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!
​
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

For Pam and me, despite our busy lives, we can typically find time to exercise, and we generally eat pretty well.  Sleep, on the other hand, can often be a bit more elusive (thank you middle of the night babies!), but there are certainly a number of positive health benefits from sleep that we just can’t get any other way. 

​Ever go to bed wondering about a problem and then woke up with the answer?  Sleep actually helps consolidate memory and new skills, and it can help clear out the “junk” processes that occur during the day.   In fact, a correlation has been suggested between lack of sleep and development of dementia, whereas adequate rest can not only help with improving cognition, it can also help spur creativity.  Whether studying for a test, writing new music or practicing your golf swing, you’ll likely perform better after a good night’s sleep.

Speaking of your golf swing, sleep can also help improve athletic performance.  Studies suggest that participants in sports see both speed and stamina are improved following an increase in sleep duration.  These athletes also saw improved ability to focus and learn plays due to less daytime fatigue.

Got your diet and exercise in line but still aren’t seeing the results you want?  Lack of sleep may be a culprit.  One studied showed that dieters who had adequate sleep lost more fat than those who were sleep deprived, who tended to lose more muscle mass.  Sleep deprivation also tends to trigger hunger, which can in turn increase caloric intake.  The bottom line is sleep more, lose more fat and consume fewer calories.

Think those issues are bad enough?  Unfortunately, there’s more.  Lack of sleep is a known trigger for inflammation, which is a risk factor for cardiovascular disease such as heart attack and stroke, not to mention diabetes, arthritis, and inflammatory bowel disease among others.  Even more concerning, it can lead to premature aging :0

So, what can you do to help improve your sleep?  Chances are, if you’ve been dragging through the day, you’re looking for caffeine.  Caffeine is fine, just remember to avoid it, alcohol and nicotine for at least 4 hours prior to bedtime.  Screen time should also be limited before bed.  Blue light can disrupt your natural sleep/wake cycle and negatively affect your quality of sleep.  Other culprits for sleep disturbance can include a room that’s too noisy, too hot (cooler rooms tend to promote sleep), or too bright.  Lastly, try for consistency (both with bedtime and duration) when your rest.  Adapting to a routine can help establish better sleep quality.

Whether becoming a new parent, working at a stressful job, or simply being born an insomniac, sometimes getting adequate sleep can definitely be a challenge.  Still, by making time for rest, you can begin to see significant improvements in your health.  Good luck with your good night’s sleep, and we hope you have sweet dreams!

Dr. Nick

So, I get asked this question all the time.  If I start an anti-depressant pill, will I have to take it forever?  Is it addicting? Anti-depressants have helped millions of people with the debilitating symptoms of depression.  However, long term use of anti-depressants has been increasing significantly.  Overall 35 million people in the U.S. are on antidepressants.  15.5 million of Americans have been taking these medications for depression for at least five years.  This number has tripled since 2000. 

Some people have no problem stopping the medications without any issues.  However, a large percentage of patients (about 75%) have significant withdrawal symptoms.  These symptoms consist of dizziness, confusion and fatigue.  Anti-depressants were never considered an addictive medication like opiates.  Because they are so effective at treating the symptoms of depression, withdrawal symptoms and the inability to discontinue were not well studied.  Most studies really explored use for a couple of months, not years.  However, today there are millions of patients that have been on these medications for years and we have very little data about the effects of taking these medications for so long. 

So, who cares and why is this an issue?  If it makes you feel better, you should just stay on it right?  Anti-depressants are not harmless and have lots of side effects.  They can cause increased appetite, weight gain, erectile dysfunction, loss of sexual desire, insomnia, dry mouth, fatigue, drowsiness, constipation just to name a few.  There is also concern that instead of developing good coping skills for common life issues like death in the family, financial hardship, relationship issues, we are resorting to popping pills.  While there are lots of patients that have legitimate psychiatric issues that require them to be on medication to prevent them from harming themselves, milder forms of depression, such as life circumstances like a death in the family, can often be solved with counseling and developing better coping mechanisms. 

So, what can be done to help patients transition off anti-depressants better?  First, we need more studies that explore long term effects of different classes of anti-depressants.  This will allow us to counsel patients more carefully about withdrawal symptoms prior to starting the medication.   Second, as providers we need to be more careful about prescribing antidepressants and encouraging our patients with milder symptoms to seek other options first.  Third, for patient that have had bad experiences with withdrawal symptoms, there are certain antidepressants with a longer half-life that have fewer symptoms.  It may be prudent to switch them to one of those medications or start them on one of those it they need to reinitiate antidepressants.  Fourth, encouraging micro tapering over 9 months to a year rather than quicker tapering may help prevent the severity of withdrawal symptoms for some. 

Hopefully, you won't find yourself in a position to need these medications, but if you do, be sure to discuss all possible options with you doctor.  Also, and even more importantly, be sure to speak with your doctor before stopping your current medications or changing your own dose.  Everyone goes through challenging circumstances in his or her life, but only you know if your current situation is beyond your abilities to get through.  In those cases, seeking help isn't a sign of weakness; it's a sign that you're strong enough to do whatever it takes to get through your challenges.

​Dr. Pam

I’ve often heard people joke about “being addicted” to sugar, but as it turns out, sugar addiction may not be a laughing matter.  Believe it or not, the same reward pathways in the brain the reinforce drug and nicotine use also reinforce sugar use.  Dopamine (essentially a chemical in the brain the makes you feel good) causes us to feel both withdrawal from and cravings for sugar.  The bottom line is withdrawal+craving=addiction.

