Unfortunately, obesity is linked to a lot of stuff: cardiovascular disease, diabetes, kidney disease, liver disease, osteoarthritis, endometrial cancer, colon cancer, postmenopausal breast cancer- the list goes on and on.  Recent studies have unfortunately linked it to a reduction in cognitive function like Alzheimer’s and other dementias as well. 

Currently, an estimated 47 million people are affected with dementia worldwide and one of the risk factors for dementia as we grow older is obesity.  How did these studies measure obesity? They used a waist to hip ratio as their measure of obesity- not BMI.  BMI is body mass index and takes the height and weight of individuals into account to determine body fat.  However, this is not always a reliable measure as body builders and very athletic individuals can be considered obese but have very little body fat. 

What did these studies find? The studies evaluated the cognitive performance by testing memory and visuospatial tasks and found that adults over the age of 60 with higher waist to hip ratios had reduced cognitive performance in such tasks. 

Why is belly fat (increased waist to hip ratio) associated with cognitive decline? Researchers believe that the reason individuals with increased belly fat show more cognitive decline than their counterparts in similar age groups is because fat cells produce inflammatory markers.  In addition to this, just because you are overweight or obese does not mean that you have the appropriate amount of vitamins and minerals.  The body needs a diverse spectrum of antioxidants and phytochemicals to remain healthy and for our cells to function normally.  Unfortunately, while the standard American diet is heavy on sugar, salt, and carbohydrates, it tends to be low on antioxidants which helps decrease the inflammatory response.
So what can I do to decrease the risk of developing dementia?

1. Focus on reducing belly fat.  Belly fat harms the brain because it produces hormones and chemicals that promote inflammation and insulin resistance. 
2. Decrease processed foods as much as you can.  All sorts of additives are added in processed foods to increase the shelf life and make it taste good.  These additives promote inflammation and are usually nutrient poor meaning they have very fewer antioxidants that help in repair and regeneration of cells.
3. Exercise at least 30 minutes a day! Being active and exercising regularly really helps decrease belly fat and improves your overall health. 

 Some amount of cognitive decline, much like physical decline, is somewhat inevitable as we age.  That being said, being proactive about your health can help minimize those changes, and while your 60s may not be quite the same as your 20s, it also doesn't have to be your 90s.  Good choices now can allow you to see the benefits of your healthy decisions both now (fitting into a favorite dress) and later (being sharp enough to own the competition in the weekly card game).  After all, how else are you going to keep up with your grandchildren?  :)

Dr. Pam

We’ve discussed the overall issues of dealing with infertility on our blog, and we’ve also gone into a bit of detail in the female factors for infertility that we manage more frequently, but today we’re going to take a look at infertility from the male perspective.  This is pretty important as male factors can contribute to infertility in at least 45% of cases (roughly 35% male factors alone and another 10% contributing to cases also involving some female factors). 

So, what makes for healthy sperm?  Essentially, the goal is to have an adequate number of sperm that look and move normally.  That number ranges from a minimum of around 15 million per mL of ejaculate to over 200 million per mL.  Typically, there is about 2-5mL of semen per ejaculate, so if you do the math, that’s a lot of swimmers to try to fertilize one egg.

If a man’s count is low, what kind of testing is done, and what may be some of the causes?  Depending on how low the count is and if there are any concerns noted on either exam or history, testing can involve urinalysis (to look for backward ejaculation), ultrasound (to check for testicular or vas deferens lesions), bloodwork (to look for hormonal causes or genetic issues) and in some cases, even testicular biopsy.  That being said, for levels that are only mildly low, skipping to treatment for the low count may be a reasonable option. 

How can a man help improve the health of his sperm?  Turns out, a man’s overall health can play a big role in his ability to conceive.  Maintain fitness by doing exercise of any type (unless you’re over 6 hours per DAY), and particularly resistance training, which has the greatest effect on increasing testosterone.  From a dietary standpoint, limiting processed foods and emphasizing whole foods will certainly be beneficial.  Also, any food high in zinc such as seafood, legumes, and meats can help with improving fertility. 

