Obesity - is it Your Fault?; Food Labels; Nighttime Leg Cramps; Overdose on Supplements; Lactose Intolerance; Insomnia.
Let's Talk Medical with Doctor Gigi aired live on Friday March 2, 2012. Following are the highlights of which we spoke, with a bit more educational content. As always, I hope this information is useful to you & your loved ones, & please feel free to respond here or via e-mail (DoctorGigi@SkipShow.com) if you have further questions or concerns. The blog is not simply a transcript of the show, so also feel free to refer to the recorded podcasts if you prefer to listen, especially as some content there is not repeated here.
Several people were apparently a bit offended by the conversation Skip & I had the week earlier when we discussed weight loss. There is a new weight loss drug available, & I believe it will help certain people with obesity. The drug is named Q-Nexa, & you can refer to last week's blog for more specific information regarding what it is & how it works. During our conversation we discussed that diet & exercise are still utterly important to achieve longlasting weight loss, & some felt that we were insinuating that a person who is overweight is that way due to his or her own choosing or fault. It is not necessarily a person's fault if he is overweight, but without making appropriate dietary changes & without doing some form of exercise, it is not likely that he will lose weight & keep it off. A few helpful hints will follow, but if you truly struggle with obesity, consider seeing a dietician to help review your eating habits, as you might not know what you are doing wrong, AND consider beginning some sort of exercise regimen. I tell my patients to be sure to eat 3-6 times per day, as people who "graze" tend to be thinner than those who eat 1-2 times per day. Of course, you need to eat small meals, so I sometimes recommend dividing each meal into 2 meals. Thus you would eat 1/2 of your breakfast, then finish the other 1/2 about 2 hours later. You would do the same with lunch & supper. Also, try to include protein in every meal as protein makes you feel full, whereas carbohydrates make you hungry shortly after eating. Remember that fats have more calories per gram so eat less of them... carbs & proteins each have 4 calories per gram, whereas fats have 9 calories per gram! Also, do not eat "empty calories"... these are foods that have calories, but essentially no nutritional value... such as soda, sweet tea, & alcohol. As for exercise, you don't need to run a marathon, you just need to expend more energy than you are right now. It is simple & free to take up a walking program. Start walking slowly, & increase the speed & distance as you get in shape. Try to talk or sing as you walk, as that actually uses more energy, or better yet, carry a 1-2 pound weight in each hand & swing your arms as you go. If you need more structure, consider joining a gym such as You Fit (which is fairly inexpensive & seems to attract REAL people rather than just those who look like they don't really need to go to the gym!). Though I can give all these helpful hints, I know from personal experience that it is not easy to lose weight... I have been to weight loss clinics, & I have had a suction lipectomy to remove fat from my hips & thighs... I have even worked in weight loss clinics. But... I am still overweight & don't like my body! It does seem that I have to work hard to lose 5 pounds, but by the same token I don't gain more than about 5 pounds even when I eat poorly & "forget" to exercise. It is as though my body just likes weighing about 135-145 pounds! So I agree that there is more to obesity than just calories in (what you eat) & calories out (what you exercise off). No one seems to have a grip on that yet however, so for now, your best weight loss success will likely come from a combination of good dietary choices & good exercise habits, both of which should be done for a lifetime, & brief episodic use of medications like Q-Nexa.
There was a brief discussion regarding food labels. I am not a nutritionist, so I am not an expert in regards to this! I do know however that the most misunderstood part of the label is the "serving size." This often leads us to make bad choices & to overeat, so let's talk about it briefly. The serving size is of course what the food producer feels is an appropriate serving, but the misunderstanding comes when we assume that the entire package is ONE serving! For example, a Big Gulp is a 32 ounce soda, but one serving of soda is likely 8 ounces. So you must look at the label & do a little math. If a serving size is 8 ounces & that has 150 calories, then you must realize that if you drink the whole Big Gulp you will get FOUR servings, & thus 4 times the calories... which is 600 calories! Apparently, the Mars company recently agreed that people do not understand serving size & have agreed to stop producing king size candy bars in an attempt to help America with her obesity dilemma! Their candy bars will be sized to an appropriate serving, so people will hopefully eat less & get less calories. If you want more calories you can eat 2 or 3 bars, but you will be more likely to understand the number of calories you are getting in this manner.
