The most common complaint I’ve been getting lately is this- “I’ve gained a ton of weight since this pandemic started.”  Many of us went from working full time to working in our PJ’s at home.  Everything has been closed including the gym.  Fourth of July celebrations and the Rodeo were cancelled. Weddings, graduations, kids’ sports activities and summer vacations were are cancelled.  After being told not to mingle with family or friends and just stay home to be safe, it’s easy to find yourself 19 pounds heavier.  Here are some simple tips on what you can do to lose some of those pandemic pounds while regaining your mental and physical health. 
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1. Rule #1: No Snacking at all.  Snacking throughout the day causes continuous insulin release.  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 while drinking 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 processed.  Most 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, and while there are limited social options, now is a good time to learn a new skill that may even become a hobby.  It will also save you lots of money. 
4. Rule #4: 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.  Believe it or not, Dr. Atkins died obese and likely of heart disease.
5. Rule #5: Get outside and get active.  Go for a walk, run, hike, bike ride whatever, but you need to get out of the house.  Studies are beginning to suggest that most contracted the coronavirus at home.  Enjoy the fresh air and get some Vitamin D.  While exercise and activity does not contribute to weight loss as much as dietary changes, it helps maintain weight loss and is overall good for your physical as well as mental health.  Also, especially important right now, is the fact that exercise helps boost your immune system.

Hopefully this helps!  Don’t let the 'Rona get you down.  Eat health and enjoy the outdoors!
 
Dr. Pam

After the long Idaho winter (seriously, snow in June?!) and all of the Covid lockdown, those nice summer rays warming your skin are the last thing you want to block, right?  Unfortunately, while a little Vitamin D from the sun is a good thing, a nice summer tan is a bit less healthy than you might think, and even worse for your skin is that first summer burn.  Even for those diligently applying sunscreen, chances are good that you’re putting it on all wrong.  Here’s what you should know about both the short and longterm effects of all that sunshine and how to enjoy the nice summer weather while protecting your skin.

What happens when you tan or sunburn?  A tan is your first line of defense against the sun.  Skin damage releases melanin, which in turn increases skin pigmentation, i.e. skin gets darker.  While this does provide some protection, this level of protection is only about SPF 3.  Once the level of skin damage begins to cause cell death, an inflammatory process increases bloodflow to the area, resulting in the warm, red appearance of a sunburn.  Tanning is more of a chronic damage whereas sunburn is more of an acute damage.  Even if you aren’t worried about the increased risk of skin cancer associated with this damage, do you really want to look like Magda from there’s something about Mary?  Skin damage from the sun is a BIG contributor to aging.

Don’t I have to get all of my Vitamin D from the sun?  While Vitamin D is important for bone and immune health, not all of it has to come from the sun.  Eggs, milk, and fish are important sources of dietary Vitamin D, and in fact, dietary intake can provide adequate levels of Vitamin D without the need for excessive sun exposure or additional supplements.

How should I put on my sunscreen and what kind should I use?  Sunscreen should generally be applied about an hour before sun exposure, and you should be using a lot more than you probably think.  For the face alone, a nickel-size amount is appropriate, but for the entire body, a shot glass-sized amount (a full ounce) is necessary.  Also, don’t forget to reapply frequently, every 1-2 hours, to prevent sunburn.

As for the type of sunscreen, SPF 15 blocks about 93% of UVB rays, SPF 30 blocks about 97%, and SPF 50 blocks about 98%.  Mineral sunscreen are typically more effective than chemical sunscreens.  Another benefit of mineral sunscreens is that they don’t contain ingredients like oxybenzone or octinoxate that can be harmful to coral and ocean ecosystems.

If you’re absolutely against sunscreen, there are certain clothing lines geared toward SPF protection.  Some long-sleeved shirts, pants and hats can also be effective protection against the sun, but remember that any area of exposed skin will still be vulnerable to UV damage.

So, should you hide in the shade all summer?  Not necessarily.  There’s evidence that some sun exposure may trigger release of nitric oxide and in turn lower blood pressure, but at the same time, there’s no sense in burning until you become a California raisin either.  As with most things, moderation is probably key.  Apply your sunscreen and don’t get sunburned, but go outside and have some fun, too.  It’ll be snowing again before you know it.

