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Do fasting diets work?

2/25/2020

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Let’s face it, in today’s world everyone’s always trying to lose a little weight. We live in a world where UberEATS and groceries can be delivered to your doorstep.  We have dishwashers, washing machines, cars and all sorts of luxuries that we have never had.  If you think how many calories you would have been burning hunting for food and fetching well water, it is not surprising that in our modern-day world it’s so hard to maintain our figure and physical fitness. 

​In our quest to look cute on the beach and be healthy too, there are so many diets out there that claim to help you lose weight.  The question is do they work?  One of the newest ones that has gained a lot of traction is the fasting diet.  There are lots of variations- fast for days, fast for hours and alternate.  Is this the newest fad diet or does it work?
Most of the options for this type of diet recommend severe calorie restrictions the days that you are fasting (500 for women and 600 for men).  Some recommend every other day fasting while some recommend 2 days of fasting per week.  Now, if you are restricting your caloric intake like this even if it is just 2 days a week it’s not surprising that you will experience some weight loss and health benefit. 

Also, most fast diets are rooted in achieving health and fitness goals.  So even while they are saying on your off days you can eat what you please, their recommendations are to eat clean and stick with lean meats and limit processed foods on your non fasting days.  Eating clean and avoiding sugar and highly processed foods is always beneficial to both your health and weight loss goals. 

In addition, there is a physiologic reason as to why fasting if done right can be so successful.  One of the theories out there is that by snacking all day, the body is constantly producing insulin spikes which can put oxidative stress on the body.  This worsens the responsiveness of our cells to insulin creating an environment of resistance to insulin.  Decreasing insulin levels by fasting will cause several things to happen.  First, blood glucose will remain normal and the body will switch to burning fat stores in the absence of food.  This is exactly what we want- we want the body to burn all that extra fat!  Second, regular fasting in addition to lowering insulin levels has been shown to improve insulin sensitivity.  Fasting, in essence, is an efficient way of reducing insulin resistance. 

Let’s review how fasting can help you lose weight.  First calorie restriction and eating healthy non processed foods will help you lose weight.  Second, while fasting your body will start to burn fat stores since it doesn’t have another option.  Third, decreased production of insulin will combat insulin resistance and provide you with another tool to combat insulin resistance and the oxidative stress high insulin levels place on your organs and blood vessels. 

Of course, there is always a catch.  If it was that easy, everyone would be doing it right?  For many fasting even twice a week is just too cumbersome.  Sticking to a 500-calorie diet on your fasting days is hard.  In a society where food is so cheap and easily available, this is a much more difficult task than it appears to be. 

So, will the fast diet help you lose weight?  It likely will if done right.  However, it will not be an easy task, and be sure to discuss any diet plan with your healthcare provider prior to starting.  Hope this helps, and good luck on all your weight loss goals!
 
Dr. Pam
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What do we know about the coronavirus so far?

2/18/2020

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One of the biggest international headlines of the year has been the outbreak of coronavirus in China, and its potential spread around the globe.  Here in Idaho, that seems pretty far away, but with the connectedness provided by international travel, are we really that isolated?  It turns out, cases have been reported as close as Washington state, right next door.  While there are many things we don’t yet about this disease, here is an overview of the information we have so far:

What is a coronavirus, and where does it come from?  These include a large number of viruses common in animals but that in some cases may spread to humans.  For instance, SARS was a coronavirus thought to have originated in civet cats (a nocturnal Asian mammal).  There is some speculation that this new Coronavirus (COVID-19) may have originated in bats in Wuhan, China at the live food market.  In answer to your next question, yep, some people may eat bats. 

How does it spread?  If this disease was only limited to those with a culinary affinity for flying mammals, then it would have likely remained relatively isolated; however, COVID-19 appears to have developed the ability to spread from person to person.  This transmission appears to mostly occur via spread of respiratory droplets affecting those within up to 6 feet of the infected individual, so please cover your mouth when you cough.  Transmission may also occur through fomites (things people touch with their dirty hands), though, so be sure to wash your hands regularly.  In fact, this latter form of spread has become enough of a problem in China that they may be considering destroying currency (money) in circulation and printing new yuan (bills).

