Paging Dr La Puma

Archives

Mar7

Lose Weight, Lower Your Blood Pressure

Posted in: Uncategorized

Fatty tissue in arteries

Weight and hypertension go hand in hand. The more you weigh, the more likely you are to have high blood pressure, and the more vascular resistance your heart will have to work against.

An estimated 43 million Americans have hypertension, and more than double that figure are dangerously close to developing it. Hypertension is the leading cause of cardiovascular disease, which is the leading cause of death in America.

Males over the age of 45 and females over 55 are at a greater risk of developing hypertension. Too much alcohol or salt, and too little activity or ability to handle stress worsen the risk. By changing any of these factors you can give your heart a hand and lose weight while you are at it: just 5% weight loss can lower your blood pressure enough to lower your dependence on medication.

A great way to lower sodium and lose weight is to avoid eating highly processed food. Instead, just once a week, try cooking fresh clean food at home, in quantity (the link is to Pinterest, where there is more).

Eating fresh clean food is the best way to control your weight and make yourself healthier. Check out my healthy recipes for delicious meals that are healthy, easy and filling.

Along with eating healthier, start a simple exercise regime. By devoting just a few minutes out of each day to a simple workout, anyone can be on their way to lower blood pressure and a healthier weight. Here is a great workout tool that I recommend to help you lower your weight and avoid hypertension–it is my favorite elliptical trainer, on Amazon.

If you are not at your ideal weight, losing between 2-4 pounds a week is a great goal for your body, and most importantly your heart.

Starvation diets, fasting diets and extreme diets, put unnecessary stress on your organs and ultimately do not keep the weight off. That is why it is so important to create a healthy eating plan for every day of your life and supplement that with a simple exercise, sleep and stress control program. For men, that’s Refuel.
Jan21

Osteoporosis – The Silent Disease

Posted in: Aging and Costs of Aging, Obesity and Weight Loss, Wellness and Health

Osteoporosis is thought of as a women’s disease, but osteoporosis in men can be even more dangerous.

Men are at greater risk of complication and death when they fracture their hip than are women: men are twice as likely to die as women after a fracture.

Up to 25% of men over the age of 50 will break a bone due to osteoporosis or because of low bone mass, and about 80,000 men break their hips each year. Bone is constantly changing and old bone is replaced by new bone. But that’s not the way you want to remodel your bones.

Osteoporosis, courtesy of Health News Updates

As we age though, the rate of change of bone remodeling declines.

Men in their 50s experience less bone loss than women of the same age. Somewhere between the ages of 65 and 70, the playing field is leveled and men lose just as much of their bone density as women, which makes them more prone to debilitating fractures.

This is where healthy weight loss and muscle gain come into play.

Being obese or overweight will put extra stress on your bones, but losing weight rapidly puts you in a position of greater risk for osteoporosis.

When you drop weight rapidly, you lose important minerals and hormones such as testosterone. A low testosterone level is one culprit behind osteoporosis in men. Too much alcohol, long term steroid use, smoking, and a low vitamin D level are four others.

One way men can increase testosterone levels is by working out. Lifting weights twice a week will help your upper body, and a brisk walk for 30 minutes daily will begin to fortify your hip bones. Not only will exercising build your muscle mass and strength, but it will also help to increase your bone density, which will put you one step closer to preventing osteoporosis.

Changing your diet will also help you lose weight and prevent osteoporosis. I suggest at least 600 IU of Vitamin D3, and up to 1000 (measure your level!) and no supplement of calcium: you don’t need it if you get enough greens and dairy.

Start with a gradual change in exercise and diet to give you a head start on preventing osteoporosis. See your doctor if you have any questions or want a bone density evaluation: if you have osteoporosis, and you’re over 40 and you’re a man, you need a testosterone level check.
Jan14

Heavy Blues: Weight and Depression

Posted in: Aging and Costs of Aging, Common Conditions, Obesity and Weight Loss
Problems with weight control can be an issue for your health, but did you know overweight could also be causing depression?

When a man gains those extra pounds around his waist, which is where men do, his testosterone levels may be reduced.

Testosterone affects a man’s mood and outlook on life. It also helps build stamina, and increases sex drive, energy, and motivation. Testosterone levels in men commonly fall naturally over time through aging, though they don’t have to: testosterone decline is not necesarily part of normal aging. Being overweight in the middle, with visceral fat, can also significantly decrease those levels. That can lead to depressed mood, irritability, a loss of vitality, and poor sex drive. And performance, not just in bed, but at work.

A man as little as 30 pounds overweight can be affected. Studies have shown that if a man who is 6’1” gains 30 pounds he will suffer a drop in testosterone equivalent to adding 10 years to his current age.

A male who displays any of the following behavior may be showing symptoms of undiagnosed depression.
- Anger issues
- Regular substance abuse
- Constant controlling or violent behavior
- Being overly involved in work or sports
- Infidelity
- Hazardous behavior or unnecessary risks
I’d like to use this space on my Paging Dr. La Puma blog to let you know that depression can be treated. Drugs do help some people who are seriously ill, but for most people, there are reasons to consider food, fitness, sleep and mindset measures first.

Try adding these foods to your diet to help give your mood a boost; walnuts, fish, dark chocolate, saffron, lentils, and chilies. An easy meal to help combat depression and is also easy on the waistline would be my Saffron Scallop, Shrimp, and Chickpea Paella recipe.