A gentleman wrote a note requesting help for his wife who often awakens with severe leg cramps. Though this is a common complaint it is not one for which we have a great answer. I suggest that someone with significant nighttime leg cramps should discuss this with his physician, who in turn will hopefully order blood tests. Generally these tests should include: a Calcium, Magnesium, Potassium, Phosphorus, & Vitamin D level, as deficiencies of these minerals & vitamins can certainly cause cramps. If these are normal, you might also need further tests to include: thyroid studies (TSH & T4), muscle studies (such as a CPK & an LDH), & tests for connective tissue disorders (such as an ANA, Rheumatoid Factor, & Sed rate). I had a patient with severe cramping, & as I could not help her, she sought a Neurologist for another opinion. The above work-up came from him, so I learned some tricks! If any of the labs show a significant abnormality, that should be further evaluated, but as is often the case, my patient had no abnormalities. The Neurologist treated her with a muscle relaxant (such as Flexeril or Skelaxin) at bedtime. I know that the old remedy was Quinine, but many of the over-the-counter products with Quinine have been taken off the market. Not to fear! If you want to try Quinine, look no further than your local liquor store where you can purchase Quinine water, & try several ounces just before bedtime! If you don't like the taste or need to limit your fluids, perhaps you can find a pill with Quinine, such as Hyland's Leg Cramps with Quinine. Lastly, as I am a fan of old remedies, some of my patients tell me that putting a bar of soap in the bed near their feet stops the cramps... to which I say, why not try it???
One point of interest is the fact that you should not just increase your intake of vitamins or minerals without first discussing with your doctor, as some are toxic in excess. In other words, you can actually overdose on certain vitamins & minerals! The potentially toxic vitamins are the ones that are fat-soluable, so they can "build up" in your body. These are Vitamins A, D, E, and K, so if you take them in doses above the recommended daily amount (=RDA), be sure to occasionally check a blood level. Minerals such as potassium & calcium can also lead to problems if taken in excess, & in fact I believe the Veterinarians still use Potassium as the injection for euthanasia, as it causes the heart to stop beating when given in a large amount intravenously!
Mandy asked about why she might have lactose intolerance. Well, first, lactose is the sugar found in dairy products, such as milk & ice cream. Lactase is the enzyme which digests or breaks down the lactose. Babies obviously have lactase, but evolutionarily it is not necessary to have this enzyme once you get teeth... as that is when your mother generally stops breastfeeding you! Though many people have this lactase enzyme all their lives, others lose it... at varying ages... & thus become lactose intolerant. Without the enzyme to breakdown the lactose, this sugar passes through the intestines & ferments, leading to gas, cramps, & diarrhea! Thus lactose intolerance is not really a disease process, though it can really make you feel bad! If you are unfortunate enough to have lost your lactase enzyme, I recommend you try getting some lactase pills from the health food store. You take these pills with the dairy product, thus correcting your deficiency, & thus appropriately digesting the lactose before it ferments! Though this doesn't work for everyone, it does work for many, so give it a try! You might also want to try Lactaid which is a milk that already has the digestive enzyme in it.
Our last topic was in regards to a 51 year old gentleman who has sleep problems. Time did not permit a long conversation nor a long answer, but perhaps we can delve into this deeper in the future! The short answer was that not sleeping well might just be a nuissance OR it can be a significant health issue! Some people have what is called "poor sleep hygiene" which means that they do things which keep them from sleeping well. This might include: watching TV in bed, reading a book in bed, falling asleep on the couch (only to awaken later & have to get yourself to bed after you lock the door, brush your teeth, etc.), & sleeping with pets or partners who make noises which awaken us. My sleep specialist has a rule that the bed is for sleep & sex, but nothing else! When you go to bed, you go to sleep! Do not lay in it awake reading a book or watching TV, as your mind can get confused if you do not give it proper clues as to when it is appropriate to sleep. By the same token, you must have quiet & dark, so try to create this in your bedroom. If your pets, partner, or neighbors are noisy, try earplugs! Certainly a Sleep Doctor can help you further with these techniques, but more importantly he can help diagnose more severe sleep issues such as sleep apnea. Sleep apnea is a common problem, especially in overweight people, & it is associated with high blood pressure & premature death! It is caused by obstruction of the airway, so literally you stop breathing during your sleep. When the brain perceives it desperately needs oxygen, it arouses you & you take a big gasp to open your airway. This results in you awakening briefly, but you re-establish breathing... at least briefly. This cycle repeats through the night, resulting in you having stressed your heart & body with the low oxygen episodes. As a result of your multiple arousals, your body does not get into deep sleep, & in the morning you feel as if you never slept! This results in daytime fatigue & sleepiness. If this sounds like you, I suggest you see your doctor & consider getting a sleep study to see if you indeed have sleep apnea, as it can often be successfully treated with something called CPAP which provides pressure to keep your airway open. Weight loss is often helpful, & in rare cases surgery is necessary. As a last thought, do not use alcohol to help you sleep! It will cause you to "pass out" but it does not cause you to sleep... in other words, you do not go through the proper sleep cycle, so you will not feel well rested!
