​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.
​
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

It’s always interesting to address the concerns about epidural anesthesia during labor.  While there are a number of common questions, epidural anesthesia has taken on almost a mythical status for some patients, and it’s kind of incredible to hear what is attributed to this type of pain relief during labor.  Here I’ll try to offer some insight on epidurals, how they work, and how they do (or don’t) affect labor and delivery.

First, what is an epidural?  An epidural is regional anesthetic.  This means, as opposed to IV pain relief, it isn’t expected to go into the blood stream, make you loopy or cross the placenta to the baby and sedate him/her.  A simple way to think of the difference between an epidural and a spinal is that typically an epidural procedure involves placement of a small catheter attached to a pump for continuous, but usually lighter, anesthesia than a one-time injection in a spinal.  If you think about it, that makes sense.  Pushing and movement are required during labor whereas we don’t want you moving anywhere during a cesarean section.  Some techniques involve a combination of the two, but that’s probably best explained by an anesthesiologist.

So, does an epidural slow down labor and increase risk of cesarean section?  The answer to the first question is yes…sort of.  The first stage of labor (dilation of the cervix) actually has no significant difference in duration regardless of when an epidural is placed.  The second stage of labor (pushing and delivery of the baby) takes about 15 minutes longer on average with an epidural vs without.  That, too, makes sense as walking with feet that have fallen asleep is going to be a little slower going than on feet that aren’t a little numb.  As for increasing the risk of cesarean section, there is no apparent increased risk of cesarean section with epidural, although we do see slightly higher incidence of operative vaginal delivery, i.e. vacuum or forceps.

Can an epidural harm mom or baby?  More common side effects for mom can be nausea/vomiting, low blood pressure, itching and difficulty with urination.  While more severe effects such as infection and nerve damage are possible, they are fortunately very rare.  Backache or headache can also occur, but these are not expected to persist if they do.  Generally, sensation and ability to walk returns with a few hours after stopping an epidural.  As for effects on the baby, because the anesthesia is regional, we don’t expect it to cross the placenta into the baby’s blood supply.  Occasionally, we can see a decrease in blood flow to baby from mom if blood pressure gets to be very low, but if present, this is usually quickly corrected by treatment of mom’s blood pressure.  Otherwise, much like numbing a tooth for extraction doesn’t affect your toes, the effect on baby from epidural is expected to be rather minimal.
             
For some women, epidural anesthesia can be a very effective option for pain control during labor, delivery and any laceration repair (hopefully, you don’t have any vaginal tearing during labor, but if you do, numb is good!).  Other women either don’t need it or don’t want it.  I’ve had some moms say that better pain relief allowed them to be more in the moment and really enjoy their baby more, but others felt that abstaining from pain relief allowed them to be more present during labor.  Fortunately, unless there are medical reasons you can’t have an epidural, it’s a decision that you can make in conjunction with your OB and anesthesia providers.  Be sure to discuss with them any concerns that you may have, and also pay close attention to your anesthesia provider to clarify all of the risks, benefits, alternatives and indications prior to proceeding with any medical procedure.  Good luck with whatever decision is the right fit for you, and as always, we wish you your healthiest pregnancy, delivery and baby 😊

Dr. Nick

​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

One of the more common complaints during annual exams involves weight gain, and while the tendency is to want to blame it on hormones, the truth is that, with the exception of thyroid function, hormones play less of a role in weight gain than many people think.  Unfortunately, to some degree, our body’s metabolic rate simply slows down with age, and that change in metabolism begins as early as 25.  We generally see about 150 calories per day decline in energy expenditure (how many calories your body burns with activity) and also another 2% of the basal metabolic rate (how many calories we burn at rest) each decade following a person’s 20s.  Even though there’s not a lot that we can do to change the aging process, the good news is that about 2/3 of the expected decline in metabolism is in our control, and there are things that we can do to help minimize those changes.

