Diet Change And Depression

Depression and anxiety are incredibly common symptoms that we see in primary care. It is estimated that 75-90% of visits to doctors are related to problems caused or made worse by stress. I was so excited to see a new study published showing a link between diet change and depression symptoms!

We all have to eat. Most people recognize that our diet has a huge impact on our health. Heart attacks, strokes, cancers, obesity and many other illnesses are impacted by what we eat. Doctors spend a lot of time advising people to eat less sugar, less saturated fat, and more fresh fruits and vegetables.

Many people don’t realize what you eat affects your mood, too! I’ve had great success with nutritional supplements in helping people with depression and anxiety feel better. A new research study has shown a very clear association between diet change and depression as well.

Researchers in Australia studied 76 young adults with depression and anxiety symptoms. They were randomly assigned to two groups – one group got no intervention, and one group got instructions to improve their diet via a 13-minute video they could re-watch whenever they wanted to.

They were instructed to increase their intake of

  • vegetables to 5 servings per day
  • fruits to 2-3 servings per day
  • whole grains to 3 servings per day
  • lean protein (lean meat, poultry, eggs, tofu, legumes) to 3 servings per day (Remember, plant sources are healthier than animal)
  • unsweetened dairy to 3 servings per day
  • fish to 3 servings per week
  • nuts and seeds to 3 tablespoons per day
  • olive oil to 2 tablespoons per day

They were also instructed to take 1 teaspoon of turmeric and 1 teaspoon of cinnamon most days. They were to DECREASE their intake of refined carbohydrates, sugar, fatty or processed meats and soft drinks. They were given sample menus and handouts answering common questions as well.

After 3 weeks the average depression questionnaire scores had not changed in the control group, not surprisingly. However, in the diet-change group the scores had returned to normal! And the improvement was maintained when they were rechecked after 3 months.

This study supports what I’ve said for a long time. Depression and anxiety are not just related to stress or genetics. Our nutrition strongly impacts our brains’ ability to manage and cope with stress. A crappy diet predisposes us to depression and anxiety, and we can improve our mood by improving our diet.

If you struggle with stress, depression and/or anxiety, improving your diet is something you can do TODAY. Improving your diet is as effective as medication, and works just as quickly. It also has no side effects! What are you waiting for?!

QUESTION: Do you see a link between how you eat and how you feel?

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Low Carbohydrate Diets And Health

Confession time. I tried Atkins in the ’90s to try to lose that stubborn 10 pounds that clung to me like stink on a skunk. I dutifully checked my urine every day to see if the magical ketones were present. Unfortunately I found that unless I ate nothing but meat and cheese those ketones kept disappearing. Unable to exercise due to profound fatigue, I eventually gave it up. The few pounds that I did manage to lose came right back, and brought along friends. My experiment with low-carbohydrate diets was a miserable failure.

Many of my patients proudly tell me that they are eating “low carb” to lose weight. A research study was recently published that looks at the evidence regarding the health effects of low-carbohydrate diets.

Credit: GreatLakesLedger.com

It doesn’t matter if it is called “keto,” Atkins, South Beach, or Paleo. Proponents of low-carbohydrate diets all insist that carbohydrates are the cause of overweight and obesity and must be avoided. The original ketogenic diet was developed to treat intractable seizures in children and did have some success. However, low-carbohydrate diets today are almost exclusively used for weight loss. A survey of over 1000 adults conducted in 2018 found that 16% reported eating some sort of low-carb diet in the previous year.

Are low-carbohydrate diets better than diets (low-fat, calorie-controlled, DASH, Mediterranean, etc) that don’t restrict carbohydrate intake? It seems that, in the short term, they do promote more weight loss while suppressing appetite. They also do increase insulin sensitivity and decrease blood sugar levels in diabetics.

However, low-carb diets are notoriously difficult to maintain. It is just really hard to avoid fruits, root vegetables and whole grains for long periods of time. Once a person starts adding back carbohydrates, it is a slippery slope and the weight typically starts coming back, with interest.

