Can eating processed carbs thwart attempts to treat other addictions?

A recent article in the New York Times: “How Carbs Can Trigger Food Cravings” discussed the mechanisms by which high-glycemic index foods based on processed carbs trigger similar brain reward responses as highly addictive drugs like cocaine.

While the author mainly concluded that people wanting to lose weight should avoid processed carbs and sugar, which is obvious, I think the next logical implication is that people trying to detox from addiction to opiates, alcohol, stimulants and other substances should also avoid flaring up their nucleus accumbens reward pathway by simultaneously avoiding processed and refined carbohydrates.

Another interesting research study in the journal Obesity, June 2013 edition, measured retinal responses to specific light stimuli with a technique called electroretinography which had been found to have a specific pattern when a person was given a dopamine-releasing, rewarding stimulus like the amphetamine-like drug methylphenidate (Ritalin). They then showed that a chocolate brownie, a highly potent source of processed carbs and sugar, created a very similar reward pattern on electroretinography to the amphetamine, and was also associated with increased binge eating behavior.

Ultimately, I think brains need to have a more stable, less quickly fluctuating, and therefore more “boring” neurochemical balance to achieve better function and performance over time.

The irony of Alcoholic Anonymous meetings is that often the attendees gather outside to, yes, binge on cigarettes, coffee and pastries. In other words, maximally stimulating their deprived reward pathways with “acceptable” rewarding substances (nicotine, caffeine and processed carbs/sugars) to compensate for the absence of alcohol or other drugs of abuse. Since nicotine, caffeine and high-glycemic-index foods are very short-acting agents, producing a rapid rise and then fall in blood levels of the rewarding substance, this behavior just keeps the neurochemical roller coaster going, and I believe makes achieving lasting brain stability more difficult.

The NYT article is here: http://well.blogs.nytimes.com/2013/06/27/how-carbs-can-trigger-food-cravings/

The abstract of the June 2013 article in Obesity is here: http://www.ncbi.nlm.nih.gov/pubmed/23784899

Food is indeed medicine, acting just like a prescription drug, and we should respect it as such.

Do you or a loved one have the Female Athlete Triad?

How often does a doctor say “you need to gain weight?” We’re all used to medical professionals (and the media) focusing on weight loss and other ways to prevent diabetes and cardiovascular disease. What’s often overlooked is that a surprising number of otherwise healthy people actually suffer from being underweight, sometimes with devastating consequences.
One group of such people is those with the Female Athlete Triad, with a combination of three elements:

Too few calories available. This can be due to not eating enough, exercising too much, or both.
Menstrual irregularities. Menstrual periods can be irregular or absent.
Bone loss.

This develops into osteopenia and snowballs into osteoporosis. Stress fractures are a key early warning sign. The diagnosis requires a bone density (DEXA) scan and sometimes an MRI to detect early stress fractures.

Why does it matter?

Amenorrhea is a key part of infertility;
Osteoporosis can lead to broken bones at any age. The older you are, the more serious the consequences of a break can be. With severe osteoporosis, even normal activities like lifting a box can lead to a fracture;
Osteoporosis can result in compression of the spine, causing decreased height and deformities like a dowager’s hump (kyphosis);
Depression, anxiety, and mood disturbances are often related to the hormonal imbalances caused by too much exercise and/or insufficient nutrition;
Electrolyte imbalances and anemia can both lead to fatigue, cramping, fainting, and under-performance in sport and daily activities;
Heart arrhythmias and low blood pressure can be life threatening in serious cases of disordered eating and malnutrition.

How does it happen?

Essentially, the Triad is caused by stress on the body. Stress can come in many forms:

Not eating enough calories;
Intermittent fasting;
Cutting out carbohydrates or fat;
Exercising too much;
Not having enough body fat;
Not sleeping enough;
Taking certain drugs, dietary supplements or medications.

Ongoing stress shuts down the GnRH signal from the hypothalamus, which will stop the production of the hormones FSH and LH. Without FSH and LH, estrogen and progesterone levels will plummet. Estrogen is necessary for bone formation and preservation, so inadequate estrogen guarantees bone loss.

What can I do?

If you (or someone you know) identify with any element of the triad, go see your primary care doctor as soon as possible. The doctor can measure your body fat, order blood work, and request a DEXA scan. The two of you can check your body composition and hormonal status and devise a plan to bring you back to a healthy, bone building state. Alterations in diet, exercise, supplements, and overall lifestyle will likely be necessary. Medically supervised “self tracking” is a useful tool for keeping track of dietary intake, exercise, sleep, body pH levels, and correlating these with changes in bone density. Having a Quant Coach and Quant-friendly Doctor on your team can give you the support and guidance you need to stay on your route to recovery and health.