Depression in males often goes undiagnosed. Anyone with symptoms is urged to seek out help, especially if you’re considering hurting yourself. If you’re depressed, need help and your doctor is unavailable, call the USA Depression Hotline- 630-482-9696

Araujo, A. B., Travison, T. G., Bhasin, S., Esche, G., Williams, R., Clark, R., & McKinlay, J., (2008, November). Association of Testosterone and Estradiol with Age-Related Declines in Physical Function in a Diverse Sample of Men. J Am Geriatr Soc., 56(11), 2000-2008.
Dec2

New Weight Loss Coverage–A Better Version of Yourself (video)

Posted in: Obesity and Weight Loss, Wellness and Health

There are 3 weight loss months in the U.S.: January, or New Year’s Resolution Month; May, aka pre-SwimSuit Season; and September, or the leaves are changing and so must I. (video inspiration below)

Booksellers, commercial weight loss programs and pharmaceutical manufacturers (to say nothing of fitness shops, resort managers and food and drink vendors) mark these seasons with special offerings, and why shouldn’t they? More than ever, people need the help. For example, here are my 3 favorite elliptical trainers: the Octane Fitness, the Smooth Fitness, and the Sole Fitness (which is the previous year’s model and half price)

There are 4 inescapable truths (derived from the National Weight Control Registry research databases) about weight loss maintenance: self-monitoring, accountability, individualization of diet and adequate exercise. Many people confuse the first two, but they are different.

In other words, because you track your weight, your steps, your belt holes doesn’t mean you change them.

If, however, you are accountable to someone for identifying why the tracking did or didn’t make enough of a difference in your food choices, exercise regime or wine consumption to move the needle on the scale (or the blood pressure cuff or the cholesterol test or your blood sugar), then you are half way to control.

Some of my patients have told me that having me on their shoulder is the accountability they need for the steady, slow, deliberate, steady results that our program provides. People love to have a coach, and have an expert in their corner.

And next year, some clinicians will begin to try out a new step-by-step approach to helping patients lose weight, for two reasons:

First, because Medicare is paying for up to 26 visits in a year, with proper documentation.

And second, because Aetna will now cover the new obesity drugs, Qsymia and Belviq if the insured’s plan covers obesity drugs (many do not); if (1) their BMI is> 30 kg/m^2,; or if it’s > 27 kg/m² with one of five risk factors (coronary heart disease, high cholesterol, hypertension, sleep apnea, and type 2 diabetes) and (2) if they have tried for 6 months but have not lost an average of a pound per week.

From a health policy and payment standpoint, it’s important that obesity is recognized as a chronic disease with significant health consequences, not as a cosmetic or willpower problem. From a patient care view, however, I don’t have a single patient who thinks he is chronically ill, irrespective of his medications or conditions. And to me, he or she is not: my patients are on their way to being better men, better women, better and healthier versions of themselves.

Here’s a recent Foodbank video I participate in that illustrates men and women doing just that—not just by getting healthier, but by helping others who do not have enough nutrition or enough food.

The Table of Life (Stir-Fry), from the Foodbank of Santa Barbara County from John La Puma MD on Vimeo.
Jul18

Diet Drug Redux: How Will Qsymia and Belviq Change Practice?

Posted in: Common Conditions, Obesity and Weight Loss, Wellness and Health

With the newly FDA-approved Qsymia available in the 4th quarter at earliest, and Belviq probably the same or later, it’s too early to know what doctors will do.

But nearly a generation has passed since 1997 when one too many docs recoiled in fear, having prescribed the off-label phen-fen to young women, some of whom later developed heart valve problems. Interestingly, docs don’t take prescription weight loss drugs themselves.

Then the obesity rate was 33% in women, and 27% in men (versus 35% today for both). Hmmm. There’s something there, about that difference between men and women.

And since memory is short and the art is long, and medicine is more competitive than ever, and patients more well-informed than ever, docs will prescribe them and that will be an opportunity gained–for waist measurement. My favorite measuring tape is cloth and hard to find: I use it in my own clinic: look for it here.

Financial companies are delighted: pharma is one of 4 industries in Merrill’s Globesity Index, estimated to prosper in the coming 25-50 year global crackdown on obesity. The other 3: sportswear, nutrition and diet industries.

Dieters should be cautious. Not because these drugs don’t work: they seem to, like Meridia and Orlistat before them (Alli is still on the market OTC). But because too many physicians have not been trained in how to push the right buttons for their patients who want to lose weight and keep it off.

A simple “lose some weight” or “eat less and exercise more” or “eat less sugar and fat” are not enough. But they are all many physicians have been schooled in, and doctors themselves could set a better example.

Even educated commentators writing in prestigious journals make the inane mistake of saying “fizzy drinks and chips are fine in moderation.” No, they’re not. Not if you’re trying to lose weight.

Instead, what is on the horizon are excellent devices and programs that allow dieters to do it themselves, without pharmaceuticals, like the Fitbit Ultra, which I recommend to patients and the Withings Scale, which I also recommend.

There are some cases in which medicine is responsible for overweight: many antidepressants, steroids, even insulin. Yet the cure is in the kitchen, and with the right foods, and a smart approach–one that embraces and uses social technology and mobile health–will allow DIY answers.