Scientists have not done long-term studies on those who eat a low-carb diet. We don’t know if they are less likely to have a heart attack, cancer, diabetes or other lifestyle-related illness. Low-carb diets are associated with higher levels of LDL (“bad”) cholesterol. And after a year or more, those who eat low-carb haven’t lost more weight than those who use other diets.

A healthy diet is pretty simple, but it isn’t easy. Plenty of whole fresh fruits and veggies. Green leafy vegetables, nuts, seeds and beans. Small amounts of lean meats and lowfat dairy, if any. Fatty fish several times per week. Water, water, water. Avoid processed foods and artificial food ingredients when possible. Carbohydrates-good fat-protein macros in a 50-30-20 ratio for most people. If you’re not sure what your macro ratios are, you can track for a few days at MyFitnessPal.com (not an affiliate, just a happy user of the app).

Low carbohydrate diets sound like an attractive way to lose weight rapidly. But they are hard to maintain and result in yo-yo dieting. They are not more effective for long-term weight loss than other diets. And they haven’t been shown to create long-term health.

QUESTION: Have you tried a low-carbohydrate diet? What was your experience?

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Kids And Martial Arts

Do you worry about your kids?  Do you worry that they will grow up overweight and/or obese?  Are you concerned they will be the target of bullies?  Worse, will they BECOME bullies?  Are you seeing a tendency for them to boss their friends and classmates around?  Are they clumsy and prone to injury?

If you answered “Yes” to any of these questions, martial arts training would help.  There is lots of evidence that martial arts training helps children grow up healthy and happy, able to interact comfortably in groups and one-on-one.

My family has participated in martial arts for my children’s whole lives, and over half of my life.  I have seen with my own eyes remarkable results in behavior, self-esteem and self-confidence both in children and adults.

Children with autism-spectrum disorders who have shown improvement in their ability to tolerate touch.  Children with ADHD who are able to meditate quietly for short periods.  Children with little or no self esteem or self confidence who gradually bloom into skilled teachers and leaders on (and off) the mat.

What does the science say?  There are LOTS of scientific studies published on martial arts training in kids.  Kids who study martial arts tend to enjoy physical activity more than those who don’t.  Martial arts is effective for prevention of fall-related injuries.  Martial arts training improves creativity, flexibility, self-control, and discipline.

Martial arts training benefits adults too.  I’ve seen adults with asthma develop vastly better lung function.  Core strength and stamina are particular targets of martial arts training.  Mindfulness, meditation, and stress relief are core principles.

If you choose to enroll your child in a martial arts program, how should you go about it?  Look for a school that particularly emphasizes teaching children (not as an afterthought).

Go to your prospective school(s) and observe classes.  See if the children have plenty of time to ask questions and understand the exercises and techniques.  See if the master or sensei of the school teaches the children him- or herself, or if classes are taught primarily by junior instructors.  Talk to the other parents and get an idea of what improvements they have seen in their children, as a result of the training.

Two other concerns to make sure you address before enrolling your child:

  • What is the teacher’s attitude towards bullying?  Does he or she specifically address measures to prevent and handle bullying in and outside of school?
  • What are the safety measures taken?  Injury prevention is a huge issue in martial arts, especially with developing children’s growing bones and flexible joints.  Make sure safety equipment such as mouthguards and groin protection are worn whenever contact is expected.

If you choose to enroll your child in a martial arts class, you should consider taking classes yourself.  Spending time on the mat is a great way to relieve stress and build strength, endurance and confidence that you can handle challenges that come your way.  If you’re not interested in external, combat-style arts you can consider Tai Chi, which is gentle and meditative but still has great health benefits.

martial arts

Credit: thesilentmind.com

Martial arts training is of benefit to the whole family.  Give it a try!  Your results should speak for themselves.

QUESTION:  Have you tried martial arts?  What was your experience?

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Gout Risk And Lifestyle Factors

Do you know anyone with gout? I do, unfortunately, quite a few people. It is one of the few illnesses I am willing to treat sight-unseen. It is on my top-five list of illnesses I NEVER want to have, right up there with kidney stones and cluster headaches.

