Friday, November 10, 2017

Health Tip: Weight Maintenance Over The Holidays

Did you know that most Americans gain weight between October and the New Year's Eve, and that it takes about 5 months to lose it again?(1) It doesn't have to be this way, and knowing you're at risk may be the first step in avoiding packing on the holiday pounds.

The over-eating cycle is all too familiar. It starts with Halloween candy, then Thanksgiving feasting, then holiday office parties and pot lucks, culminating in New Year's festivities and then diet and exercise "resolutions" that last a few weeks. The New York Times reports (2) that over a third of people don't stick to their diets through the entire month of January.

But we are going to beat the odds, right? I think we should form a support group or something, don't you? I'm very much prone to winter weight gain, but I thought I'd share some of my strategies with you and see if we might keep each other accountable.
  1. Pack your own lunch. It's so easy to grab fast food or high calorie snacks when you're at work. And who knows how many calories are in them? If you do some simple meal prep at the beginning of the week, you can stack up a bunch of healthy lunches in advance. Grab one Tupperware container (I put frozen veggies, brown rice, and grilled chicken in single serving packs and nuke them at work), a fruit, cheese stick, and some nuts and your nutrition day is covered.
  2. Don't eat your friend's candy. You know that temptations are all over the place, especially right after Halloween. Remember that you should not eat ANY candy mindlessly - one extra 50-calorie hard candy per day can add up to 5 lbs of extra stored energy (aka fat) per year!
  3. Put fruit slices in your water to make it more tasty. So many beverages (especially non-diet sodas) have hidden calories or are high-sugar. I know that water is boring, but if you fill up a jug with some cucumber or fruit slices and pour yourself a big sport bottle of it every day as you leave for work, you'll stay hydrated and feel like you're having a treat to boot.
  4. Don't skimp on breakfast. I know you may think that if you skip breakfast you can allocate those calories to sweet treats or a larger lunch. That sounds fair in theory, but what happens is that your hunger gets out of control and you eat a much larger portion later than you normally would, adding up to more calories overall.
  5. Eat a small dinner. If you've eaten a good breakfast and lunch, you're probably winding down your day at night and don't need to eat such a large meal, especially before bed. Eating just before you sleep can contribute to reflux and heartburn.
  6. Do aerobic activity. The Office of Disease Prevention and Health Promotion recommends (3) that we do one of the following per week:
  • 150 minutes (2 hours and 30 minutes) each week of moderate-intensity aerobic physical activity (such as brisk walking or tennis)
  • 75 minutes (1 hour and 15 minutes) each week of vigorous-intensity aerobic physical activity (such as jogging or swimming laps)
  • An equivalent combination of moderate- and vigorous-intensity aerobic physical activity
  1. Lift some weight. Strength training at least twice a week builds muscle, and muscle naturally burns more calories than fat.
  2. Be accountable. If you have a friend who also does NOT want to gain weight over the holidays,  create a plan and stick to it together.
  3. Don't keep high calorie, low nutrition foods in the house. Have the courage to throw out or donate your "trigger foods" - the snacks you just can't stop eating. Everyone has different favorite junk foods (chips, cookies, ice cream to name a few common ones). Make sure yours are not easily accessible to you. Mine is Nutella.
  4. Try on your skinny jeans. Normally I don't recommend weighing yourself too frequently because there are natural gains and losses that can drive you crazy. But if you have a favorite pair of jeans (or other clothing) that you feel good in at the weight that's healthy for you… try on those clothes every now and then to give yourself an early warning signal if they're getting too tight!
Good luck beating the odds this season, my friends. I'm right there with you!

References
  1. https://www.realsimple.com/health/nutrition-diet/weight-loss/holiday-weight-gain
  2. https://well.blogs.nytimes.com/2007/12/31/will-your-resolutions-last-to-february/
  3. https://health.gov/paguidelines/guidelines/adults.aspx

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Friday, November 3, 2017

Could you get altitude sickness at your local ski resort?

As they say in Game of Thrones, "winter is coming." Time to break out the snow gear and prepare for mountain sports (or find some dragon glass to fight off the white walkers - your choice). If you're planning  a trip out west to Colorado, New Mexico, or Utah, however, you may need to think about altitude sickness.

Altitude sickness is also known as "acute mountain sickness" or AMS, and it's caused by lower oxygen levels at higher elevations. AMS gives symptoms similar to a hangover - headache, nausea, dizziness, poor sleep, and fatigue. Most people are not affected by AMS until the altitude is greater than 2,500 meters or 8,200 feet, however, there is wide (and sometimes unpredictable) variation in when and how severely symptoms are felt. Those with kidney, lung, or heart disease may experience symptoms at lower elevations. Some people are genetically predisposed to AMS as their bodies do not adjust as quickly to lower oxygen levels. In moderate altitude (2000-3500 meters or 6,550-11,482 feet) ski resorts, about 10-40% of people experience AMS symptoms.

When AMS becomes more severe (more common at very high altitudes:  3500-5600 meters or 11,200-18,000 feet) it can result in two life-threatening syndromes, causing rapid swelling in the lungs and brain.

