Carbs and depression

Can carbs affect my depression?

Yes, there is a lot of data on foods that can affect depression. In general foods that have high dietary glycemic index scores, refined sugars and processed foods have been linked to risk of new onset depression, while foods with high dietary fiber, whole grains, vegetable and non-juice fruits have been associated with a low risk. If you already have depression, consumption of food with high dietary glycemic index can trigger or exacerbate your symptoms. So the take home advice is eat less processed foods and avoid too much of simple sugars. Remember there is no diet that can treat or cure depression. the sole most effective treatment for depression is medications. So do not substitute diet for antidepressant medications. 

How can i gain weight?

I have AIDs and would like to gain weight. Is there something I can take to improve my appetite?

Yes, try megace. It is a synthetic progestin which has been available for at least 70 years. It has been recommended for patients with have anorexia or weight loss due to cancers. How it works is a mystery. It does work in about 50% of cases.  At least 5% of people develop adverse effects like diarrhea, abdominal cramps and men may have difficulty sustaining an erection. It is often given to cancer patients but I am not sure how great it works in these individuals. It does improve appetite but does tend to work slow. I would say try it for at least 2-3 weeks. It is relatively inexpensive and there are generic versions available. The agent is widely abused by bodybuilders and other athletes.

Itching and renal failure

I have renal failure and often develop severe itching. Is there something I can use?

There are several things you can do. Use a moisturizer liberally. Keep the home humidified. Avoid excessive use of AC-which may not always be practical if you live in Florida or southern USA. You can apply topical hydrocortisone. Now there is a research study showing that topical vitamin D is very effective for the treatment of itching in patients with renal failure. While the drug is very safe, the down side is that it is also very expensive. My best advice is go with hydrocortisone-which is available OTC. Also use an oil based moisturizer and that should do the trick.

Blood thinner and atrial fibrillation

I have atrial fibrillation and am on three blood thinners. Is this safe?

Atrial fibrillation is one of the most difficult disorders to treat. Converting patients to normal sinus rhythm with medications, surgery or with use of pacemakers does not always work. All patients with atrial fibrillation need to be on blood thinners to prevent stroke. The latest data is that most people do fairly well with 2 blood thinners. Use of three blood thinners also works but the risk of bleeding is also higher. You need to discuss this issue with your doctor; not a nurse or a pharmacist as they are clueless in the management of this serious disorder. Not even a general physician is good enough to give you advice on management of atrial fibrillation. Make sure you speak to an experience physician as this is critical. Strokes that occur in patients with atrial fibrillation are devastating.  You will need to speak to a cardiologist and weigh out the risks and benefits of 2 versus 3 blood thinners. I can’t give any more specific advice

Oral sex and sore throat

After oral sex, the back of my throat has become red.  Have I acquired an STD?

I am assuming you are in a monogamous relationship, where there is no hanky panky going on. Women often give a blow job to men, and sometimes the man gets carried away and will start to thrust the penis at the back of the throat. When the thrusting of the penis is rough, you can develop small areas of hemorrhage on the soft palate at the back of your throat. This is nothing to worry about- it happens quite often but women do not exactly brag about blow jobs to doctors. Give your mouth a rest for a few days and the minute bleeding (called Petechiae) will disappear in no time. If you are not in a monogamous relationship and develop redness or a sore throat after giving a blow job to a stranger, get yourself checked out for gonorrhea. Pharyngitis caused by gonorrhea is on the increase globally.

Can calcium intake lower blood pressure?

First let me get the facts straight.  A lot has been written on calcium over the past two decades. Most of the anecdotal stuff has been written by uneducated people who do not even have grade 2 education. Social media sites like Facebook are full of wannabe doctors giving out BS advice on everything from surgery to nutrition. For example, a person, usually a female, takes calcium pills and notices that the blood pressure is low one day and then she starts blogging about the wonders of calcium. This person then starts to recommend calcium to every Tom, Dick and Harry. This is nonsensical medical advice and dangerous. Blood pressure control and modulation is dependent on hundreds of factors and there is no one mineral or supplement that controls it. In the majority of people with high blood pressure, there is no known cause. Almost everything underneath the sun has been tried out as a cure and failed. So simply telling someone to take calcium or vitamin D is bullshit advice.

The latest study shows that in YOUNG PEOPLE who do not have high blood pressure an increase in calcium may drop the blood pressure slightly. This indicates that perhaps regular calcium ingestion may be preventive against hypertension. However, these results should be viewed with caution as the mechanisms for this BP lowering are not known and the studies need to be reproduced. How much calcium to take, or for how long is not known. The current evidence suggests that in people over the age of 35 with normal blood pressure, a dose of calcium between 1000 to 1500 mg/day may be beneficial.