Here's to our health!
Doctor Gigi
PS Feel free to check out the radio show at 1PM Eastern time on Fridays via www.SkipShow.com or listen to the podcasts via the same site. If you want to be a part of the show, call me live at (727)-441-3000 or toll-free at (866)-TAN-1340.
Several people were apparently a bit offended by the conversation Skip & I had the week earlier when we discussed weight loss. There is a new weight loss drug available, & I believe it will help certain people with obesity. The drug is named Q-Nexa, & you can refer to last week's blog for more specific information regarding what it is & how it works. During our conversation we discussed that diet & exercise are still utterly important to achieve longlasting weight loss, & some felt that we were insinuating that a person who is overweight is that way due to his or her own choosing or fault. It is not necessarily a person's fault if he is overweight, but without making appropriate dietary changes & without doing some form of exercise, it is not likely that he will lose weight & keep it off. A few helpful hints will follow, but if you truly struggle with obesity, consider seeing a dietician to help review your eating habits, as you might not know what you are doing wrong, AND consider beginning some sort of exercise regimen. I tell my patients to be sure to eat 3-6 times per day, as people who "graze" tend to be thinner than those who eat 1-2 times per day. Of course, you need to eat small meals, so I sometimes recommend dividing each meal into 2 meals. Thus you would eat 1/2 of your breakfast, then finish the other 1/2 about 2 hours later. You would do the same with lunch & supper. Also, try to include protein in every meal as protein makes you feel full, whereas carbohydrates make you hungry shortly after eating. Remember that fats have more calories per gram so eat less of them... carbs & proteins each have 4 calories per gram, whereas fats have 9 calories per gram! Also, do not eat "empty calories"... these are foods that have calories, but essentially no nutritional value... such as soda, sweet tea, & alcohol. As for exercise, you don't need to run a marathon, you just need to expend more energy than you are right now. It is simple & free to take up a walking program. Start walking slowly, & increase the speed & distance as you get in shape. Try to talk or sing as you walk, as that actually uses more energy, or better yet, carry a 1-2 pound weight in each hand & swing your arms as you go. If you need more structure, consider joining a gym such as You Fit (which is fairly inexpensive & seems to attract REAL people rather than just those who look like they don't really need to go to the gym!). Though I can give all these helpful hints, I know from personal experience that it is not easy to lose weight... I have been to weight loss clinics, & I have had a suction lipectomy to remove fat from my hips & thighs... I have even worked in weight loss clinics. But... I am still overweight & don't like my body! It does seem that I have to work hard to lose 5 pounds, but by the same token I don't gain more than about 5 pounds even when I eat poorly & "forget" to exercise. It is as though my body just likes weighing about 135-145 pounds! So I agree that there is more to obesity than just calories in (what you eat) & calories out (what you exercise off). No one seems to have a grip on that yet however, so for now, your best weight loss success will likely come from a combination of good dietary choices & good exercise habits, both of which should be done for a lifetime, & brief episodic use of medications like Q-Nexa.
There was a brief discussion regarding food labels. I am not a nutritionist, so I am not an expert in regards to this! I do know however that the most misunderstood part of the label is the "serving size." This often leads us to make bad choices & to overeat, so let's talk about it briefly. The serving size is of course what the food producer feels is an appropriate serving, but the misunderstanding comes when we assume that the entire package is ONE serving! For example, a Big Gulp is a 32 ounce soda, but one serving of soda is likely 8 ounces. So you must look at the label & do a little math. If a serving size is 8 ounces & that has 150 calories, then you must realize that if you drink the whole Big Gulp you will get FOUR servings, & thus 4 times the calories... which is 600 calories! Apparently, the Mars company recently agreed that people do not understand serving size & have agreed to stop producing king size candy bars in an attempt to help America with her obesity dilemma! Their candy bars will be sized to an appropriate serving, so people will hopefully eat less & get less calories. If you want more calories you can eat 2 or 3 bars, but you will be more likely to understand the number of calories you are getting in this manner.