As Americans, we consume roughly the equivalent of 65 lbs of sugar per year.  That’s a lot, right?  To put it in perspective, even the suggested amount of no more than 9 teaspoons of added sugar per day for men and only 6 per day for women add up to 29 lbs and 19 lbs, respectively.  Instead we consume nearly 20 teaspoons per day, more than double the recommended daily amount!

So, what’s the problem with some sugar?  Obviously, most people are aware of the negative effects on heart health, blood pressure, cholesterol, and rotten teeth, not to mention risk of diabetes and obesity, but that’s really only the tip of the iceberg.  Cancer cells thrive on sugar, and there’s probably also a link between asthma and sugar intake.  Also, excess sugar intake can inhibit the ability to get a good night’s sleep and even predispose to depression and dementia.  Lastly, if the above reasons aren’t good enough to limit sugar intake, excess sugar consumption makes you look older faster, aging you nearly 5 years faster per 20 oz soda per day.  You might as well be smoking for all of the harm it does to your face.

Good thing I really don’t add sugar to my food, right?  Unfortunately, roughly ¾ of packaged food contains added sugar, and the companies don’t have to let you know until 2020.  Not only that, but many packaged foods marketed as “healthy” are actually some of the biggest culprits.  Gluten-free foods typically have more sugar, salt, fat and saturated fat as well as less protein and fiber than their gluten-containing counterparts.  Not to mention, these products are typically much more expensive.  Other “healthy” products that often contain high amounts of added sugar include smoothies, trail mix, flavored yogurts, oatmeal and salad dressing.  Even juices labeled 100% juice often have very high sugar concentrations.
Trading in soda for energy drinks?  On average, energy drinks contain about 30 grams of sugar.  Sports drinks can have as many as 40 grams, and flavored coffee drinks can clock in at nearly 50 grams.  Just one of these per day can push you well past the recommended 24-36 grams per day.

Ready to make a change?  Often the first, and simplest, step is limiting sugary drinks.  Focus on increasing water, unsweetened tea, unsweetened coffee, and did I mention water intake?  Not only will this reduce your intake of added sugar, but being well-hydrated also increases satiety (fullness) thereby decreasing cravings.  Next, be sure to check out nutrition labels.  In addition to sugar levels, scan ingredients for other sweeteners like honey, anything named syrup, and anything ending in -ose (dextrose, glucose, maltose, fructose, etc.)  Finally, use whole fresh ingredients whenever possible so that you get to be in charge of the flavoring/seasoning process.

Good luck kicking that nasty sugar habit!

Dr. Nick

What is raw water?  It is supposedly unfiltered, untreated, unsterilized spring water that can cost more than $60.99 for a 2.5-gallon jug.  So, what is the concern here?  Why would someone pay so much to get their drinking water from the Middle Ages before proper sewer and sanitation systems had been created?  The rationale is that the existing water supply has many chemicals and pollutants and that there are naturally occurring minerals that are filtered out when the water is treated.  
 
How does water treatment occur?  Step one is coagulation and flocculation.  This is a fancy way of saying that dirt has a negative charge so adding a chemical with a positive charge will grab the dirt floating in the water (opposites attract).  This new bigger particle is heavy and settles to the bottom of the water (sedimentation).  Filtration happens next.   Small holes allow water to pass while trapping bigger particles (remaining dirt, bacteria, etc).  Lastly, a small amount of chlorine is added to kill any remaining viruses and bacteria.
 
What are the health risks of consuming “unfiltered, unsterilized, untreated spring water?” Unfiltered and untreated water even from the cleanest streams can contain animal feces which can lead to the spread of Giardia, Hepatitis, E. Coli and cholera.  Not to mention, runoff from our streets generally drains through a creek system.  Because of the advances in sanitation and safety of our water supply, most of us don’t know anyone that has died of hepatitis and cholera (although a recent outbreak in the homeless population in California led to 20 deaths in 2017).  Ever hear of dysentery, that illness which can kill people by extreme dehydration from nonstop defecation (pooping)?  It’s another example of water-borne illness.  Even for those who recover, it’s hard to imagine them calling bloody diarrhea a fun way to spend 2-4 weeks of recovery time.  One last example is naegleria fowleri.  This little amoeba isn’t ingested, but if some water contaminated with this species accidentally goes up your nose, it can cause primary amebic meningoencephalitis (PAM).  With fever, nausea, seizures, hallucinations and coma, nearly all cases of this illness have been fatal.
 
Who is consuming this raw water?  It’s currently limited to a largely wealthy clientele and seems popular in more expensive neighborhoods.  At 60 bucks for 2.5 gallons, this is only something that only the likes of Silicon Valley executives can afford in significant quantities.  If you are spending $4000.00 to rent a one-bedroom apartment- what is 60 bucks for a gallon of water?  Otherwise, people are left to collect their own.
 
From the standpoint of a health professional, recommendations would certainly be to avoid drinking untreated water due to concern for water-borne infection, and this applies doubly during pregnancy.  We know that the immune system is weaker during pregnancy, and any of the bacteria, viruses or amoebas listed above could easily cause a pretty devastating illness.  Not to mention, if you’re spending nearly $30 per gallon of drinking water, how much money are you going to have left over for diapers?  😊

​Dr. Pam