If you need a doctor who understands these issues, and has a team ready to help, just give us a call here at My Doctor Medical Group.

Key Questions to Ask Before Getting a #Dog For Yourself or a Loved One

You might have been thinking about it for a while now. You might be motivated by the recently published statement from the American Heart Association (backed up by multiple studies) about how having a dog might reduce your risk of cardiovascular disease and improve your health. Whatever the reason, you want to share time and maybe even a home with a dog, and that's great!

A few things to consider (or at least remind yourself about):

1. What kind of dog?

Have goals, but be realistic, and think about what kind of life you currently lead.

How much you are at home? Can a dog come to work with you or will you have to arrange for care during the hours that you are not there. There are doggy day-cares, and dog walkers who can come to your home.
How big is your place? If you live in an apartment that is slightly larger than your own body's square feet, you may want to reconsider the idea of a Great Dane or other giant breed dog, since that dog and its bag of food alone will leave no additional room for you.
Do you have a yard (and if so, is it enclosed)? At 3am, do you just need to open the back door and stand there, or will you also have to get up, get dressed and go outside with the dog whose bladder is calling?
What is the climate in your area? Brachycephalic breeds such as Pugs are predisposed to trouble with overheating, so desert living without air conditioning is asking for trouble. Whippets without an appropriate wardrobe of down jackets will get very cold in Arctic climes.
What activities might you want to share with a dog? If you are going to run more than 5 miles a day, a Chihuahua may not be the right choice; try something with slightly longer legs. If you are going to swim or enjoy other water activities, be aware that English Bulldogs will sink like a stone. If they are going to accompany you, they will need to wear a personal flotation device (PFD).
Are there other people in the home (e.g. children, elderly)? Be aware that to a dog, a young child can easily be mistaken for a big squeaky dog toy, as they are dressed in bright colors, make high-pitched sounds and are often already smeared with delicious jam and peanut butter. In addition, children will have to be taught how to interact with a dog. Seniors often have fragile skin that will bruise or even tear from well-meaning but eager paws or nails that might scrape against them.
Do you have allergies? Some dogs (e.g. Dalmatian or Jack Russell Terrier) will definitely shed, and their dander is more likely to exacerbate allergies. But dogs that have ‘Poodle type' hair (e.g. Poodle, Bichon Frisee, Portugese Water Dog) are less allergy-provoking.
What is your current physical status? As sweet and gentle as a Golden Retriever will likely be, 80 pounds of enthusiasm on the end of a leash will pull you over every time, or at least strain your joints with the effort to hang on. The same untrained energy from a 7-pound Maltese might be easier to handle.

Do some homework ahead of time on certain breed characteristics and traits (N.B. these are general breed characteristics, and not absolutes; like us, they are all unique individuals).

There are some breeds that are meant for a lot of physical activity as often as possible (e.g. Labrador Retriever, German Shorthair Pointer) and some that are more low key and happy to take a more leisurely paced stroll and then relax doing more sedentary tasks (e.g Cavalier King Charles Spaniel).

Some breeds require a lot of mental stimulation as well as physical exercise (e.g. Border Collie, Jack Russell Terrier). Other breeds require a lot more upkeep and assistance with grooming (e.g. Poodles) and basic hygiene (e.g. Brachycephalic breeds).

2. Shelter or Breeder?

There are many shelters and rescue organizations. Most of them have websites where you can view photos and read descriptions. There are puppies, adults and senior pets all available and in need of homes. Shelters will often end up with many purebred dogs if hybrid vigor is not your thing. Petfinder.com is a great online resource that brings you access to just about anything you are looking for.

If you still aren't finding what you are looking for at the shelter, or are simply set on a breed that you want, don't forget to check breed-specific rescue organizations. There usually is one for most any breed you fancy. Often you will find dogs who have been loved very much, but whose owner has had to move (often overseas), has become ill, or has had a major lifestyle change that didn't agree with the dog, such as having a new baby. If you do go with a breeder check to be sure they are actually the breeder and not a broker, since many brokers advertise themselves as breeders but are just flying in the purebred puppies from what might be a disreputable ‘puppy mill.' American Kennel Club (AKC) is a valuable resource for breed information. But AKC certification just means that the dog is registered with them and therefore recognized as that particular breed. It does NOT reflect on the health or quality of the bloodline or breeding that was involved.

