’t feel like yourself, your body doesn’t work the way it used to, and you’re stressed out all the time. Don’t put pressure on yourself to lose too much, or too quickly. Find a safe, healthy plan that you can commit to, and be gentle with yourself along the way. Your body has done something amazing - treat it well.
 
Photo Credit: Unsplash
​
Guest blog courtesy of Elena Stewart

These are really stressful times.  Even for those of us in Bonneville County with so few Covid 19 cases and the majority of our hospitalized patients with Covid 19 being from out of state, this is really hard.  The stress of getting Covid 19, potentially giving it to an older family member with questionable health, and the financial stressors of having an economy in shutdown mode is very stressful.  Every day I get asked how to deal with the anxiety and the stress that this has caused.  The good news is the original projections have been wrong so far.  The fear of millions dying, the fear of having a health care system being overrun and not having enough beds and ventilators has not come to fruition.  The Lancet medical journal has now estimated the mortality rate to be about 0.6%, with the majority of deaths occurring in patients who are either elderly or who have underlying health issues, and this does not even take into account the huge number of asymptomatic carriers that already have it.  As testing improves and immunity testing (a test that would allow us to know if you have already been exposed to it) becomes more readily available, the mortality rate will likely decrease further.  So, we can all take a deep breath.  Here are some coping mechanisms that can be helpful to get us through this pandemic and economic shutdown.

1. Decrease screen time: Since a lot of us are now doing schoolwork or working from home, our screen time has already skyrocketed.  Unfortunately, increased screen time is associated with increased anxiety, weight gain, depression and insomnia.  Also, the media has stoked fear and anxiety about Covid 19 even further.  Turning off the constant barrage of projections and modeling may help decrease the anxiety related to this novel virus.  
2. Getting Outside: Spending time outside whether it be exercise (running, cycling, etc. especially as all the gyms are closed) or yardwork or other activities is really important because it helps expose the skin to sunlight maintaining healthy vitamin D levels, which in turn decreases the chance of seasonal depression and keeps us healthy.  Exercise also releases natural endorphins.  Endorphins have been shown in studies to be just as effective at combating depression as antidepression medication.  Exercise will also help combat weight gain that is bound to happen by being stuck indoors and feeling the pressure to eat your way through your coronavirus food stash before it expires (anyone know what to do with 2 dozen brown bananas?!)
3. Spring Cleaning and organizing can be therapeutic for some especially when you’re stuck indoors all day.  It will give us an opportunity to channel our inner Marie Kondo and have a fresh start when everything opens back up. 
4. Explore new hobbies.  Whether it be cooking or doing puzzles or sewing masks, exploring new hobbies will help deflect energy towards something positive. 
5. Take up meditation.  Even if you’ve never done it before, there are a number of easily accessible apps to guide you through the process.  Meditation can reduce anxiety and stress, lengthen attention, improve sleep and lower blood pressure while also providing a more positive outlook on life and even making you a kinder person.  That last benefit may prove extra beneficial when cooped up with someone who may be getting on your last nerve!
6. Read a book.  While for some, bad reality TV provides a temporary escape from daily stressors, reading can expand vocabulary and knowledge, improve memory, decrease depression and stress, and even improve sleep (especially with some boring nonfiction!).  In all seriousness, though, a book can be an oasis from the worries of your day without the baggage of screen time.

2020 has been challenging on a number of levels.  While it started off with a lot of promise, for many health concerns have gone from a more nebulous concern (I should probably get in for my pap soon) to a daily worry.  Add in some financial hardships as so many people have lost their jobs and top it off with confinement at home in close quarters with limited privacy and outlets for stress, and it’s easy to see how stress can become overwhelming.  Fortunately, these restrictions can’t go on forever, and eventually life will have to return to normal.  We hope that when it does, we can get back to supporting all of the local restaurants and other businesses that make this community special.  By then, we’ll all need a haircut 😉
​
​Dr. Pam

​For many women, taking prenatal vitamins is a chore.  I often hear “Do I really have to take them?”  They’re too big to swallow, they make me sick, they make me constipated, I forget, and I don’t like to take pills are just a few of the reasons that some women give for not taking them.  It turns out, though, that prenatal vitamins actually play multiple important roles in having a health pregnancy, and unless you’re in a very small minority, it’s unlikely that you’re getting all of these nutrients from your diet alone.
​

1.  Folic Acid – you want a prenatal with a minimum of 600 micrograms of folic acid although, depending on your medical history, you may need up to 2000 micrograms per day.  Folic acid helps prevent neural tube defects.  In case you were wondering, the neural tube is the part of the embryo that becomes the brain and spinal cord, so of all of the growing parts of your baby, this is definitely one of the most important.
2. DHA – this is an omega-3 fatty acid that helps with development of your baby’s brain and eyes.  You’ll want to shoot for 200 milligrams per day.
3. Iron – 27 milligrams of iron per day helps reduce your risk of anemia during pregnancy.  A low blood count decreases the amount of oxygen delivered to your baby, and since he/she can’t breathe on their own just yet, oxygen has to come from mom.  Additionally, anemia near the time of delivery lowers the reserve for mom and increases the chances that she may have to have a transfusion if she has more bleeding than expected during delivery.
4. Calcium and Vitamin D – 1,000 milligrams per day is important for a developing baby’s bone growth and muscular function, and it also helps prevent bone loss in mom as her baby grows within her.  Adding 600 IU of Vitamin D daily helps your body with the absorption of calcium.