We’ve known for a long time that gout risk is tied to lifestyle factors. It used to be known as the “disease of kings” and was associated with a rich diet, obesity, and alcohol intake. Recent research suggests that a huge percentage of gout risk is related to four risk factors: overweight and obesity, not eating a heart-healthy diet, alcohol intake and taking a diuretic medication.

First of all, what is gout? Gout is the most common inflammatory joint disease in the US. It is related to high blood levels of a substance called uric acid. When levels of this substance get high, it creates crystals in the joints that look like tiny needles under the microscope. Just looking at the crystals hurts! No wonder this illness is so painful!

A patient’s gout risk is directly related to serum uric acid levels. What makes uric acid go up? You got it – overweight or obesity, alcohol, a diet rich in meat, saturated fat and sugar, and diuretic medications.

Researchers at Harvard Medical School analyzed NHANES survey data and found that the most important risk factor for high uric acid levels was weight. People with a body mass index (BMI) over 35 were 3.5 times more likely to have high uric acid levels (and therefore increased gout risk) compared to people with a BMI less than 25. The higher the BMI, the higher the risk.

The closer people stuck to the DASH diet (the standard heart-healthy diet rich in fruits and vegetables and low in sodium, sugar and saturated fat) the better, too. Alcohol use increased the risk, and so did taking diuretics (water pills) for blood pressure and water retention.

If you or someone you love has gout, there are real things you can start to do TODAY to lower your uric acid levels and reduce your risk of gout attacks. You DO NOT want gout attacks. Trust me, I’ve seen them, it’s not pretty, and it is VERY painful. It will destroy your joints.

  • Stop drinking alcohol
  • Download a guide to the DASH diet and start following it. Reduce your intake of soda, sugar, processed foods, meat, dairy, eggs and shellfish. Add more fruits, veggies, beans, whole grains, nuts, seeds and fatty fish.
  • Over time, work on bringing your weight down. It won’t happen overnight but you CAN do it!
  • Talk to your doctor if you take water pills. The risk of causing gout isn’t huge, but it is there.

QUESTION: Do you know someone who has gout?

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Vape Lung And E-Cigarette Use

It always sucks to see a young, healthy person die. Car accidents, homicide, suicide, overdose. There are so many dangers out there! What we don’t expect a young healthy person to die from is a sudden, severe lung illness that strikes out of the blue.

Well, six people in the US have died of this sudden severe lung illness over the last few months. The CDC has received 380 reports of so-called “vape lung” over the last several months. All the patients had a history of using e-cigarettes, most had used e-cigarettes that deliver THC, many used products that deliver both THC and nicotine, and some had used only nicotine products.

There is no evidence of infection in these patients. Right now researchers believe it is a direct toxic effect of inhaling the vape liquid on the lung tissue. Many theories are being discussed about which chemicals might be responsible, but the answers aren’t clear yet.

vaping, e-cigarette
Credit: theverge.com

What symptoms should people watch out for? If you use e-cigarettes or other vape products and get sick, these symptoms mean you should see the doctor to make sure you don’t have Vape Lung:

  • Respiratory symptoms like cough, chest pain and shortness of breath
  • Systemic (whole-body) symptoms like fever, chills, fatigue and a high heart rate
  • Gastrointestinal symptoms like abdominal pain, nausea, vomiting and diarrhea
  • Abnormal findings on chest Xray and chest CT scan.

Please consider stopping using e-cigarettes if you already use them. Ask your doctor for help, the same treatments that help with cigarette smoking cessation help with giving up e-cigarettes. They have NOT been proven safer than cigarettes.

The most important measure, though, is not to start using e-cigarettes in the first place. It is scary to realize how many tweens and teens use e-cigarettes: over 5700 kids start vaping every day! You have to talk to your kids about this. If you need help starting the conversation, the American Lung Association has resources to help.

Vape lung is real. Vaping is not safe. It is not a good way to try to stop smoking cigarettes. Vape products are marketed to children, easy to get, and easy to hide. It is important to protect yourself and your family from these dangerous products.

QUESTION: Have you heard of vape lung? Have you tried vaping?

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Measuring Biological Age In Humans

Have you ever heard the phrase “Age is just a number”? I have patients who are young at 80 years of age, and patients who are old at 59 years of age. What’s the difference? BIOLOGICAL age.