What else can be done to limit the spread of coronavirus?  In addition to handwashing and good hygiene, the government is limiting travel to and from affected areas.  Recent travelers and those with confirmed cases are also being held in quarantine as affected individuals may not show symptoms for up to 2 weeks.  While putting your life on hold for a couple of weeks of mandatory isolation may sound aggressive, it’s certainly not as intense as the North Korean government’s reported execution of an official who broke quarantine by going to a public bath after returning from China.

What hasn’t worked to limit transimission of coronavirus?  Use of surgical masks on a day-to-day basis hasn’t been proven to reduce infection frequency except in health care workers regularly exposed to the virus.  Also, despite the name, there is no association of the virus with Corona beer.

Well, just how big of a problem is the coronavirus?  At this point, over 70,000 people have been reported infected, and a little under 2,000 have died, or approximately 2.5% of those infected.  2.5% mortality would place it as somewhere more deadly than the flu, which kills only 0.1% or so of those infected, but much less lethal than Ebola, of which some outbreaks are fatal in 90% of infected individuals.  That being said, the actual death rate may be either higher (many of the 70,000 infected individuals are still sick and may still die) or lower (many mild cases may be present and not ever diagnosed).  Even so, 2.5% mortality would be “nothing to sneeze at” if the number of infected individuals becomes high enough.  For instance, the flu typically infects 3 million people in the US each year, and a similar number of coronavirus cases would cause the death of 75,000 people.

So, what is the take home message from all of this?  At this point, we haven’t seen any cases of coronavirus in this state yet, but that could change in the future.  Continue to use good health hygiene, limit your and your family’s exposure to sick individuals, and continue to keep an eye on the news for updates.

Dr. Nick
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ADHD and Pregnancy

2/4/2020

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“I have ADHD and take Adderall.  I just found out I’m pregnant.  Now what?”

ADHD, or attention-deficit/hyperactivity disorder has become one of the most commonly diagnosed neurodevelopmental disorders of childhood, and the number of people on medication for ADHD has increased dramatically.  According to the CDC, 6.1 million (9.4%) of children between the ages of 2 through 17 have been diagnosed with ADHD.  Two thirds of these children are taking medication.  4% of adults have been diagnosed with ADHD and this number has increased steadily over the last couple of years.  Currently the number of women with ADHD on medications is small.  About 1 in 100 women took ADHD medication during pregnancy.  This number will likely increase dramatically as so many more adults carry the diagnosis. 

Medications taken for ADHD include the following: Adderall, Concerta, Vyvanse, Ritalin, Focalin, Dexedrine, Metadate to name a few.  These medications are stimulants and can be short acting, intermediate or long acting.  The side effects of these medications include loss of appetite, weight loss, sleep problems, tics, heart palpitations, or worsening of anxiety or depression. 

Is my baby at higher risk of birth defects if I take medication for ADHD?  The answer to this is, unfortunately, yes.  ADHD medication in early pregnancy may be related to the following birth defects: gastroschisis (a condition where the baby’s intestine develop outside the baby’s body), omphalocele (a condition where the intestine of other abdominal organs are outside of the body), and transverse limb deficiency (where all or part of an arm/hand or leg/foot don’t develop).  A study performed by the CDC found that women who took ADHD medicine during early pregnancy were at a higher risk of having a baby with certain birth defects compared to women who did not take ADHD medication. Since the overall risk of birth defects is very low, data from this study was based on small numbers and so the literature on ADHD medication during pregnancy is very limited. 

In addition to this, there is an increased risk of low birth weight, prematurity, preeclampsia and increased morbidity because of increased placental vasoconstriction (when the blood vessels contract and don’t deliver blood effectively).  There can also be symptoms neonatal withdrawal. 

So, what should I do?  Unfortunately, we don’t have a great reservoir of information on the topic because the data is limited.  The data is even further limited to determining long term behavioral and learning effects to children who were exposed to stimulants in utero.  For these reasons, we encourage women with mild to moderate ADHD symptoms to consider discontinuing medication and switch to behavioral therapy while pregnant or even before conceiving if possible. 

For patients with severe ADHD, this decision would likely be made on a case by case basis in conjunction with their psychiatrist.  If you are pregnant or trying to conceive and currently taking medication for ADHD, please have a detailed discussion with your provider prior to continuing (or discontinuing) the medication while pregnant or attempting pregnancy.
 
Dr. Pam
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