One of the most common questions I get asked every day is weight loss tips.  It’s frustrating to come in for your annual and notice that you have gained 15 pounds since last year.  I usually know the question is coming right when I walk into the room.  Obesity increases the chance of developing many chronic diseases- heart disease, diabetes, breathing problems, certain cancers, arthritis, high blood pressure and stroke to name just a few.   For the first time, we are actually seeing a decrease in life expectancy due to chronic diseases that can be easily prevented by lifestyle changes.  So, here are some tips on how to help with weight loss and improve your overall health. 

1. Rule #1: No snacking at all.  Snacking throughout the day causes continuous insulin releases.  This tells your muscle and fat cells to store all the fat and sugar you eat.  This is how you gain weight.  Also, more frequent insulin release leads to insulin resistance because your cells stop responding to the insulin produced.  I always tell patients to stick to only 2 to 3 meals a day and no more than that.  Only water in between.  This is the reason that fasting diets are so successful- they take advantage of decreased insulin release throughout the day and this is how they contribute to weight loss.
2. Rule #2: Stay away from processed foods: Anything that can survive in your refrigerator for more than 2 weeks is likely processed.  Again, the emphasis is on refrigerator.  Most things in your pantry other than dried spices are also processed.  In general, processed foods are high in sugar, salt, and artificial everything.  These foods were made in a laboratory somewhere and have an excessive amount of sugar, salt and flavor enhancers to encourage constant cravings.  They are very calorie dense and nutrient poor.  Start looking at nutrition labels on food and if you see things like MSG, natural flavoring, disodium guanylate, yeast extract, hydrolyzed protein, autolyzed yeast, aspartame, and other long chemical names that you can’t pronounce-don’t buy it or consume it.  This is not real food.  These are mostly chemicals manufactured in a laboratory that are high in calories and artificial flavors and packaged and then sold in a grocery store near you.
3. Rule #3: Try to cook your own meals: This will help you stay away from processed foods and allow you to have control over how much sugar and salt you consume.  I know this is time-consuming, but this is the only way to have control over your overall nutritional health.  This will also save you lots of money. 
4. Rule #4: Try to stay away from chain restaurants.  Oftentimes with these restaurants, the food is premade in some industrial place (again it is likely high in calories, low in actual nutrition and full of chemicals and artificial flavor enhancers to keep you coming back) and then shipped to the restaurant where it is simply reheated before serving.  This is a just a recipe for gaining weight.
5. Rule #5: Be wary of excessively fatty foods and diet fads.  Diets like the Atkins diet are popular because they allow you to eat fatty foods like bacon and butter.  The idea is that you can eat really yummy fatty foods and, as long as you restrict carbs, you will trick your body into seeking energy in stored fat.  This sounds awesome in theory- you can eat fatty foods and lose weight.  While patients do lose weight initially, most are unable to maintain such a low carb diet for long.  In addition, eating a lot of fat puts a lot of oxidative stress on your body and is what contributes to metabolic syndrome and other chronic diseases of obesity.  Unfortunately, the Atkins diet wasn’t even overly successful for its founder as Dr. Atkins was reported to weigh over 250 lbs when he passed away.

Hopefully this helps!  While discipline and lifestyle choices play a big role in weight gain, it’s hard to make informed choices about your health when you don’t have all of the necessary information.  The more I read about processed foods, the more I realize that these are calorie dense foods that are engineered to make you fat and instill cravings so that you keep coming back for more.  In addition, these foods are so poor in actual nutritional content that they make you even more prone to developing chronic diseases like diabetes, high cholesterol, and heart disease.  While I think restaurants and food companies should be able to produce and sell their products, I also think that they should be more transparent about the ingredients and content of the food that they produce.  Good luck with your weight loss goals!

​Dr. Pam

​As I near the end of the prenatal visits with patients, I often hear “Whatever you do, I hope I don’t need pitocin,” but when I ask why, there’s never really a clear answer.  It’s usually that they heard from someone who had a friend who had a cousin, or they read online that someone said it was bad.  With this blog, I hope to help sort some of the fact from fiction.
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What is pitocin?  Here’s the fancy answer:  “it’s a nonapeptide protein.”  That’s the one you can use to sound smart.  Here’s the simple answer:  it’s the synthetic form of oxytocin, which is a hormone released by your very own pituitary gland.  Oxytocin is produced in response to labor and helps stimulate contractions, and it also is released during breastfeeding.  Those cramps you have while breastfeeding?  You can thank pitocin.