Dr. Nick

How does osteoporosis happen?  Our bones are constantly being broken down and replaced.  Whenever the creation of new bone does not keep up with the loss of old bone, they become brittle and weak.  When this happens even minor stresses can cause a fracture.  These fractures most commonly happen in the hip, wrist, or spine.  There are lots of things that contribute to the development of osteoporosis.  Genetics, age, sex, race, nutrition, lifestyle choices and medical conditions can all contribute to osteoporosis.  Unfortunately, White and Asian post-menopausal women are at the highest risk of developing osteoporosis.  However, there are lots of different options to help prevent bone loss or strengthen weakening bones. 
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There are different medical treatment options available.  The most common of these being bisphosphonates.  Bisphosphonates prevent bone from being broken done. However, this may lead to less new bone formation as it prevents old bones from being broken down.  In addition to this, this class of medications has lots of side effects- muscle aches, esophageal ulceration, osteonecrosis of the jaw, seizures and atypical fractures of the femoral shaft and even esophageal cancer.  Other treatment options include estrogen and estrogen agonists like raloxifene.  While it decreases the chance of osteoporosis, there are many individuals that are not good candidates for this type of treatment because of the increased risk of blood clots and even strokes. 

While we always recommend weight bearing exercises to prevent osteoporosis, recent studies have shown that exercise really bolsters bone mass in the hip and femoral neck decreasing the chance of developing hip fractures.  Studies showed that increases in body mass density at the hip and femoral neck were particularly noticeable in women age 65 or older if exercise training lasted more than 200 days.  Basically, exercise has a huge protective effect on bone mineral density and can prevent fractures without all the side effects that traditional medications like bisphosphonates and estrogen agonists can have.  The thought is that as we age, our bodies produce cytokines that are inflammatory and destroy bones.  Exercise prevents the production of these bone destroying inflammatory cytokines and increases growth factors that help produce new bone.  In women particularly, exercise has also been shown to have a positive effect on estrogen concentrations which helps with bone remodeling. 

With all the innovations of modern society- dishwashers, washing machines, Alexa to turn on our lights and delivery of everything from groceries to dinner, we have become very sedentary.  Unfortunately, our bodies were not built for this.  Our bodies were meant to be active.  Movement and exercise promote the resorption of old bone and the formation of new bone.  This is vital to preventing fractures, back pain from fractured or collapsed vertebra, loss of height over time and stooped postures. 

While it’s important talk to your provider about your risk of bone loss and osteoporosis as you get older to see what options are best for you, don’t discount the importance of lifestyle choices like exercise to help prevent bone loss and fractures. 

Dr. Pam

Every year, over 90% of people make New Year’s resolutions, but typically, less than 10% of them achieve their goals.  Some of the most common resolutions often involve improving diet and exercising more.  While everyone knows that these lifestyle changes improve health, what they may not know is that exercise can also boost the quality of their sex life.

For women, a short, vigorous workout in the gym (as little as 20 minutes), can lead to a vigorous workout in the bedroom, too.  The hormonal boost from intense exercise can increase arousal by over 150%!  Not only are women more aroused after exercise, but they also experience increased genital bloodflow, which, in turn, can improve the quality of the intercourse that they have.  Just don’t wait too long to “workout” with your partner as these boosts are generally short-lived.

For men, exercise can increase testosterone by up to 15%.  Weightlifting is particularly beneficial for increasing testosterone production, especially with heavier weights.  In addition to improved sexual drive associated with testosterone production, testosterone can increase muscle mass and decrease adipose (fat) tissue.  When fat loss is from the abdomen, penile bloodflow increases as can erection length (less covered by adipose).  Men shouldn’t fully neglect cardio, though, as atherosclerosis and hypertension can result in erectile dysfunction if not prevented.

For both men and women, improved self-image from weight loss and increased muscle tone often results in desire to share their new, sexy look with their partner (how about lights on in 2020?).  By being more comfortable with oneself, stress from being intimate is often lessened, thus allowing for more enjoyment of (and desire for) sex.  Lastly, as fitness increases, insulin resistance decreases, and the suppression of sex hormones by high insulin levels also ends.  With normal sexual hormone function, arousal and excitement happen more readily, and now that strength and stamina are increased from regular exercise, a person often has more energy to act on those urges.