All dogs will require a time and care commitment from you, but puppies will need extra amounts of your time for basic training (inside and outside), multiple veterinary visits up through about 7 months of age (for routine vaccine series, spay/neuter, etc.) and socialization skills. You or your representative will have to be accountable for these things, as it is your responsibility to produce a good canine citizen.

Whether adult or puppy, don't forget about some form of insurance. The money has nothing to do with how much you love your dog, but these days even routine care or non-emergent things will add up quickly. The last thing you want is for finances to be the only thing guiding your decision-making in a medical situation. There is actual pet insurance you can get, or you can set aside an ‘amount' (I often recommend about $1000) to be used if needed.

4. Borrow a dog or own a dog?

If your current schedule isn't the right fit or some other legitimate reason prevents you from bringing a dog into your home/family to live right now, there are still many options open to you.

You can arrange to ‘borrow' or take a friend/neighbor's dog for a walk on a scheduled daily or weekly basis.
You can volunteer at a local shelter or rescue facility to spend time with or walk dogs on a scheduled daily or weekly basis. Visit the website of most organizations and there is usually a link for volunteer opportunities.
You can foster or foster to adopt. If you think that you want to bring a dog home, but you are nervous that it won't be the right fit or are not sure that you can fully commit long-term to a dog, consider fostering or fostering to adopt. Most shelters and rescue organizations offer these as options (they need help with the overcrowding of the number of dogs in the shelter facility and they want dogs in homes that are the right fit, so that it will end up being permanent resulting in happy dogs and humans).

Conclusion

Getting a dog is a big financial, time and emotional commitment. It is worth every penny, moment, tear and smile. Just be honest, realistic and as prepared as you can before venturing forth. That way you are most likely to have an extremely successful and rewarding experience all around.

And if the end result for you is the resolution of your hypertension, or the ability to see your own feet again, that will be one more reason to smile back at your adoring new quadruped friend.

Laurie Pearlstein DVM

Owning a #Dog May Reduce the Risk of Heart Disease #animaltherapy

The American Heart Association released a surprising statement this month: Owning a dog is associated with a lower risk in heart disease, and maybe blood pressure, cholesterol levels, obesity and the response to stress.

Of course finding a correlation does not prove causation. But there is a mounting body of evidence that does point toward pet ownership being a good thing for people's health. Enough so that even a very conservative cardiovascular health organization like the AHA is putting out press releases! We have long been advocates of animal therapy here at My Doctor Medical Group.

According to the AHA's statement, research shows that:

Pet ownership is probably associated with a reduction in heart disease risk factors and increased survival among patients.
Dog ownership in particular may help reduce cardiovascular risk. People with dogs may engage in more physical activity because they walk them. In a study of more than 5,200 adults, dog owners engaged in more walking and physical activity than non-dog owners, and were 54 percent more likely to get the recommended level of physical activity.
Owning pets may be associated with lower blood pressure and cholesterol levels, and a lower incidence of obesity.
Pets can have a positive effect on the body’s reactions to stress.

While the statement pulled back in the end, saying “people shouldn’t adopt, rescue or buy a pet solely to reduce cardiovascular risk,” I think better advice would be “if you're going to adopt, rescue or buy a pet, be sure to educate yourself and do it right.”

Here at My Doctor Medical Group, we are fortunate to have a pet therapy expert on staff: veterinarian Laurie Pearlstein DVM, whom we have asked to write a blog post on “Getting a Dog.” We would like everyone hoping to acquire a new pet to consider important issues ahead of time:

What kind of dog?
From a shelter or a breeder?
Adult dog or puppy?
Pet insurance and animal health care
Borrow a dog vs. own a dog?

You can find Dr. Pearlstein's article here: Key Questions to Ask Before Getting a Dog for Yourself or a Loved One.

Intermittent Fasting Shows Promise for Treating Diabetes and Heart Disease

Right up there with the very well-marketed Paleo diet, intermittent fasting (IF) has achieved popular attention in the past year for its potential role in achieving rapid weight loss. But now there is mounting evidence that this approach to eating may have specific benefits for those with diabetes and cardiovascular disease.

Intermittent fasting can be implemented in various ways. Common approaches are

Alternating days spent eating normally with days when calorie consumption is restricted;
Taking two days each week and making them ‘fasting days;'
My favorite, proposed by Tieraona Low Dog MD: ‘If there isn't healthy food available, I just don't eat.'

