​Depression is one of the most commonly diagnosed mental health conditions in America.  It is estimated that 16 million adults in the US suffer from depression- that is 6.7 percent of all American adults!  About 25 million Americans have been taking antidepressants for at least 2 years, and this is a 60% increase since 2010.  These statistics are staggering.  Despite so many people being on antidepressants, I often hear – I don’t feel any better or I don’t think it works as well as it used to. 
These medications were originally only used to treat moderate to severe depression and only for short periods of time (6 to 9 months).  Now there are many individuals that are using it for mild to moderate depression and they remain on these medications for years.   So, the first question is do antidepressants work for mild to moderate depression? 

Studies have not shown that antidepressants provide much more benefit than placebo when used to treat mild depression.  What is more alarming is the side effects of antidepressants are very unpleasant: sexual dysfunction, decreased libido, erectile dysfunction, insomnia, and weight gain, to name just a few.  Fortunately, there are nonmedicinal options that may also help.  Even something as simple as exercise has been shown to work better (in some cases) than antidepressants for mild depression.  In 2005, the staff at Duke University devised a study where they compared the antidepressant effect of the popular antidepressant sertraline to aerobic exercise for four months.  What they found is rather interesting-the group that exercised at a moderate level about 40 minutes 3 to 5 days a week experienced more of an antidepressant effect than the group that took Sertraline. 

Exercise works in a similar way to antidepressants when combatting depression.  Exercise increases the blood flow to the brain causing the release of endorphins which is essentially the body’s own natural antidepressant.  It also causes the release of neurotransmitters like serotonin naturally.  Antidepressants like sertraline work by increasing the amount of serotonin at receptor sites.  However, over time your body compensates and has fewer receptors available, essentially decreasing the antidepressant effect over time.  So, if antidepressants don’t work very well or for very long for mild depression and have nasty side effects like sexual dysfunction and weight gain, then why do so many people stay on these meds for so long?

​The reason they stay on it for so long is because the withdrawal symptoms are so severe that they are unable to wean themselves off the medication once they feel better.  Also, a lot of patients on antidepressants mistake the withdrawal effects for relapse.  For instance, stopping antidepressants, especially suddenly, can cause depression and anxiety, which can be confused with the original symptoms these medications were used to treat.  Other side effects of stopping depression medications can include headaches, dizziness, fatigue, nausea, insomnia and even flu-like symptoms.

If you suffer from mild depression and feel like your current therapy regimen is not working talk to your health care provider.  There may be other therapy options available for your mild depression like exercise and psychotherapy that could be more effective for treating your symptoms.  That being said, be sure to talk to your provider before making any changes in your current medical regimen, and if you begin to worry about harm to yourself or others, then be sure to go directly to your nearest emergency department.  Remember, you aren’t alone, and there are a number of both nonmedicinal and medicinal treatment options available.  Mental health issues should be taken seriously, so take a minute to discuss any concerns with your healthcare provider.

Dr. Pam

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

In this day and age with two working parents, its so easy to stop by the frozen aisle in your grocery store and grab a quick-frozen meal for dinner.  I never thought much about it or felt that it was a potential health hazard.  However, a recent study out of France shows that frozen dinners (which are considered “ultra-processed foods”) are not only dangerous to your health but also increases your risk of early death!
Ultra-processed foods are foods that are “manufactured industrially from multiple ingredients that usually include additives used for technological or cosmetic purposes.”  They are consumed in the form of snacks, desserts, or ready to eat or heat meals.  The study examined the health and physical habits of 45,000 adults over a two-year period and they found a 14 percent higher risk of early death for each 10 percent increase in consumption of ultra- processed foods.
So, what about frozen foods makes it so unhealthy?