So far, we’ve largely focused on benefits of prenatal vitamins for baby, but there are also several benefits for mom as well.  For instance, the folic acid in the prenatal vitamins can reduce risk of ovulatory infertility by up to 40%.  Also, for women who take prenatal vitamins for 3 months prior to conceiving, there is a reduced risk of hyperemesis gravidarum (severe nausea and vomiting in pregnancy).  Prenatal vitamins begun prior to conception are the most effective in reducing risk of birth defects anyway, so about 3 months before trying to conceive could be a perfect time to start taking them.

These are the reasons that prenatal vitamins are so useful in having a healthy pregnancy.  Whether you take regular ones, gummy ones, expensive ones or cheap ones, prenatal vitamins are important.  While they won’t fill in the shortcomings of an Oreo and Cheeto-based diet, they can increase your chance of conceiving, reduce risk of birth defects, and reduce the odds of severe nausea in pregnancy.  That’s why prenatal vitamins can be a win for mom and baby 😊
Dr. Nick

The grocery shelves are empty and most of us have been to at least 3 different places just to find toilet paper.  Many of my new moms can’t even find formula for their babies.  Is there a shortage?  No, but there is a manufactured shortage fueled by hysteria.  At this point, one might wonder what is more dangerous the coronavirus (COVID 19), or the fear and anxiety that has been generated by the media?

1. So, let’s compare COVID 19 to the flu for a second.  Which is more likely to kill you? The answer is the flu.  As of March 7, 2020, 38 million people in the U.S. have been affected by the flu.  Somewhere around 390,000 have been hospitalized, and somewhere around 23,000 people have died.  In fact, the hospitalization rate for influenza in children 0-4 and adults 18-49 is the highest ever, even higher than H1N1.  To date, Covid 19 has affected nearly 50,000 people in the US and about 650 people have died.  The mortality (or death) rate from the seasonal flu is typically around 0.1%.  The mortality rate for Covid 19 currently stands at a little over 1% in the US.  What this means is if you get COVID 19, you are more likely to die than if you get the flu; however, you are far more likely to get the flu than COVID 19.  So, statistically, at this point, you are far more likely based on probability to die from influenza than you are from COVID 19.  Despite these numbers and the big push for a coronavirus vaccine, only around 40% of the population is amenable to the influenza vaccine that could potentially save more lives.
2. That being said, I am definitely not telling you to ignore the current recommendations of social distancing or taking appropriate sanitary precautions and following guidelines set by the governments.  Even though up to 20% or more of those infected may have no symptoms, coronavirus is still a very serious illness for those who become ill.  Who does this virus affect?  Those most at risk of death are the elderly, especially those with chronic disease.  The mortality rate for those over age 65 with chronic diseases is 16%.  By following these precautions, we are decreasing exposure and the chance that this age group will contract a disease that is way more deadly for them than a healthy 20-year-old (the chance of a healthy person younger than 55 dying from coronavirus is <1%; for those 85 or older, it could be anywhere from 10-27%).  As for pregnant women, the good news is that coronavirus does not appear to cross the placenta to the baby, but just like for the flu, pregnant women are at a slightly higher risk for severe respiratory symptoms because their immune system is a bit compromised in order to prevent rejection of their growing baby.
3. One of the biggest concerns for many is a comparison of our healthcare with Italy-they don’t have enough ICU beds, ventilators or even enough space to bury the dead.  Fortunately, there are a lot of differences between Italy and the US.  In Italy, 25% of its population is over the age of 65 (thank you Mediterranean diet!).  In the US, only 16% of the population is over the age of 65.  The number of critical care beds per 100,000 people in the US is 34.7.  The number of critical care beds per 100,000 people in Italy is 12.5.  So, not only is there a disparity in patient population, but it is also present in the healthcare infrastructure that is contributing to the higher mortality rate that we are seeing in Italy compared to the US.  These factors contribute to a mortality rate in Italy is currently at 9%!  This does not mean that we should be falsely reassured, though.  The U.S. population is 5 times higher than Italy, and this is going to be a huge strain on our health care system.  Covid 19 has also shown that we may benefit from reassessing our production/supply chains for medical devices/pharmaceuticals as we find decreased availability of medical supplies and medications for sick patients and healthcare providers. 
4. There will be lots of lessons to learn from COVID 19.  This will test our preparedness in adversity, and it will teach us how to be better equipped for large-scale health crises in the future.  Importantly, though, we cannot lose our humanity and touch with reality.  Stocking enough toilet paper for 1 year is not going to make you immune to COVID 19, and in fact, it may help facilitate its spread.  If the rest of us have to go to three different stores to find a roll of toilet paper, it increases our exposure to others.  This could negate the effects of social distancing that we have been practicing for the past week.  All those hours of being cooped up in the house and driving each other crazy, and the only benefit will be a really clean bum 😉 

Dr. Pam

​






Image via Pexels

Let’s face it: Nobody wants to wake up on Monday morning and start a new work week. However, the Sunday Scaries
— that feeling of anxiety at the midpoint of the weekend — can make Monday that much worse. And by stressing out, you can lose the joy of half your weekend. Here are a few resources that can help you prepare for the week ahead.
 