Diet, lifestyle, inflammation, disease and many other factors combine to influence someone’s biological age. Many of these factors actually influence the way our genes are expressed – the field of epigenetics studies this phenomenon.

There is a large group of researchers studying ways to measure biological age. One way is to study DNA methylation. Aging produces predictable changes in DNA structure. Measuring these changes can give ideas about an individual’s risk of developing age-related diseases like heart attacks, dementia.

Researchers at UCLA have found that there are a number of diet and lifestyle factors that influence biological age. A lot of it makes intuitive sense. Things like abdominal obesity, smoking, high rates of inflammation (measured by blood levels of C-Reactive Protein or CRP), high blood pressure, diabetes and prediabetes are associated with accelerated aging and a higher biological age than chronological age. High triglycerides and low HDL cholesterol, part of the metabolic syndrome (along with abdominal obesity, diabetes and high cholesterol) also are associated with more rapid aging.

Conversely, there are a number of factors that slow down biological aging. Exercise and eating fresh fruits and vegetables are protective. Fatty fish and light to moderate (NOT excessive) alcohol intake also seem to slow the aging process. Interestingly, higher levels of education and higher income also are associated with lower biological aging. I’m not sure why this is so, but it may be that more well-educated and well-off people choose healthier diets and lifestyle habits than those who are poorer and less educated.

So what conclusions can we draw from this research?

  • Exercise regularly! Choose something you enjoy and JUST DO IT!
  • Eat more fresh fruits and vegetables!
  • Maintain (or get to) a healthy weight. Your waist circumference should be less than 35 inches for women, and less than 40 inches for men. If you are very tall or very short, your waist should be less than half your height.
  • Stop smoking! See your doctor, there are treatments that will significantly increase your chances of success.
  • Choose fatty fish or take a fish oil supplement to increase your EPA and DHA intake.

If you have children, it is important to set up good habits now. Some interesting research has shown that in many respects health is more related to a person’s socioeconomic status and lifestyle in childhood than to what they achieve in adulthood. Setting a strong foundation of good lifestyle and diet habits now will help them be healthier their whole lives!

I think we all want to be the 85 year old with the health of an active 60 year old! I know I do 🙂 Epigenetic research is helping us understand how what we do today influences our biological age and how long we are able to maintain our good health.

QUESTION: Have you heard of epigenetics? Did you know your lifestyle choices influence your genes?

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Is Chiropractic Therapy Good For You?

A while back I noticed a recurrence of some mild neck and right shoulder pain, with less mobility in my neck than I’m used to.  I noticed it hurt to turn my neck all the way to the right and left (to check blind spots while driving, for instance).  There was some tightness of the muscles of my right upper back as well.

So…  Off I went to see my chiropractor.  I’m a bit of a slow learner about some things, you see.  I know in my head that regular treatments are helpful for keeping the body healthy, but actually making time in the schedule for it is a challenge sometimes.

As I was talking with Dr. Bobbi Taylor at Crossroads Chiropractic and Acupuncture, I was thinking about not much more than getting rid of this discomfort in my neck and upper back.  Then I started wondering why more people with neck and back pain don’t see chiropractors.

Unfortunately manual therapies like chiropractic therapy have a little bit of a bad rap in the USA.  Health care is dominated by western medicine and if a therapy doesn’t involve cutting the problem out or drugging it away, western medicine sometimes doesn’t have much use for it.

So what are manual therapies, and do they work?  Manual therapies involve a practitioner using parts of their bodies (usually the hands, but sometimes other parts such as elbows, knees, or feet) to treat, influence or change parts of the patient’s body.

Examples of manual therapy are massage, chiropractic therapy, osteopathic manipulation (OMT), and physical therapy.  The laying on of hands in manual therapy is a powerful treatment in its own right.  When a skilled therapist uses touch to soothe tight muscles, realign spinal vertebrae, or restore proper joint balance, the improvement can be startling.