1. Added Starch: Many frozen foods have added starch to keep the frozen foods tasting fresh.  Starch is just extra glucose and all this extra sugar increases the risk of developing insulin resistance and eventually diabetes. 
2. Added Trans-fat: Frozen foods are usually full of trans-fat.  Foods that have a lot of trans fat contribute to raising cholesterol and putting you at an increase risk of heart disease. 
3. Added Salt: Salt is a well-known preservative.  Most frozen foods contain more salt than what you would add if you made the meal out of scratch for immediate consumption.  This can increase your cholesterol and your blood pressure.
4. Lots of preservatives: there are lots of other preservatives that are added to frozen foods to improve the texture and keep them tasting fresh.  Many of these have not been well tested by the FDA and most manufacturers don’t need permission to use these preservatives. 

I think it is easy to forget that frozen foods are still ultra-processed foods.  I always thought of frozen foods as freshly prepared foods that were just frozen- kind of like when your friends bring you freezer meals after you had a baby.  Unfortunately, frozen foods bought at the store have lots of preservatives, additives and extras that you did not likely anticipate.  So, before you stop by the frozen aisle to buy dinner for the family, remember that despite all the fancy packaging and healthy claims, these quick-fix options can increase your risk for hypertension, diabetes and even early death.  The best choice is to buy fresh ingredients and cook the meal yourself.  You know exactly what is in the meal and can tweak the sugar and salt amount to your own dietary needs.  Not to mention, busy moms can still freeze the leftovers for later 😊

Dr. Pam 

As fitness wearables become more commonplace, many people may assume that if I wear my new gear and take my steps, I will instantly begin to look just like (insert your favorite fitness model’s name here).  I mean, it sounds simple.  Take 10,000 steps per day, burn an extra 500 calories per day, or 3,500 per week (the amount in a pound of fat), and then you’ll just walk any extra weight right off.  Unfortunately, as many people have discovered, that’s not exactly the case, and here’s a few reasons for these fitness setbacks:

1. Your actual body composition differs from the weight used in this calculation:  These metrics are for a 180 lb person who travels 5 miles in 10,000 steps and burns roughly 100 calories per mile.  So, if you only weight 120 lbs, then you’d really only burn about 300 calories over the same 5 miles.  Also, if your stride is too short to travel 5 miles in your 10,000 steps (ie perhaps you’re a bit more petite than allows for long enough strides to reach your 5 miles), then you may also miss out on hitting your burned calories goal.  Also, even at rest body composition can play a role in your metabolism with muscle burning 7-10 calories per pound per day whereas a pound of fat may only burn 2-3 calories per day.  Thus, even if you hit the 500 calories from the 10,000 steps, you may still not see results if you have a higher fat to muscle ratio as your baseline metabolic rate (calories burned at rest) is slower.  Also, as you lose weight, the amount of effort to burn the same calories in exercise increases while your basal metabolic rate decreases. 
2. Say you weigh exactly 180 lbs and your body composition exactly matches that of the test subjects.  Intensity in your travel may also affect the number of calories burned.  Walking at a 4mph pace (or a mile every 15 minutes) would put you on track for 500 calories burned.   So, it takes roughly an hour and fifteen minutes of walking to burn those 500 calories.  Say you increased your pace to 6mph (a mile every 10 minutes).  You could look to burn 444 of those 500 calories in just 30 minutes, or with only 3 miles of effort instead of 5 miles.  Add another 4 minutes of running, and you’d match the 500 calorie output in just 34 minutes instead of an hour and fifteen.  Alternatively, if you walked more slowly than 4mph, then it would take a longer time to burn 500 calories, so you’d need to extend your walking time to reach your goal.
3. Gender also plays a role in metabolism.  For instance, following puberty, most men began to increase their lean body mass as testosterone levels increase, whereas for women, we don’t see such a surge in lean muscle as testosterone levels are naturally lower than for men.  That being said, participation in activities, such as weight lifting, that increase lean body mass may cause a slight increase in metabolism
4. Age can also play a role.  As we age, we may begin to see a decrease in muscle mass over time.  This can be due to participating in less weight-bearing and strength-training activity, dietary changes and also that maintaining lean mass may become a little more difficult due to simply being older.  In addition to the loss of muscle mass from the changes listed above, the parts of the body responsible for metabolism begin to wear down.  While staying active and paying attention to diet can help offset these changes, the bottom line is that the whole pizza you could eat without gaining an ounce at 20 will make you gain weight at 40.
5. Speaking of diet, one of the biggest misconceptions about exercise is that once done, you can now eat whatever you want.  You know the extra 500 calories you burned?  Check out the number you’re putting back in your post-workout smoothie.  Or in your post-workout splurge at whatever fastfood you might be treating yourself with.  It’s so easy to “treat” yourself with more calories than you burned exercising, not too mention more vigorous exercise often makes us hungry, so we tend to eat more than when not exercising anyway.