Why does your ob/gyn use this medication?  There are 2 main reasons:  it can be used to increase the strength of contractions, and it can also be given after delivery to help prevent bleeding (it helps the uterus contract and squeeze blood vessels closed).  During labor, you might think, “My contractions are plenty strong on their own, thank you very much,” but occasionally they aren’t.  Generally, the ideal strength of contractions that are strong enough to change the cervix in a timely manner without being so strong as to stress out your baby is 200-300 MVUs.  The strength of the contractions can be measured with an internal monitor placed beside the baby called an IUPC, and this monitor helps the nurse adjust the medication into the appropriate range to achieve the contraction strength noted above.  This can help the labor progress in the optimal timeframe to help minimize the chance of intrauterine infection and decrease the  chance of cesarean section once your labor has started or your water has broken.  Pitocin can also be used to stimulate contractions in order to initiate labor when medically indicated.  During inductions when the cervix is unfavorable (ie closed and not thinned), this is the time when we may  see an increase in the need for cesarean delivery with pitocin.  However, sometimes deliveries are medically indicated in patients with an unfavorable cervix, such as in patients with certain blood pressure issues, diabetes or other situations where to continue pregnancy has greater risk to mom/baby than ending it.  Without pitocin, though, medically indicated deliveries in patients with an unfavorable cervix would almost certainly have to be via cesarean delivery.

Is it safe?  Oxytocin is unavoidable during labor and breastfeeding, and your body has been designed to utilize this hormone in both cases.  When used at doses to obtain appropriate strength of contractions, both mom and baby tend to tolerate this medication well.  Even if the baby shows some element of stress, the half life of pitocin is only 3-5 minutes, so the effects end shortly after the medication is stopped.  Additionally, medications such as terbutaline can also be used to relax the uterus if needed.  Lastly, oxytocin used immediately after delivery decreases the chance of hemorrhage.  Postpartum hemorrhage is the leading cause of maternal death worldwide and the main reason that the maternal mortality rate is 239 per 100,000 in developing countries vs only 12 per 100,000 in developed countries.

Are there any other options?  At this time, pitocin tends to be the most effective and safest option that we have.  Some researchers have looked into the use of nipple stimulation to release natural oxytocin to stimulate labor, but at this time, there has been limited success, probably due to the fact the nurses’ hands must have gotten really tired ;)  Besides, there’s really only so much that lanolin can do for the breasts after a long labor like that!

So, while not all pregnancies require pitocin, it may be required during labor or after delivery.  When dosage is titrated to the optimal contraction strength, pitocin is often the most effective method to help obtain a safe outcome for mom and baby (not to mention decrease the odds of a cesarean section!).  And for us, this helps us to reach our ultimate goal, which is to conclude the pregnancy with a healthy, happy mom and baby :)

Nick

When you found out you were pregnant, you were probably expecting that healthy pregnancy glow.  Unfortunately, not all pregnant women are so lucky, and instead, your face is littered with zits even worse than during those awful teenage years.  So, now what do you do?!

1. I have not had bad acne in years, so why now? Acne can be very severe in pregnancy.  The increased hormone levels (particularly androgens) in the first trimester increases the skin’s production of natural oils, and many women have severe outbreaks in the first trimester.  

2. What products can I use for acne while I am pregnant?  Using small amounts of salicylic acid, benzoyl peroxide, and finacea is safe in pregnancy.  Large amounts can potentially be absorbed in the bloodstream, so please limit your use to small quantities.  This is especially true of salicylic acid, which is related to aspirin.  In LARGE doses aspirin and aspirin containing products can increase the risk of miscarriage and cause heart problems for the baby (That being said, do not be alarmed if your provider places you on baby aspirin as there are some medical indications for this medicine in pregnancy, and a small dose will not have this effect). 

3. Is Proactiv safe? Yes.  Proactiv is just benzoyl peroxide, salicylic acid and glycolic acid.  Again, as long as you use it in small quantities, it is safe in pregnancy.

4. Can I get facials for my acne while I am pregnant? Yes, for the most part facials are safe in pregnancy, and after the fun of early pregnancy (nausea, zits, etc) you probably deserve one :)  However, please make sure that your technician is aware that your are pregnant, so they can avoid the following: Retinol or Retin A containing products, Accutane and large amounts of salicylic acid.  If your technician is going to use a peel, please avoid salicylic acid peels as large quantities are not safe in pregnancy.  Peels that use glycolic acid, TCA or lactic acid should be safe in pregnancy.  Extractions are safe in pregnancy, but be careful because your skin may be more sensitive while you are pregnant.

5. Are my prescription antibiotic creams that I use for acne safe in pregnancy?  It depends on which antibiotic you are using.  Clindamycin or erythromycin based creams are fine while pregnant.  However, you should avoid tetracycline, doxycycline, and minocycline because they can damage your baby’s teeth.  

6. Accutane and retinoids.  Definitely, definitely don’t use Accutane if you may be pregnant or become pregnant.  It has been associated with multiple birth defects and also pregnancy loss.  If you use anti-wrinkle cream with retinoids and are pregnant, please stop because most of these creams all contain retinol-based products.  While absorption through the skin is much less than if you ingest these products, they still contain high amounts of vitamin A and are best avoided in pregnancy.

I promise you, your skin will get better!  Acne in pregnancy is usually worst during the first trimester and improves as the pregnancy goes on.  When washing your face, make sure you use a gentle, oil-free, alcohol-free, and non-abrasive cleanser.  Avoid over-cleansing as it can overstimulate your skin’s oil glands.  More than anything, resist the urge to pick or “pop zits”.  This can make your acne worse and cause unsightly blemishes or scarring to form.  ​ Just be patient, and you'll have your skin back to normal soon :)

Dr. Pam