High-altitude pulmonary edema (HAPE) is the lung's response to low oxygen pressure over time. Breathing rate, heart rate, and blood pressure all increase as the body attempts to draw in and circulate more oxygen. Interestingly, the lung tissue's response to low oxygen is to clamp down its arteries. With the increased blood flow coming into the lungs, and tight vessels inside, fluid is forced out into the tissue causing swollen lungs that are less effective at oxygen exchange. This can cause suffocation and death in its most severe form.

High-altitude cerebral edema (HACE) occurs when rapid changes in adrenaline (triggered by low oxygen in the air) result in elevations in blood pressure that can swell the brain. Symptoms include changes in personality, emotional outbursts, severe headache, violence, ataxia (discoordination), then drowsiness and eventual coma. Once a coma has developed, death may occur from brain herniation. The usual course is rapid, complete recovery if descent is immediate and treatment is started promptly.

How does the body adjust to higher altitudes?

It takes about 4 days for the body to adjust to lower oxygen levels. It does this by producing more red blood cells to carry oxygen throughout the body, and the kidneys play a major role in adjusting the pH of the bloodstream.  When your breathing rate increases, you expel more carbon dioxide (and natural body acid). The kidneys respond by excreting bicarbonate in the urine to balance the acid loss in your breath, reducing the trigger to breathe rapidly and restoring a normal pH.

How can you reduce your risk of AMS?
 

Ascending no more than 500m (1,640 feet) per day is the best way to become acclimatized to a high altitude.  If you do not have the time for this, some medicines may be helpful.

There is a diuretic medicine called acetazolamide which triggers the kidneys to excrete bicarbonate. Taking this early on can jump start the pH balancing that your body needs to accomplish at higher altitudes. Drinking plenty of water is important to replace the losses as well.

In cases where HAPE and HACE may occur, rapid descent is the best treatment and may resolve the problems within hours. If this is not possible, steroids such as dexamethasone may reduce swelling. Supplemental oxygen is also useful.

Which U.S. ski resorts have the highest elevations?

Sixteen of the top twenty highest elevation ski resorts in the U.S. are in Colorado. Three are in New Mexico, and one in Arizona. For a full list of ski resorts and their elevations, click here: http://www.skiresort.info/ski-resorts/north-america/sorted/mountain-altitude/

The top 5 highest altitude resorts (all with elevations greater than 12,000 feet) are:
  • Breckenridge
  • Loveland
  • Telluride
  • Snowmass
  • Taos

So don't be surprised if you feel yucky for the first few days of your ski vacation. Try to ease into the high elevation, and take along some acetazolamide to combat AMS. The fastest way to feel better, of course, is to get back down to sea level!

References
http://www.altitude.org/altitude_sickness.php
https://emedicine.medscape.com/article/768478-overview#a4

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Monday, October 30, 2017

What to do if you awaken with a stiff neck

The common problem of awakening with a stiff neck is a topic that is addressed poorly, if at all, during medical training. In fact, it doesn't even have a consistent name in the medical literature. It is sometimes referred to as "torticollis” or "wry neck", but these terms also apply to more serious neurological or congential conditions.

What causes a stiff neck? The exact cause of a stiff or wry neck is sometimes never determined. It may be the result of a minor injury, a sudden jerk, or simply sleeping with the head in an awkward position. Some people believe that sleeping in a cold draft can cause this problem, although this has never been proven. The most likely source for the pain is a small swivel joint in the neck called a facet. These facet joints allow for great neck flexibility, but are also vulnerable to injury. With injury to a facet, muscle spasm develops that causes the neck to twist away from the painful side as a protective mechanism.

What can be done at home for a stiff neck? In most cases, the problem will resolve on its own in a few days to a week. There are, however, a number of measures that can help make you more comfortable or help speed up its resolution. These measures include:
  1. Taking an OTC pain medication, such as Tylenol or ibuprofen.

  2. Applying ice packs intermittently to the painful area during the first 24 to 48 hours of its onset. An ice massage combines the benefits of the application of cold along with massage and can help even more. This is done by freezing ice in a paper cup and massaging the painful area with the exposed ice for 10 minutes.

  3. Applying heat following the use of ice can help even further. This can be done using a warm, moist towel or heating pad, or by taking a shower and directing hot water to the neck. Some experts recommend alternating between heat and cold treatments for the first few days after the onset of neck pain.

  4. Gently massaging the neck muscles will help to relieve pain and encourage blood flow to the area. A topical muscle cream, such a Bengay or Icy-Hot, can be used along with massage.

  5. The neck should be kept mobile by performing gentle range of motion exercises. These are done by slowly moving the chin to the chest and then the ears to each shoulder. It is best to avoid the use of a cervical collar (neck brace) and to try to return to normal activities as soon as possible.

  6. Sleeping with your head on a low, firm pillow will help avoid the increased stress on the muscles and facet joints that sleeping on too many pillows can cause.

  7. Activities that require a full range of motion of the neck, such as driving, should be avoided until improved.
How might you suspect a more serious problem? Rarely, awakening with stiff neck can be due to a more serious problem than the self-limited problem described above. Neck pain associated with weakness or tingling in the arm or hand could be due to a herniated (ruptured) cervical disc. Forceful trauma preceding the onset of neck stiffness may have caused serious injury to bones, ligaments, or muscles in the neck. The presence of fever along with neck stiffness is suggestive of an infection, such as meningitis, and warrants prompt medical attention.

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