​First, the bad news.  We lose about 2% of our basal metabolic rate (the amount of calories burned per day by doing absolutely nothing) per decade after our 20s.  That means even if you ate the same and exercised the same in your 30s as in your 20s, you will gain weight and body fat.  By your 50s, this process accelerates even faster.  To put it in perspective, you are about 40 calories per day less efficient in your 30s vs your 20s at using energy if you baseline needs are 2000 calories per day.  That means 80 calories less efficient by your 40s and so on.  While 40 calories per day may not sound like much, it equates to a 4 lb weight gain per year, and about 20 lbs in 5 years by having the exact same diet and activity level in your 30s vs 20s.  Or 40s vs 30s, etc.  This inevitable change means that either calorie intake has to be decreased or activity increased just to maintain your current weight.

There is some good news, though.  Total energy expenditure, how active you are, is in your control.  We generally see about 150 fewer calories utilized per day each decade, and if you think about it, that makes sense.  Whether you participated in sports or marching band or cheer or even just riding your bicycle to your friend’s house, chances are good that you were more active as a kid.  Then as jobs start or babies come, the time you previously had to yourself and also the previous motivations for fitness (making the team, impressing a cute boy, etc.) can begin to slip away.  As your activity level declines, the amount of calories burned each day does as well, but by finding time to keep up with exercise, your body can continue to burn nearly the same amount of calories as before.

Need some added motivation to get back into an exercise routine?  In addition to burning the calories during exercise, activity also boosts the resting metabolic rate (RMR).  For instance, women who were active for 9 hours per week had a RMR about 70 calories per day higher, about 10% less body fat and a little over 15 lbs less body fat than their sedentary counterparts.  There are a number of factors that contribute to the improved body composition, including increased muscle mass (muscle burns more calories than fat, even at rest), increased production of growth hormone (this helps build muscle and reduce fat), and also the increased calorie utilization to help your body recover from the exercise.

Staying fit is hard, and avoiding weight gain is an active process.  As an unavoidable part of the aging process, nutritional needs change as we get older, but we do have some control over how our metabolism changes affect us. By being proactive and monitoring changes in our weight, we can make some small tweaks in diet and exercise to closely maintain our fitness, or if needed, bigger changes to work toward a healthier lifestyle.  Good luck in making the second half of 2019 your healthiest year yet!

Dr. Nick

​When couples come to me with infertility issues, they usually just assume that it is the female in the relationship that has problems.  However, what most couples don’t realize is that about 1/3 of the time it is male factor infertility that is preventing them from getting pregnant, and in another third of cases, both male and female issues can be present.  Making this worse is the fact that over the past 40 years, man’s sperm count has dropped steadily by 59%. Let that sink in- almost 60% drop in sperm count since the 1970’s.  What is causing the quality and quantity of sperm to decrease? Several recent studies have suggested that certain foods may be harming sperm. The timeline for the drop in sperm count parallels the rise in popularity of processed foods.

Foods that have been shown to affect sperm health

1. Processed Red Meats: Processed meats like hot dogs, bacon, and beef jerky seem to be major culprits in decreasing sperm counts and motility.  
2. Trans Fats: Fries, frozen pizza, baked goods (cakes, pies, cookies-especially with frosting), fast food, and even microwave popcorn.  The list for foods that contain trans fats is extensive. Avoiding processed foods in the grocery store and fast food restaurants is key to avoiding trans fats.  
3. High fat dairy products like cream and cheese was associated with decreased sperm motility and abnormal sperm shape.  It is thought that this is because of the sex steroids given to cows. Milk is one of those products that is probably better to buy from a source that ensures hormone free dairy.
4. Soy Products: soy products contain phytoestrogens (estrogen-like compounds) from plants, and excessive soy intake has been shown to decrease sperm concentration. 

How Can I improve my sperm health?