A mounting body of evidence in animal models and humans points to specific effectiveness of intermittent fasting for weight loss and treatment of diabetes and cardiovascular disease, most recently in a review article in the British Journal of Diabetes and Vascular Disease.

Link to original article here.

Compared to more invasive conventional medical methods of treating overweight and its complications, intermittent fasting looks downright reasonable. But we are still working on the best ways to help people implement this approach, most recently via our medically-supervised quant coach program here at My Doctor Medical Group.

What we have found, is that everyone is an individual. Some take to specific approaches like IF very easily, and others need to troubleshoot other health issues before IF is easily implemented, and it's hard to generalize since each case ends up being so unique.

Oh no, I’ve gotten into poison oak, poison ivy, or poison sumac. What do I do?

A topical post based on recent experience, unfortunately.

Poison ivy, poison oak, and poison sumac are common plants in the genus Rhus, found throughout the United States and in Africa, often near hiking trails. Four in five people are allergic to urushiol, a compound found in the plant’s sap that causes a itchy and painful allergic rash on the body in any spot that it comes into contact with. The rash typically shows up within 8-72 hours after exposure, however, those who are highly allergic may show signs within 4 hours. The rash may continue to appear and spread for up to 21 days and will only appear in places where urushiol made contact.

You cannot spread the rash by scratching or making contact with the blister fluid. However, you should avoid scratching to prevent scarring and infection. Keep the open areas clean and dry.

Common symptoms: Itching, red streaks or general redness, small bumps or raised patches of skin, blisters with or without fluid, blood blisters.

What to do if you think you have come into contact with poison oak, poison ivy, or poison sumac:

Step 1: As quickly as possible, wash your hands, under your fingernails, and the areas (or entire body if possible) with regular soap or Tecnu if you have it. If that is not feasible, you can wipe the infected areas with rubbing alcohol. Remove and contaminated clothing and wash separately with hot water and plenty of soap. Wipe down or wash anything that may have come into contact with the urushiol, like shoes, camping gear, car seats, chairs, bedding, pets, friends or gardening tools.

Step 2: Schedule an appointment with your primary care doctor or dermatologist. Mild cases of poison ivy may be treated at home with cold compresses, astringents, non-prescription antihistamine medication to reduce itching, and calamine lotion. Moderate to severe cases, if your at-home protocol does not help, should be handled by a physician. If you have inhaled urushiol by burning poison oak, if it has come into contact with highly sensitive areas or inside your mouth, or if the rash is spreading into your eyes or genital areas, seek medical attention immediately.

Medical treatments for more serious cases can include stronger antihistamines, topical corticosteroids, and even oral corticosteroids. But steroids can have adverse effects so it's important to use them only under the close supervision of your doctor, and only if absolutely necessary.

Rhus dermatitis, even with medical treatment, often lasts longer than one would like. Having a doctor on your team will help you determine if things are improving at a normal rate, or if additional actions or stronger treatments need to be employed. Most importantly: do not panic.

A natural remedy for varicose veins

Horse chestnut seed extract has been shown to have some effect when used orally for symptomatic treatment of chronic venous insufficiency, such as varicose veins. It may also be useful for relieving pain, tiredness, tension, and swelling in the legs. It contains a number of anti-inflammatory substances, including escin, which reduces edema and lowers fluid exudation by decreasing vascular permeability.

References

Ref: Jones RH, Carek PJ: Management of varicose veins. Am Fam Physician 2008;78(11):1289-1294. 2)

Pittler MH, Ernst E: Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev 2006;(1):CD003230.

Did you get a pustule at your blood draw site? Consider Behcet’s Syndrome.

The original description of Behçet’s syndrome included recurring genital and oral ulcerations and relapsing uveitis. This disease is also associated with cutaneous hypersensitivity; 60%–70% of patients will develop a sterile pustule with an erythematous margin within 48 hours of an aseptic needle prick.

It is more common in Japan, Korea, and the Eastern Mediterranean area, and affects primarily young adults. The cause is unknown. Two-thirds of patients will develop ocular involvement that may progress to blindness. Patients may develop arthritis, vasculitis, intestinal manifestations, or neurologic manifestations.

Of course, there are many other reasons you might have developed a reaction at the site of a blood draw. Consult your physician. But the diagnosis of Behçet’s is often missed and it's worth considering. Read the below free reference from Arthritis Research UK for much more complete information.

