Sitting in your car in a drive thru window is the new smoking!

 In a new study in the British Medical Journal it was found that between 1980-2010 people in Cuba were significantly healthier during the economic crisis from 1991-1995 when gas and food access were severely limited and people were forced to eat less and walk/bicycle more. Following the resolution of the economic crisis in Cuba the percentage of active adults declined from 80% to 50%, the average person gained 12 pounds, the percentage of obese adults increased by 20%, and diabetes rates almost doubled! Again, it's not surprising that increasing the amount we exercise and reducing the amount that we eat greatly improves our overall health.  I think that it is human nature to conserve energy and find easier ways of doing things such as calling someone from your car instead of parking, walking to their front door, ringing the doorbell and walking back to the car. However, I believe that in the next few years we are going to see more and more studies that reveal that our technological advances are in some ways ruining our health. We are living longer because of advances in medicine but in order to enjoy our prolonged lives we must stay active and the more we can leave our cars behind and take a few extra minutes to walk the better we will be. It is worth clicking through to check out the the BMJ article for a really cleverly designed and thoughtful medical study!

You’re not crazy, there really is something wrong with you!

You’re not crazy, there really is something wrong with you! 

In a 2007 study in the Journal of Clinical Psychiatry, over 900 patients who came to primary care visits were questioned about anxiety and depression.  Amazingly 30-40% of the patients questioned reported symptoms of anxiety and depression and more importantly these patients reported more impairment in their daily lives than people with diseases such as diabetes and heart failure. 

“When compared with patients with congestive heart failure, patients with moderate to severe anxiety or depressive symptoms reported worse bodily pain, vitality, social functioning, role limitations due to emotional problems, and mental health. Furthermore, patients with depressive symptoms also reported worse general health. The only area in which congestive heart failure patients reported worse functioning was in the physical functioning domain.”

These statistics are congruent with what I see in my office and people are always surprised when I ask them if their anxiety is limiting their social, work, and family functioning. When questioned, most people who I suspect have anxiety and depression report that their lives are significanty impacted by their depression and anxiety, but they are reluctant to seek therapy either medical or psychological for a variety of reasons. Most commonly, people state that they don’t believe that a psychologist can help them and even more commonly people are afraid that if start medications they will be on the for the remainder of their lives. When I tell people they have diabetes or early congestive heart failure, people very rarely decline therapy or testing despite the fact that most of them do not have physical or emotional limitations secondary to their disease. 

Before I treat people for anxiety and depression in my practice I try and identify whether or not it is present by asking a few questions at the annual exam. Only in he most severe cases do I offer medications at the initial diagnosis. More often when I suspect depression or anxiety and even Premenstrual Dsyphoric Disorder (PMS), I try and address lifestyle changes that have been proven to decrease anxiety and depressive symptoms. 

For all patients who I suspect may be suffering from anxiety and depression I recommend a few very basic lifestyle changes

1. A minimum of 30 minutes of cardiovascular exercise or yoga daily
2. Regular sleep of 7-9 hours nightly
3. 30 minutes of sun exposure twice daily if possible. 
4. Low fat low carbohydrate diet

These lifestyle changes typically will help with emotional stability and overall mood. When I see patients back in my office almost everyone who has adhered to these recommendations feels better. However, when I see people back for anxiety and depression, most people will report feeling better but continue to have daily symptoms that limit their overall function. For this population I usually recommend psychologic therapy and the addition of SSRI medications such as Prozac, Paxil,  or Lexapro with little reservation because I understand the severe impact that depression and anxiety can have on peoples lives and further feel that side effects of these medications are minimal compared to the lifetime impact of untreated depression and anxiety. 

Donate Your Diesel

As I mentioned in a past post "Dollars for Doughnuts", people do significantly better with exercise and weight loss when they are motivated by an external (usually monetary) reward. Charity Miles is a great app for anyone who does any walking, running or biking.  Using the app you can choose a cause and they will donate money to your charity of choice for every mile you run, walk or bike. I particularly like the social media aspect of this as it allows your friends to support you and track the good work you are doing for yourself and your charity. I think this positive feedback will propel people to exercise even on the days they feel like sitting at home and having pastry and reading the paper!