A gentleman wrote a note requesting help for his wife who often awakens with severe leg cramps. Though this is a common complaint it is not one for which we have a great answer. I suggest that someone with significant nighttime leg cramps should discuss this with his physician, who in turn will hopefully order blood tests. Generally these tests should include: a Calcium, Magnesium, Potassium, Phosphorus, & Vitamin D level, as deficiencies of these minerals & vitamins can certainly cause cramps. If these are normal, you might also need further tests to include: thyroid studies (TSH & T4), muscle studies (such as a CPK & an LDH), & tests for connective tissue disorders (such as an ANA, Rheumatoid Factor, & Sed rate). I had a patient with severe cramping, & as I could not help her, she sought a Neurologist for another opinion. The above work-up came from him, so I learned some tricks! If any of the labs show a significant abnormality, that should be further evaluated, but as is often the case, my patient had no abnormalities. The Neurologist treated her with a muscle relaxant (such as Flexeril or Skelaxin) at bedtime. I know that the old remedy was Quinine, but many of the over-the-counter products with Quinine have been taken off the market. Not to fear! If you want to try Quinine, look no further than your local liquor store where you can purchase Quinine water, & try several ounces just before bedtime! If you don't like the taste or need to limit your fluids, perhaps you can find a pill with Quinine, such as Hyland's Leg Cramps with Quinine. Lastly, as I am a fan of old remedies, some of my patients tell me that putting a bar of soap in the bed near their feet stops the cramps... to which I say, why not try it???
One point of interest is the fact that you should not just increase your intake of vitamins or minerals without first discussing with your doctor, as some are toxic in excess. In other words, you can actually overdose on certain vitamins & minerals! The potentially toxic vitamins are the ones that are fat-soluable, so they can "build up" in your body. These are Vitamins A, D, E, and K, so if you take them in doses above the recommended daily amount (=RDA), be sure to occasionally check a blood level. Minerals such as potassium & calcium can also lead to problems if taken in excess, & in fact I believe the Veterinarians still use Potassium as the injection for euthanasia, as it causes the heart to stop beating when given in a large amount intravenously!
Mandy asked about why she might have lactose intolerance. Well, first, lactose is the sugar found in dairy products, such as milk & ice cream. Lactase is the enzyme which digests or breaks down the lactose. Babies obviously have lactase, but evolutionarily it is not necessary to have this enzyme once you get teeth... as that is when your mother generally stops breastfeeding you! Though many people have this lactase enzyme all their lives, others lose it... at varying ages... & thus become lactose intolerant. Without the enzyme to breakdown the lactose, this sugar passes through the intestines & ferments, leading to gas, cramps, & diarrhea! Thus lactose intolerance is not really a disease process, though it can really make you feel bad! If you are unfortunate enough to have lost your lactase enzyme, I recommend you try getting some lactase pills from the health food store. You take these pills with the dairy product, thus correcting your deficiency, & thus appropriately digesting the lactose before it ferments! Though this doesn't work for everyone, it does work for many, so give it a try! You might also want to try Lactaid which is a milk that already has the digestive enzyme in it.
Our last topic was in regards to a 51 year old gentleman who has sleep problems. Time did not permit a long conversation nor a long answer, but perhaps we can delve into this deeper in the future! The short answer was that not sleeping well might just be a nuissance OR it can be a significant health issue! Some people have what is called "poor sleep hygiene" which means that they do things which keep them from sleeping well. This might include: watching TV in bed, reading a book in bed, falling asleep on the couch (only to awaken later & have to get yourself to bed after you lock the door, brush your teeth, etc.), & sleeping with pets or partners who make noises which awaken us. My sleep specialist has a rule that the bed is for sleep & sex, but nothing else! When you go to bed, you go to sleep! Do not lay in it awake reading a book or watching TV, as your mind can get confused if you do not give it proper clues as to when it is appropriate to sleep. By the same token, you must have quiet & dark, so try to create this in your bedroom. If your pets, partner, or neighbors are noisy, try earplugs! Certainly a Sleep Doctor can help you further with these techniques, but more importantly he can help diagnose more severe sleep issues such as sleep apnea. Sleep apnea is a common problem, especially in overweight people, & it is associated with high blood pressure & premature death! It is caused by obstruction of the airway, so literally you stop breathing during your sleep. When the brain perceives it desperately needs oxygen, it arouses you & you take a big gasp to open your airway. This results in you awakening briefly, but you re-establish breathing... at least briefly. This cycle repeats through the night, resulting in you having stressed your heart & body with the low oxygen episodes. As a result of your multiple arousals, your body does not get into deep sleep, & in the morning you feel as if you never slept! This results in daytime fatigue & sleepiness. If this sounds like you, I suggest you see your doctor & consider getting a sleep study to see if you indeed have sleep apnea, as it can often be successfully treated with something called CPAP which provides pressure to keep your airway open. Weight loss is often helpful, & in rare cases surgery is necessary. As a last thought, do not use alcohol to help you sleep! It will cause you to "pass out" but it does not cause you to sleep... in other words, you do not go through the proper sleep cycle, so you will not feel well rested!
Here's to our health!
Doctor Gigi
PS Feel free to check out the radio show at 1PM Eastern time on Fridays via www.SkipShow.com or listen to the podcasts via the same site. If you want to be a part of the show, call me live at (727)-441-3000 or toll-free at (866)-TAN-1340.