So, here’s to a healthier 2020.  Keep making those resolutions for a fitter you, but when your exercise routine gets a little stale or your life gets busy, a healthy heart or lower cholesterol isn’t your only reason to stay active.  Remember that getting sweaty in the gym can lead to getting sweaty with your significant other, too!
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Dr. Nick

Every winter I get lots of questions from patients about skin changes, and while some of them are definitely pregnancy related, a lot of the more annoying skin conditions actually start with the weather.  So, when the snow starts falling, here are a few tips to keep your skin from flaking.

1.  Healthy skin starts from the inside out.  Drinking extra water, even when you’re not as thirsty because of the cold, is an important first step to maintaining good skin health.  Fish oil and flaxseed oil both provide omega fatty acids that can be beneficial in severe conditions, too.
2. Stay warm, but not too warm.  While it’s tempting to crank the heat on a cold day, anything above 72 begins to zap the moisture from the air and can in turn dry out your skin.  If you really must turn the heat higher, then consider investing in a humidifier to offset the moisture loss from the heat.
3. The same goes for showers and baths, too.  Warm (not hot) water is best for keeping the moisture in your skin, and time in the water should be limited to less than 10 minutes.
4. As soon as you get out of the shower, moisturize while the skin is still damp, and be sure to use a heavy-duty moisturizer rather than simply a lotion during the winter months.
5. Limit exfoliants, toners, astringents, and scented skin products during the winter.  Even if they don’t usually cause skin sensitivity, the more fragile state of your skin during the winter can allow problems to develop.
6. Be wary of scented detergents and those with dyes, too.  Exposure to even small amounts of these chemicals left in clothes can potentially result in irritated skin.  That being said, don’t forget to wash new clothes before wearing as excess dye left in new clothes can also cause skin issues.
7. Warm clothes can sometimes be an issue as well.  For those with sensitive skin, wool can lead to rather profound itching, and other types of heavy clothes are often made of more coarse materials.  Be sure to layer with lighter, more comfortable clothes protecting you from the rougher texture of your winter garments.  Heavy clothes also tend to hold moisture longer than lighter layers, so if you do end up with snow falling into your jacket or boots, try to change as soon as possible as wet clothes can be even more irritating to skin than dry ones, and in turn, make you that much itchier.
8. Don’t forget your sunscreen!  Even on bleary days, UV damage is quite possible (as anyone who’s ever come home from a ski trip with goggle outlines can attest).  A combination of moisturizer and sunscreen can limit the number of skin products needed during the winter.
9. Lastly, at the end of the day, don’t forget to gently wash your face before bed to rinse of any accumulated products, oil and grime accumulated during the day.  A gentle nighttime moisturizer is a good investment in protecting your skin before bed.

Skin dryness and itchiness is a very common problem during the winter, and some irritation over the colder months may not be avoidable.  Still, a good skin care regimen for winter weather can go a long way toward making things better.  In turn, that healthy skin allows for even more enjoyment of peaceful, snowy days, whether you’re carving turns on the ski hill or admiring the snowfall while enjoying hot chocolate and a book by a crackling fire 😊

​Dr. Nick

Having a good social support group and friends can play a significant role in your  health.  A lot of these effects are good, but occasionally, there can be some negative effects as well.  Here Dr. Nick talks about the good (and some of the less good) consequences of these relationships.

First, let’s start with the good stuff.  Those who have quality relationships with friends tend to have a reduced risk of some significant health problems.  Better support tends to lead to less stress and in turn, lower blood pressure and decreased odds of developing diabetes.  It can also help keep your mind sharp as you age, and if you have good friends, then you tend to live longer to use that sharp mind, too.  Heart disease and depression are also less common in those with quality friendships.  Unfortunately for those who lack close friends, loneliness can have the same effect on health as smoking up to 15 cigarettes per day.