As always, there are some things to avoid when trying to achieve pregnancy as well.  Alcohol intake and should be limited, and men should avoid tobacco and drug use, both while trying for pregnancy and even when not trying.  Anything that causes significant increase in heating “his boys” should likewise be avoided.  This can include hot tubs, laptops (on the lap), really tight underwear, and saunas.  Any prescription medications should be reviewed with his doctor to see if decreased fertility may be a side effect, but please don’t have him stop any prescription without reviewing your medication change with your prescriber.  Lastly, some lubricants can be toxic to sperm.  Be sure to check the label, and if you are planning to use lubrication, then select one like Pre-Seed that’s approved to not hinder conception.

If my partner has a low sperm count, what can we do about it?  One of the simplest approaches involves IUI (intrauterine insemination).  This involves collecting your partner’s sperm and have a lab concentrate it for placement directly into the uterus by your provider.  Think of this as providing a head start to the sperm to reach the egg by cutting their travel time down to maybe half.  For other causes, hormonal treatment may be the next step, or in cases of a lesion in the scrotum, surgery may be required.  If all else fails IVF (combining the sperm and egg outside of the body with placement into the woman’s uterus after the embryo begins to develop) may be the best bet.

Discussion of infertility often starts at the ob/gyn office, but depending on the cause, collaboration with either a urologist or a reproductive endocrinologist may be required to achieve successful pregnancy.  The journey can sometimes be rather long, but in the end, a healthy pregnancy is definitely worth it.  Regardless of how you get there, we wish you all the best in having your most enjoyable pregnancy and cutest baby 😊

Dr. Nick

Every couple of months I read a new article about something that needs to be placed in your vagina for for one reason or another.   So, do these products serve any purpose in your vagina, or is this just a way to scam you into purchasing something?  You decide…

​First, there was vaginal steaming, which was touted on popular celebrity websites.  So, what is vaginal steaming?  It involves positioning your vagina for up to 45 minutes over a steaming pot of herbs such as rosemary or basil.  I guess you could figure out how to do this yourself or pay $100 a session at a fancy spa offering such services.  The idea is that the steam can relax your muscles and help rejuvenate your vagina. Spas that offer these services even claim that this increases fertility and helps promote weight loss.  If steaming your vagina could cause weight loss, we would likely see a vagina steaming spa on every corner. 

Next came the Jade Eggs.  For a reasonable price, you can purchase a 1-inch egg shaped stone made of jade to put in your vagina.  So why would one want to put stones in her vagina?  Apparently, it allows you to have better sex, improves bladder control, prevents prolapse, intensifies feminine energy and even invigorates life force.  What can’t these eggs do?  Apparently, they’re good for just about anything but weight loss.  Is there any scientific evidence backing the alleged benefits?  Unfortunately, the answer is no.  However, if you want Jade eggs for your vagina, you may have to wait.  In the past, demand has been so high as to cause the eggs to be sold out online!

Another recent trend was wasp nests in your vagina.  On Etsy, you can purchase oak galls, a medicinal paste of bark and wasp excreta (less gross-sounding, scientific way to describe any waste from the body) to put in your vagina.  The product is touted for its ability to tighten and dry the vagina.  What an awesome treatment goal-hooray for the dry vagina? That would just make intercourse more uncomfortable and increase your risk of infection and abrasions. 

Now the latest fad is inserting garlic in the vagina to treat vaginal yeast infections.  Yep, you heard that right- garlic in the vagina.  This fad has become popular because garlic contains “allicin.”  In a laboratory setting, it may be associated with some antifungal properties.  The operative words here are “in the lab.”  This has not been proven effective in animals, much less humans, and last time I checked, the vagina wasn’t a high school chemistry set.  In addition, the idea of crushing garlic (sorry, it wouldn’t work unless you crush it first), and inserting it in your vagina-ewwww!!!  If you just left cloves in there, would you wait until it sprouted to remove it?  Another serious concern is that garlic grows in the soil.  While there are bacteria in the soil and there are bacteria in the vagina, these bacteria are NOT the same.  This sounds like a vaginal bacterial infection waiting to happen.  It would be a lot easier to go to the pharmacy and pick up some Monistat!!

Why do people keep on coming up with all these strange expensive things to put in your vagina?  Probably in order to make some money.  The list keeps on getting longer and crazier.  It’s especially frustrating because most of these items are touted under the guise or organic, natural, and holistic when they should really be described as dangerous and/or expensive, or at least without a proven scientific benefit.  Before placing anything in your vagina, please talk to your provider because, chances are, your vagina is happy just the way it is 😊

Dr. Pam