What does the science say about manual therapy?  Since I am committed to advocating and promoting evidenced based treatments, I looked into the evidence.  Manual therapy is helpful for neck and back pain, headache, recurrent otitis media in children, colic in babies, preterm delivery, Parkinson’s disease, and even heart attack patients.

What can you expect if you decide to see a chiropractor or other manual therapist?  It depends on the problem you’re addressing.  As with other practitioners it’s important to be clear from the first visit about your goals for therapy.  What’s wrong?  What do you want done about it?  How often can you expect to see the practitioner?  What will you feel?  How long will it take to see results?

It is also important to remember that manual therapy practitioners are people just like anyone else.  Most of them are good.  Some are excellent and a few are quacks.  Get recommendations from friends or family or check with the practitioner’s regulating body before making an appointment.  If your condition isn’t improving like it should, don’t hesitate to get a second opinion.

Manual therapy is an excellent addition to a holistic approach to wellness.  Give it a try and experience the healing touch!

QUESTION:  Have you seen a chiropractor or received other manual therapies?  What was your experience?

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Protein Intake Changes In Seniors

I don’t think it will come as a surprise to anyone that our diet changes over time. We like different foods, we tolerate different foods, we CHOOSE different foods at different stages of life. As we get older, these diet changes impact our chances of getting certain diseases.

There was a study published recently that looked at protein intake in seniors. They found that WHERE the protein in your diet comes from is associated with your risk of aging in an unhealthy way.

Researchers in Spain studied over 1000 seniors and had them fill out questionnaires about their diet and other habits and about their health status. Following them for over 8 years, they found that changes in where their dietary protein intake came from was associated with changes in their health status.

protein rich foods

Seniors who increased their calorie intake from vegetable protein showed healthier aging markers than those who decreased their plant protein intake. Similar changes were NOT seen in those who increased animal protein in their diet.

We have many instances of plant foods helping people improve their health and reduce their risk of disease. This is just one more example of the benefits of protein rich plant foods (like nuts, seeds, beans, legumes, soy, quinoa and others) for human health.

This won’t come as a surprise to many of my long-term readers who know I’ve been a plant-based eater for over 8 years. With my medical patients I recommend a plant-based diet for just about all humans. In fact I can’t think of a single condition that is improved by eating meat or dairy.

Looking for a simple way to get more plant protein in your diet? Yep, I’ve got a Shaklee solution! We’ve got both soy and non-soy options and they are super tasty – we guarantee you’ll like them. Want more suggestions? Shoot me an email at DrJen@jenniferwurstmd.com and let’s talk!

QUESTION: What are YOUR favorite protein-rich foods? Do you tend to reach for meat and dairy? Will this info change your habits?

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Tai Chi To Prevent Falls in Seniors

A few years ago I went running in my neighborhood on Mother’s Day. It was a beautiful day, the sun was shining and flowers were blooming. I wound up limping home with blood dripping off my hands because I caught my foot on some uneven pavement and went sprawling.

The worst thing that happened to me with that fall was skin off my hands and my left forearm and difficulty typing at work for a few days. (Yay for jiu jitsu training and knowing how to fall properly!) For older patients, though, a fall can result in a much worse outcome. Hip fractures from falls result in surgery and extended time in rehab. About 25% of elderly patients who suffer a hip fracture never are able to leave the nursing home and live independently afterwards. Fall-related complications are the fifth leading cause of death in people over age 65.

There is a gentle form of exercise that promotes strength, balance and relaxation. It also happens to be a formidable martial art for those who want to study that side of the practice. It is ideal for seniors because it is simple to learn a set of moves, can be done anywhere, and generally is taught in a group setting (thereby promoting social interaction). At the beginning it is not physically demanding although as one progresses in practice moves can be modified to provide more physical benefits.

This exercise has been practiced for thousands of years. It is Tai Chi.

tai chi
Multi-ethnic group of adults practicing tai chi in park. Main focus on senior man (60s) in blue shirt.

I’ve studied Tai Chi since I was a teenager and have found it very relaxing and helpful with stress management and with my health. On days when I’m tired or have an injury and can’t do a full gym workout (or full martial art workout for that matter) I can always do Tai Chi.