On the other hand, just like momma said, friends aren’t always good influences.  For instance, having a close friend who becomes obese increases your odds of becoming obese by 57-71%.  Is your best friend your spouse?  Having a spouse who becomes obese increases your chances by about 40%.  Now, obesity isn’t contagious in the sense that by being in the same place as obese person causes you to become obese, but sharing the same meals together can definitely have an effect on your health.  For example, eating out at work with friends increases your calorie intake, on average, by just under 1,300 calories per week.  Unless you and your colleagues also have intense workouts scheduled later, then that average increase in calorie intake could lead to over 20 pounds of weight gain each year!  With that amount of weight gain, you could now see higher chances of high blood pressure and diabetes as opposed to reaping some of those health benefits listed above.

So, in general, friendships are good.  Having friends who are there to help through life’s challenges and to celebrate life’s victories can lead to a healthier and longer life.  As long as you’re doing good things together, life with close friends to share it with can definitely be more fulfilling, and TWHC wishes you a happy holiday season with those friends.  Just remember to go easy on the stuffing 😉
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Dr. Nick 

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

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!
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Dr. Nick

What are probiotics?  Probiotics are bacteria.  Yep, they’re the same type of organism responsible for pneumonia or strep throat or gonorrhea.  Fortunately, not all bacteria are bad, and, in fact, many of them are part of a healthy body.  There are actually more bacteria in your intestine than there are cells in your body.  While typically the “good” bacteria outnumber the “bad” bacteria, problems begin to occur when there are shifts in the types of bacteria usually found in the healthy body.  This type of imbalance can lead to bowel issues, weight gain, some skin conditions and may be a contributing factor to bacterial vaginosis.

​What are the most common types of probiotics?  Bifidobacterium may be helpful in treating IBS (irritable bowel syndrome), and this bacteria can be found in certain dairy products.  Another common probiotic that can be helpful for bowel symptoms is lactobacillus.  It can be found in a number of fermented foods.  Lastly, saccharomyces boulardii, a yeast, and bacillus coagulans, another bacteria, can also be helpful for digestive issues.

Why take probiotics?  A diverse gastrointestinal flora (lots of different kinds of bacteria in your digestive tract) may help reduce irritable bowel symptoms, manage weight, improve diarrhea after antibiotics, increase immune function, bolster mental and heart health, and decrease the severity of allergy symptoms.  That being said, research hasn’t been able to consistently show these benefits in all studies, and there is still a lot of research to be done.

Is there anyone who shouldn’t take probiotics?  Anyone who has a suppressed immune system or serious health conditions should probably avoid taking these supplements, and pregnant women should also use caution.  Remember, effective probiotics are live bacteria, and some bacteria can call illnesses.  More common side effects are GI distress, although serious allergic reactions or infections can sometimes occur.  Since probiotics are a nutritional supplement rather than a medication, the FDA guarantees neither the safety or efficacy of a probiotic supplement.

What is the best way to get probiotics?  The simplest way to incorporate probiotics is often to supplement, but since these supplements aren’t FDA regulated, the quality can vary a lot from one supplement to the next.  For instance, probiotics have to be both living and highly concentrated to be effective, so any process that either kills the bacteria or doesn’t adequately protect the bacteria from stomach acid isn’t going to allow proper supplementation.  For a more natural way to add probiotics, look toward fermented foods such as yogurt, kimchi, sauerkraut, kefir milk, and some cheeses. 

Another option to improve gastrointestinal health is to feed the bacteria already present in the intestines.   Bacteria in the bowel thrives on fiber, so increasing daily intake of fruits and vegetables can be helpful in improving overall GI health by nurturing the good bacteria already present in the bowels.  In fact, for the roughly half of people who have “resistant” gastrointestinal flora, this may be more effective than a probiotic supplement that will end up making for some expensive poop.  Even for those whose GI tract welcomes the new probiotics, these bacteria are more likely to grow (and their hosts reap benefits) when fed a high fiber diet.

So, there you have it.  Probiotics seem to have a lot of promise for helping with a variety of health conditions, but for now, the best way to incorporate them into the diet and who is most likely to benefit from them is still up for debate.  In the meantime, it appears that an old-fashioned high fiber diet will still be a winner whether you plan to supplement or not 😊

Dr. Nick