The bottom line is that there’s no easy way to lose weight and stay fit.  Those who tend to have the most success make changes that they can live with long term.  Results from a crash diet and daily intense workouts will only last as long as your motivation.  Ultimately, you will gain the weight back.  If you hate running, then you won’t keep doing it.  If you find that you love hot yoga and long walks with your dog, then do that.  If you’re eating 500 calories a day and are always hungry, then you can’t do that forever, and the weight will come back.  It's the same with diet pills you take for a few months and then have to stop for heart health.  Switching out healthier recipes for foods you already love to eat can be something you can allows for not feeling deprived while making positive progress.  The bottom line is that more calories have to be expended than consumed for weight loss to happen.  Gradually eating more healthily and learning to be active in a fun way are changes can allow for lifelong success.
Dr. Nick

Looking for a little more motivation to keep up with your New Year’s health goals?  New data from the American Cancer Society suggests that being overweight or obese increases your risk of both developing and dying from cancer.  As many as 8% of all cancers and 7% of all cancer deaths are thought to be caused by excess body weight, even if you’re otherwise healthy.

There is a clear association between obesity/being overweight and endometrial cancer, (menopausal) breast cancer, colon cancer, esophageal, renal (kidney) and pancreatic cancer.  There may also be a link to ovarian, cervical, gallbladder, liver, multiple myeloma, and non-Hodgkin lymphoma as well as aggressive prostate cancer (while prostate cancer is not a concern for women, it may affect your partner).  Even for normal weight women, having increased belly fat is associated with the development of cancer. 

Why do researchers think this happens?  It seems like “healthy” and “obese” may not go together after all, as obesity can have negative effects on immune function, inflammation, and hormone.  These changes can impact not only overall health but may play a role in the development of certain cancers.  For instance, excess estrogen production from adipose (fat) tissue can change the flow and length of the menstrual cycle, and this unopposed estrogen is associated with the development of endometrial cancer.  This same mechanism may contribute to some types of breast cancer as well.

Even a small amount of weight loss may be helpful for decreasing cancer risk, and, of course, there is a reduction in heart disease and diabetes.  Weight loss can also be helpful in bringing some predictability back to the menstrual cycle without the need for hormonal birth control to regulate bleeding. 

Given all of the benefits above, not to mention an improved sense of overall wellbeing, now is the perfect time to start making and working toward your own health goals for 2019.  Whether that’s to take an exercise class, run an 5K or just lose those pesky (fill in the blank) pounds, we hope that this information can help provide some motivation.  Good luck living your best 2019!
​
Dr. Nick

I get this question a lot: “Ever since I had my babies, my trouble spots have only gotten worse. I have tried everything- diet, exercise, more crunches than I ever thought I could do. Doctor, what do you think about CoolSculpting? “

Fat is such a complicated thing to get rid of. Of course, there is liposuction, tummy tucks and lifts for everywhere. Most of these procedures require surgical intervention in the operating room by a plastic surgeon (unless, of course, you want to end up on the latest reality tv show that specializes in botched outcomes). These procedures unfortunately require time to perform, down time from work and are rather expensive.  Who has time for that? Recently we have seen the advent of non-invasive fat reducing procedures such as CoolSculpting and Sculpsure. The purpose of these procedures is to get rid of those trouble spots that the crunches aren’t touching. 