1. Try to stay away from processed meats, processed foods and trans fats!  Realistically the only way to do this is to cook most of your meals so you know what ingredients are going into your food.  This will allow you to control the salt and sugar content of your meals as well.
2. Eat your fruits and veggies. 
3. If you are overweight or obese, losing weight can help with sperm health.  Weight loss achieved with exercise has also shown to improve testosterone levels and sperm count!
4. Eat more fish!  Omega 3 fatty acids in fish has been associated with better sperm motility in some studies.  If nothing else, it provides a nice alternative to consuming red and processed meats.  
5. Eat Walnuts: It is thought that the fatty acids in walnuts help sperm development and can improve sperm shape, movement and vitality. 
   

There you have it.  Not only can diet have negative effects on a person's health, but it can also affect his sperm and ability to conceive as well.  Sometimes simple changes can be enough.  That being said, if you're doing all of the right things but still not having luck with conception, it may be beneficial to see someone for further testing.  Depending on the test results, there can be several options to help those having difficulty with conceiving, so be sure to discuss any concerns with your provider.  Good luck to all of those working to grow their families!

 Dr. Pam

While sex is intended to be fun by nature, for many couples there is a lot of stress to either make sure to have a baby or to make sure NOT to have a baby.  We’ve talked about infertility in the past, so today we’ll talk about the stress of avoiding pregnancy until you’re ready.  With about half of all pregnancies in the US being unplanned, here’s how likely you are to be successful with your chosen method to prevent pregnancy.

1. Progesterone-releasing IUD – this type of IUD is over 99% effective at preventing pregnancy and is good for up to 5 years, depending on the brand.  As an added bonus, your menstrual cycle is usually lighter, although sometimes the cycle can be a bit irregular.
2. Copper IUD – this type of IUD is also over 99% effective at pregnancy prevention and can be used up to 10 years.  It’s also hormone free, although sometimes it can make for heavier periods.
3. Nexplanon – another very effective birth control option, it releases progesterone and is over 99% effective for pregnancy prevention and works for up to 3 years.  Some users may experience irregular bleeding or weight gain.
4. Birth control injection – a progesterone shot that when used perfectly, is over 99% effective, but typically falls around 94% effective due to late injections.  Its side effect profile is similar to the implant, but slow return of menstrual cycle can cause a delay in the ability to conceive when stopped.  Also, there is an FDA warning regarding loss of bone density with longterm use.
5. Birth control patch – with the next few methods, efficacy can vary somewhat.  Perfect use happens when the contraception is used precisely as directed; typical use is, you guessed it, the way the method is typically used.  For the patch, perfect use would be about 99% effective, but typical use is closer to 91% effective.  The patch combines estrogen and progesterone is changed weekly, but sometimes it may fall off sooner.  This would require early replacement and may decrease efficacy.  Also, if you weigh over 198 lbs, then it may be less effective at pregnancy prevention.
6. Vaginal ring – another combination of estrogen and progesterone, the vaginal ring has a perfect use efficacy of 99% but again is only about 91% effective with typical use.  If not replaced on time or left out for more than 48 hours during the weeks it’s supposed to be in place, then these missteps can decrease efficacy.
7. Birth control pills – these can either be a combination of estrogen and progesterone or progesterone only (there are different indications for each), but again perfect use is over 99% effective whereas typical use is about 91% effective.  Be sure to review antibiotics and other medications with your provider to ensure there’s no interaction that can make the birth control pills less effective.
8. Condoms – condoms are great at reducing risk of sexually-transmitted infection, but they are a bit less effective at pregnancy prevention.  Even used perfectly, the male condom is only 98% effective, and this decreases to 85% with typical use.  Female condoms are even less effective, with only 95% effectiveness with perfect use and dropping to 79% with typical use.
9. Fertility tracking – whether basal body temperature, calendar method or cervical mucous method, this type of pregnancy prevention only works between 76-88% of the time, and if you have irregular cycles, the efficacy can decrease even further.
10. “Pullout method” – interestingly, this method can have a very substantial variation in just how effective it is.  While in theory, if done before ejaculation, the efficacy could be as high as 96-98%, typically it fails 20-30% of the time.  That’s essentially the same as using no contraception.  Part of that may be due to user error, whether in withdrawing too late or not understanding exactly when the sperm is released, and part of it may have to do with an individual’s particular composition of pre-ejaculate fluid, and another part may be due to residual sperm in the urethra from previous ejaculation (those little swimmers live for up to 5 days after all).
11. Permanent sterilization – both vasectomy and tubal ligation are over 99% effective; however, both are meant to be PERMANENT, so be sure that you’re sure no more children are in your future before considering a sterilization procedure.  While there are procedure to attempt reversal of sterilization, these are expensive, generally not covered by insurance and not always effective.
12. Nothing – pregnancy generally occurs 20-30% of the time with regularly unprotected intercourse each month, and most couples conceive within a year.