Your Home, Your Sanctuary
 
Your overall attitude is partly determined by how you feel when you’re spending time at home. Here’s how to make your space a sanctuary.
 
57 Inspiring DIY Fire Pit Ideas and Plans to Make S’mores with Your Family
8 Must-See Features for the Ultimate Spa Bathroom Makeover
5 Tips to Create a Relaxing Bedroom
Room-by-Room Stress Reducers for Your Home
 
Feed the Senses
 
Sight, sound, touch, and taste also make a difference in how we perceive stressors.
 
The 10 Most Relaxing Songs in the World, According to Science, Ranked
21 of the Most Comforting TV Shows to Watch When You're Stressed
9 Foods That Calm Anxiety (and 3 That Make It Worse)
Reduce Stress Using the 5 Senses
 
Exercise Does a Body (and Mind) Good
 
Exercise really is nature’s medicine. Whether you want to walk or spend the weekend trekking the backcountry, the more you move, the better you’ll feel.
 
Can Exercise Help Treat Anxiety?
The Pacer Blog: Walking, Health, and Fitness
10 of the Best Weekend Backpacking Trips in the US
33 Ways to Increase Dopamine to Boost Your Productivity
 
Monday does not have to be a terrible “four-letter word.” The above links are full of great information to help you get your entire family mentally prepared to enjoy the weekend, and then tackle the week ahead.

Elena Stewart

As a definite meat-eater married to a definite vegetarian, we have certainly discussed the health aspects of eating meat (or not).  Now that there’s a new spin on typically meat-based dishes, we’ve had a chance to rehash some of those discussions, and after doing some research, here’s what we’ve found.

First of all, what’s this “fake” meat made of?  Meat alternatives generally start with a plant-based protein such as soy, pea, wheat or potatoes.  Mushrooms can also be a foundation of synthetic meats.  The “blood” that comes out after a big bite of your rare burger is produced either from beet juice or leghemoglobin, the plant version of the protein that makes your red blood cells red.  Given the variety of sources of plant-based “meats,” be sure to check the ingredients for any triggers of food allergies.  Also, as there are a number of oils and other preservatives, sometimes there can be some GI sensitivities as well, so it’s probably best to see how your body responds before downing a meat substitute breakfast sandwich followed by a plant-based burger for lunch and some faux fried-chicken for dinner.

Is it really healthy?  One of the most common misconceptions about a meat-free diet is that it’s inherently healthy.  A cinnamon roll for breakfast, cheese pizza for lunch, and fries with a milk shake for dinner is technically vegetarian, but it’s not healthy.  Unfortunately for many meat substitutes, while base ingredients like pea protein can be very healthy, the amount of salt and additives you have to add to convince my taste buds that I’m devouring a juicy hamburger renders most of the health benefits a moot point.  The caloric content is roughly equivalent, the few grams of fat you save are replaced by carbs, and you’ve increased the salt content by about 25%.  You do end up with less cholesterol and a little more fiber, but you’ve lost a few grams of protein.  You may also lose out on some of the benefits of eating meat to begin with, which are vitamin B12 and iron (these micronutrients are often deficient in vegetarians).  Lastly, we don’t really have any studies regarding the longterm health effects of meat substitutes and the additives needed to make them taste like meat.

So, there’s not really any benefits?  From a health standpoint, a greasy burger or fried chicken (real or fake) isn’t going to be the foundation of anyone’s healthy diet, but there are a few advantages of fake “meat.”  First, there’s no need to inject antibiotics or hormones to make an animal grow faster and increase food production.  Also, to be fair, there is noticeably less impact on the environment to grow vegetables than animals for food.

What’s a person to do then?  From a health standpoint, we do note increased health benefits from a plant-based diet, although that’s probably not one based entirely on meat substitutes, at least with how these are produced now.  As for real meats, less processed is generally preferred, and free range, antibiotic-free and hormone-free are going to be the best options with regards to health.  When it comes to choosing some of the healthiest meat of all, wild game is another strong contender.  These animals tend to have the leanest meat as they are inherently free range, and it also guarantees avoidance of hormones and antibiotics while having the added advantage of increasing exercise for the hunter.

In the end, whether eating real meat or fake, moderation is going to be key, and be sure to keep an eye on the ingredients in those foods, especially synthetic ones.  Cooking for yourself will give you even more control over your food ingredients, and to maximize your health benefits, try making the foundation of your meals unprocessed vegetables and fruits.  It turns out that when your mom made you eat your vegetables before you could go play, she knew what she was talking about after all 😊

Dr. Nick