Having said all that, I should add that these studies on calcium were sponsored by the industry- and that usually means you have to think about the fudge factor.  Doctors who are paid a lot of money to conduct trials usually always report positive results. My advice is always the same. To prevent high blood pressure, eat less, walk more and cut down on salt. If you want to add calcium there is no harm in it but do not expect miracles, because the blood pressure lowering is miniscule.

If you have been diagnosed with high blood pressure, I highly recommend you remain complaint with your medications- there is no substitute. High blood pressure is a silent disorder but it has devastating complications if it remains untreated.

Pilates for low back pain!

Can Pilates help ease lower back pain?

Pilates were once hyped up as the best exercise for low back pain. People who recommended Pilates claimed that this exercise was very beneficial and had a lot of health benefits. I am not sure about a lot of health benefits but it is a good form of exercise. As far as low back is concerned, only a few randomized studies have been done to assess the benefits of Pilates. The results indicate that Pilates is better than sitting on your butt for relief of low back pain. On the other hand, it is no better than any other type of exercise. What this means is that Pilates is not superior to any other exercise for low back pain. Plus, there is a whole bunch of razzmatazz behind Pilates like breathing techniques and precision to make it work. If you like Pilates, go ahead and it can help ease mild to moderate low back pain. If you are like me and not a stickler for rules and regulations, do any type of exercise and you will have the same benefit.

Can I lose weight with Phaseolus vulgaris (common bean)?

People who live in Mexico and South America have been making claim that the common bean has anti-obesity effects. Millions of Hispanics and Latinos consume the common bean regularly and some claim that they do not put on weight.  Many reports exist that the common bean can suppress appetite and mobilize fat reserves.

However studies on the common bean have not yielded any significant benefits when compared to a sugar pill. In one study, some individuals lost 3 kg over 26 weeks after eating common beans every day. Bottom line is that you could lose that much weight by walking alone.

Plus remember, after eating the common bean you will pass flatus, which is very offensive. So unless you are a hermit living on Mount Everest, this is not a great supplement for weight loss.

Should I eat a Low fat or low carbohydrate diet for weight loss?

For decades, people who have wanted to lose weight were told to stick to a low fat diet. Now there is a change in thinking. Low Carb diets are fast gaining attention and some experts believe that they can help obese people lose weight and sustain the weight loss. One recent study showed that a low Carb diet was as good as a low fat diet but the differences in overall weight loss were not that different. Until more long-term studies are available, the choice of diet for weight loss is strictly personal.

Final note, unless you starve yourself, there is no diet that can help you lose weight if you sit on your butt all day. If you exercise, you can lose weight with almost any diet. Remember all this diet stuff is a billions dollar business designed to scam gullible and lazy individuals. If you want to lose weight, walk more and eat less.

Is the new ReShape balloon for weight loss available?

Yes Reshape the balloon for weight loss has just been approved by the FDA. The balloon has a dual shape and the reason for this is to prevent slippage into the intestine. The Reshape balloon is placed in the stomach during an endoscopic procedure. The doctor uses a flexible scope to place the balloon and then inflates it with about 500 cc of saline. Once the balloon is inflated, it makes you feel full and you no longer feel hungry. The procedure requires mild sedation and is done as an outpatient. So does it work? 

In one small trial, after 3, 6 and 12 months, people who had the balloon did have weight loss. However, you also have to remember that the study was sponsored by the makers of the balloon.  The study was not randomized nor was it blind. The person who performed the study received money from the manufacturer of the device- so that alone should be an indicator that results may be fudged.

Adverse effects during this study included constant abdominal discomfort, nausea and vomiting. A few patients required early removal of the balloon. The cost of the balloon procedure is about $15,000 and add in another $5,000 for miscellaneous expenses. So should you go for the Reshape balloon to lose weight?

If you have money and are too lazy to walk, sure, you can go ahead. If you have money and have common sense, I do not recommend it. Similar balloon treatments for weight loss have come and gone without much success. The lap band was a similar procedure but failed miserably. Plus, there is always a risk of serious complication like the balloon moving into the intestine and that means having a formal surgery procedure to remove it.

My advice has always been the same for people who want to lose weight –walk more, eat less and you will have the same result. Walking is usually without any complications (unless you are texting and get hit by a car) and it is free.