So, there you have it.  Be sure to discuss any change in contraception with your provider as some methods may not be appropriate if you have certain medical conditions, and there can be a delay of up to a week (or more for vasectomy) before your chosen contraception method becomes effective.  For some couples, an unplanned pregnancy is simply an unexpected surprise.  For others, it may be a much bigger deal, whether due to the stability of the relationship, financial limitations, medical restrictions or conflicts with job, education or other goals.  Generally speaking, if pregnancy would be a very big deal, then using one (or more) of the more effective contraception methods probably makes sense.  If the thought of a cute little surprise doesn’t stress you that much, then feel free to use any of the options for pregnancy prevention.  Just make sure to take prenatal vitamins in case you end up making that new addition to the family 😊

​Dr. Nick

Decreased libido is probably one of the most common complaints I get.  The conversation usually goes something like this- I have no desire to have sex- can you please check my hormones.   For women, hormones like estrogen, progesterone, and testosterone usually fluctuate based on the time of the cycle they are checked. Their value at different times in the cycle rarely gives us any insight as to the source of low libido. 

However, what most people forget is that the most common culprit for low libido is side effects from medications used to treat common maladies like hypertension and depression.  About 44% of Americans take at least 1 prescription medication and 17% take 3 or more.  If you look at a list of side effects for commonly prescribed medications, the list is so long that something like low libido can be easily overlooked.  Let’s go over some common medications that can affect your libido.
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1. Antidepressants: SSRI’s like Prozac and Zoloft just to name a few are very well known to decrease sexual desire and diminish or delay orgasm.  58 to 70% of people taking SSRI’s experience these kinds of sexual side effects.  Why does this happen? SSRI’s work to increase the amount of serotonin circulating in the brain.  While serotonin helps you feel less depressed, too much serotonin can decrease a person’s sex drive and make it harder to achieve orgasms.  Talk to your provider if you experience this.  There are other antidepressants that have less of an impact on sex drive, and depending on your medical history, these may be an option. 
2. Birth Control Pills: Oral contraceptive pills, especially those with estrogen, can lower hormones like testosterone, and this can affect libido.  If you experience this, talk to your provider about other options like IUD’s. 
3. Marijuana: While not always used in a medical application, just because it is legal in some states does not mean that there aren’t side effects.  Marijuana can have a significantly negative impact both on libido and even the ability to have intercourse.
4. Opioids: Opioids can lower testosterone and have an adverse effect on sex drive. 
5. Hypertension medication: Blood pressure medications help lower the pressure inside blood vessels, so the heart doesn’t have to work so hard.  This reduced flow can interfere with orgasms in women and erections and ejaculation in men.   Common hypertension medications like beta blockers and diuretics can help lower blood pressure but can also have a negative impact on your libido.
6. Benzodiazepines: Xanax can help reduce anxiety, but it can also dampen your sex drive. The sedative and muscle relaxant properties are thought to lessen interest, excitement and sensation. Essentially, while making you numb to anxiety, it can also make you numb to arousal.
7. Statins: Statins are used to treat patients with high cholesterol.  Cholesterol is one of the building blocks for testosterone.  Interfering with the production of sex hormones like testosterone can adversely affect sexual desire. 
8. Antihistamines:  Benadryl and other allergy medications can dry out your runny nose, but they can also make you dry down there.
9. H2 Blockers (Zantac, Tagamet, Pepcid), which are used to treat gastroesophageal reflux and ulcers, while not as much of an issue for women, can cause impotence as well as breast enlargement in men. 