Researchers have found that seniors who practice Tai Chi are much less likely to fall than those who don’t. They reviewed 18 research studies looking at almost 4000 participants. The researchers found that those who practiced Tai Chi were much less likely to fall than those that didn’t practice. In fact the effect was so strong that one fall would be prevented for every 10 seniors who practiced Tai Chi. That’s better than statins for preventing heart attacks!

If you or someone you love is getting older, worried about falling, limiting themselves due to fear of falling, or otherwise in need of exercise and social interaction, please check out a Tai Chi class. There are introductory classes available just about everywhere through adult community education or you can look up private studios near you. Tai Chi players

If you are located in northern Ohio I would encourage you to check out the non-profit studio where my family and I study Tai Chi and other martial arts: The Silent Mind in Twinsburg. We have free introductory classes, membership assistance for those struggling financially, and a wide variety of programs for everyone. Kids, teens and adults, beginners and experts, anyone will find something of interest here. Come play with us!

QUESTION: Have you studied (or do you currently study) Tai Chi or another martial art? What has been your experience?

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3 Reasons You’re NOT Losing Weight

So you’re exercising 5 days per week, watching what you eat and not seeing success with your weight loss efforts. Trust me, I have these conversations with patients all the time. There are 3 main reasons why you’re NOT losing weight.

Diet Mistakes

Eating Too Much

It’s very easy to eat too much. Sitting in front of the TV snacking on chips or pretzels or popcorn. Eating out too much. Rewarding yourself with a treat after a good workout at the gym. Tracking your intake with an app like MyFitnessPal can help keep you mindful of “extras” that can sabotage your efforts.

Don’t forget your beverages. Soda is a waste of calories and promotes the development of fatty liver disease. Alcohol is also a very high calorie indulgence and hard on the liver too. The best beverage for those trying to lose weight is plain filtered water.

Eating Too Little

Over-restricting can sabotage your weight loss efforts because the body goes into conservation mode. If you’ve been tracking and very attentive to your intake and you’re not seeing success, try loosening up and adding an extra piece of fruit or two daily (about 100 calories each).

Eating The Wrong Foods

Too much protein, too much convenience foods, too much processed carbohydrates, too much saturated fat. All these can change the metabolic and hormonal state in the body towards storing fat instead of burning it. Remember that the best macro balance is 50% COMPLEX carbohydrates (like whole grains, beans, legumes and fruit), 30% healthy fats (avocados, nuts, seeds and oils that are liquid at room temperature) and 20% protein (plant protein is best for your heart). Tracking for a short while can help you adjust your macros to the proper balance.

Indulging in artificially sweetened foods and beverages also can work against your weight loss efforts. Artificial sweeteners increase insulin and have not been shown effective in promoting weight loss.

Exercise Mistakes

Undertraining

If I had a nickel for every time someone said “I don’t have time to exercise.” Or “I don’t like to exercise.” Or “I can’t exercise because my XXX hurts,” – with XXX being the body part of choice (knees, back, feet, etc).

In order to lose weight you have to move around. It is extremely difficult to have long-term weight loss success without some sort of fitness regimen. Now it doesn’t have to be going to the gym or paying a lot of money for a trainer, although that is a good investment. I’ve written before about different exercise options. Joint pain requires different choices, but our health depends on regular movement!

Overtraining

It’s also important to rest and give our bodies time to recover between training. It’s not good to stress or work the same groups of muscles two days in a row, they need time to recover and build new muscle tissue. Even runners and cyclists have rest days.

Not Sleeping

You’ve got to sleep. It’s just one of those things, our bodies and brains need to have enough sleep and if we go without it does a number of bad things to us. One of those things is weight gain. Chronic sleep deprivation is a known cause of weight gain. It also increases stress hormones like cortisol and decreases our resistance to snacking and poor food choices.

Most adults need 7-8 hours of sleep daily. You can get away with sleeping less for a little while but over time it will backfire.

If you’re trying to lose weight and not having success, first take a look at your sleeping habits. Then think about your eating habits and your exercise or lack thereof. The reason you’re not losing weight is probably there.

QUESTION: Did I miss anything? Did I miss an important reason why someone would have trouble losing weight?

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