References

Free E-Booklet on Behçet’s Syndrome from Arthritis Research UK: Download Here

Fauci AS, Braunwald E, Kasper DL, et al (eds): Harrison’s Principles of Internal Medicine, ed 17.

McGraw-Hill, 2008, p 2132. 2) Klippel JH, Stone JH, Crofford LJ, et al (eds): Primer on the Rheumatic Diseases, ed 13. Springer, 2008, pp 435-439.i

A Medically-Supervised Self-Tracking Program Might Work Better for Migraines #quantifiedself

There's a growing body of research supporting the methodologies we use in our medically supervised Quant Coach Program here at My Doctor Medical Group.

If you get violently ill every time you go on a roller coaster, what do you do? Unless you are a peculiar breed of masochist, you likely avoid roller coasters at all costs. The avoidance of pain is a core component of human instinct, but sometimes the root causes of pain are not as clear-cut as in the roller coaster example.

Creative Commons Licensed (CC BY 2.0): Link to Original

Migraines can be a debilitating, painful and time-consuming medical condition. Sufferers of severe migraines typically must isolate themselves from light, sounds and other stimuli for hours or sometimes even days. The cost in terms of pain and suffering, and lost productivity, can be considerable. Many “migraineurs” pursue the hope of figuring out a trigger that can be avoided, thereby reducing migraine frequency or severity.

Finding the trigger. It turns out that people are often wrong about what they think their migraine triggers are. Many people blame a certain food item or environmental stimulus, but in reality are not making the right cause-and-effect association. We often suggest that rather than trying to figure it out on one's own, it is often better and more productive to enlist the help of a doctor who can help you in implementing a methodical self-tracking approach. A “Quant-Friendly Doctor,” as we have come to call such a physician, can help you design and execute experiments to figure out exactly what does or doesn't trigger your migraines.

A new study from Wake Forest Baptist Medical Center confirms that while migraine sufferers often think they know their triggers, it is actually almost impossible to know without a formalized experiment. This is due to a web of undulating factors, such as hormones, sleep, physical activity, stress, alcohol intake, diet, and the weather. To more quickly and truly know which variables cause your migraines, the author recommends teaming up with your doctor to devise experiments. Tracking the variables and occurrence, duration, and severity of the migraines is key for determining what does and does not make a difference. For example, you wouldn't want to forgo chocolate or your beloved morning mug of precious coffee if you didn't need to, right? Perhaps what you really need is another hour of sleep, or increased water intake, or to correct a mineral deficiency.

Of course, we always recommend those suffering from headaches work with a physician on a medical workup and plan in addition to their own self management efforts. But if medical approaches are not producing adequate results, then self tracking, particularly with the guidance of a Quant Coach and medical supervision of a Quant-Friendly Doctor, may be the best way to put the migraines to rest once and for all.

Link to article on Science Daily

Link to our Medically Supervised Quant Coach Program page

New Avian Influenza A H7N9 Virus in China: The Next Pandemic?

It's not time to panic.

The latest April 14, 2013 update on the H7N9 Avian Influenza A outbreak from the Chinese Center for Disease Control and Prevention reports 11 additional cases of human infection have been laboratory confirmed. Three cases are from Shanghai, two from Jiangsu, four from Zhejiang and the other two from Henan. There are two more deaths, and both are from Shanghai.

Mainland China statistics:
Total confirmed cases to date: 60
Total death to date: 13
Number of provinces affected: 6

So far, no close contacts of the identified cases have been found to be infected, so it appears that these human infections are sporadic without evidence of human-to-human spread thus far. Based on previous experience with other avian influenza viruses such as H5N1, some limited human-to-human spread of this H7N9 virus would not be surprising.

What would change things, is if this virus mutates to allow for easy human-to-human transmission. That did happen with the H1N1 swine flu, but that particular strain turned out not to cause severe disease in most people. Experts say that the combination with a highly-aggressive influenza strain and human-to-human spread will occur sooner or later, and we will all be potentially affected.

So far, all three viruses seem to be susceptible to the influenza antiviral drugs oseltamivir and zanamivir, but they are resistant to the adamantanes. Bad news for consumers and taxpayers: both of the effective drugs are “on patent” and extremely expensive.

For sure, vaccine manufacturers and other stakeholders in the “epidemic industry” are making plans to capitalize on the legitimate concern of a pandemic influenza strain developing.

Sources:

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