 
This blog is actually the short version of the list of medications that can interfere with both desire and performance of intercourse.  There are many more medications that can adversely affect your sex drive.  If you are on one of these medications and have noticed an adverse effect on your libido, please talk to your provider before discontinuing the medication.  Weighing the benefits of the medication as it relates to your individual health as well as whether alternative treatment options are available is a conversation that you should have with your provider prior to making any changes in your medical regimen.  Good luck keeping that healthy desire burning!

Dr. Pam

While we may not think about it often, it turns out that our adipose (fat) cells are actually one of the largest endocrine organs in our bodies, and these cells are responsible for secreting a number of hormones that help regulate everything from appetite to the menstrual cycle.  For instance, the average woman in the US weighs just over 170 lbs, so with an average body fat range of 25-30%, approximately 40-50 lbs of her weight will be composed of adipose tissue.  In comparison, the thyroid weighs about 25 grams, the pituitary gland weighs half a gram, the pancreas weighs about 90 grams, and an ovary generally weighs 5-10 grams.  That means the total weight of these other endocrine organs is less than a pound, and while the hormones produced by these organs tends to be more potent, adipose tissue can sometimes have negative effects by the sheer volume of hormone production.

So, what kinds of hormones do adipose cells produce?  While some play expected roles in things like appetite, obesity and insulin resistance, other hormones are responsible for steroid metabolism.  In simple terms, even though we think of the ovaries and adrenal glands as responsible for sex hormone balance, at least 50% of testosterone in premenopausal women and 100% of estrogen in postmenopausal women is regulated by adipose.  Also, depending on each woman’s amount of adipose, a significant portion of estrogen can come from these cells even in premenopausal women.

Why does that matter?  That means extra adipose tissue can cause hormone related issues such as unwanted hair growth on the face/body, increased acne and in some cases, even hair loss from the head.  For women struggling with heavy menstrual cycles, this can be directly related to the increased estrogen because estrogen causes increased thickness of the uterine lining shed each month during the menstrual cycles.  More tissue in the uterus to get rid of means heavier flow and often more cramping each month.  In more severe cases, too much estrogen from adipose can even cause the menstrual cycle to stop.  While this may sound exciting to some women, a lack of normal menstrual cycle can cause everything from infertility issues (no menses=no ovulation=no egg for pregnancy) to increased risk of uterine cancer (gradual buildup of uterine lining over time without shedding can predispose to cancer).

So, too big is bad, but what about too skinny?  We can sometimes see problems at the other end of the spectrum as well.  Super-intense athletes who have extremely low body fat and women with a very low BMI may also have issues with the menstrual cycle.  If the body shifts into starvation mode because there isn’t enough body fat, then one of the functions that may stop is the menstrual cycle and ovulation.

In general, a regular menstrual cycle with normal flow can be a marker of good overall health in premenopausal women.  Granted, there are always exceptions to this rule.  For instance, some women may not have a cycle due to hormonal contraception, which can be normal.  Also, we know that for some women who are very athletic, such as competitive weightlifters, BMI may not be the perfect measure of health.  That being said, generally a healthy BMI ranges from 18.5-24.9, and the average BMI for women in the US is 29.6, which means many women are just below the threshold for obesity.  So, if you’ve been having menstrual cycle issues with either heavy or irregular flow, and your BMI is elevated, especially above 35, then one of the simplest interventions to help improve your cycle may be weight loss.  These normal cycles can also provide health benefits of improved fertility and decreased uterine cancer risk.  By regulating your hormones on your own, then you may be able to avoid having to take synthetic hormones and in turn, also having to deal with unwanted side effects from these medications.  Besides, who wants to deal with daily pills anyway?

Dr. Nick

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