First- what is CoolSculpting? Coolsculpting is an FDA-approved treatment that involves freezing fat cells. There is an applicator that applies suction to the area that you want to target and the applicator brings the temperature of the fat cells down to the point where they are irreversibly damaged. These cells eventually die and are then eliminated by the body, which is why it takes a few weeks to see the final effects of the procedure. This technology is really for specific trouble spots that are large enough to adhere to the applicator- tummy fat, love handles, thighs, bra fat, banana roll (fat underneath your butt).

Instead of freezing fat cells, Sculpsure uses heat to kill fat cells and then the body eliminates those cells within a couple of weeks. Because it is using heat to kill fat cells, this can be a more painful procedure especially for people with sensitive skin.

The biggest advantage of these minimally invasive fat reducing procedures is that there is very little down time and the risks are minimal compared to more comprehensive surgical procedures like liposuction and tummy tucks. The biggest disadvantage is that they only target specific areas, the results take weeks to appreciate, and can be very variable: up to 15% of participants did not see any improvement after treatments. At $1500 per trouble spot, that can be pretty frustrating.

If you are considering a fat reducing procedure, of course we always recommend that you give that cheap, old-fashioned option a try first- diet and exercise.  If that doesn’t work, we recommend that you consult with a board-certified plastic surgeon to discuss your options before making a decision.  While Coolsculpting may be the perfect remedy to eliminating fat in certain areas, there may be certain instances in which a more traditional surgical approach would help you achieve your desired goals.  While this is not a service we offer, we hope this information is helpful!

Dr.  Pam

​We’ve talked about the recommended amount of exercise in the past, so I’ll just take a moment or two to review the guidelines.  You should generally get 150 minutes of moderate aerobic exercise (swimming, brisk walking, push mowing, etc.) or 75 minutes of vigorous aerobic exercise (i.e. running) each week in addition strength training at least twice per week.  In order to see significant weight loss, this amount should increase to closer to 300 minutes per week, or about an hour a day for 5 days per week.  We often get really excited about our workout goals in the beginning, but sometimes, those workouts can begin to feel like even more “work” than usual.  Here are a few signs that you may benefit from a day off:

1. Ever feel so exhausted that you just can’t fall asleep?  That means your sympathetic nervous system may be working overtime.   Pushing too hard for too long can sometimes cause constant release of stress hormone that keep you wired for “flight or fight,” and that imbalance can totally throw off your sleep.  Another sign may be the disappearance of your menstrual cycles.
2. Constantly sick?  Either you have a toddler, or your immune response could be lowered due to inflammation and stress from overtraining.  Make sure you’re getting adequate breaks between hard workouts.
3. Reached a plateau in your workouts that no amount of training can push past?  Sometimes a short break for either a rest day or simply changing your preferred workout activity can help you resume making gains in your 5K pace or your weightlifting one-rep max.
4. Are you so tired that every day feels like a blur?  After sleep and dietary change, constant stress, either from workouts or even daily life, can really wreck your body.  We’re made to undergo cycles of work and rest, so being constantly “ramped up” can keep you from reaping some of those down-time benefits and even make it harder for you to rest when you finally have a chance.
5. Does that walk from your car to the gym make you tired just thinking about it?  The reason that people often begin to look forward to their daily workout involves the brain’s own reward system.  Dopamine, the body’s feel-good hormone that provides positive feedback for everything from workouts to intercourse, and endorphins, the body’s natural painkillers, are both released during and after exercise.  That being said, excessive training can blunt that response, and thus, blunt your satisfaction with your workout routine.

The bottom line:  working out and exercise are good, but be sure not to overdo it.  This is especially common when just beginning more intense exercise.  If you notice any of the symptoms of burnout listed above, it may be time for a little break or a change in your routine.  If those symptoms persist, then it may be wise to check in with your doctor to see if these symptoms are a sign of something else.  Before you do that, though, you might consider one last try for some fun exercise outside where you can really enjoy this lovely spring weather 😉
Dr. Nick