Sugar, sugar

Ask Dr. Annie K:

Why do I always crave something sweet after a big meal? Even if I ate enough and I feel full it seems like there’s room for a little dessert. Is there a medical explanation for this?

“Would you like to take a look at the dessert menu?”

Someone invariably in the group says yes.

It all goes back to the primal connection between our brain and our gut – why we refer to the gut as the “Second Brain”.

We could blame it all on ghrelin . Ghrelin is known as the “hunger hormone” which is produced in the gastrointestinal tract and brain. It stimulates the appetite and signals the brain to eat. New studies show that it can keep you eating, even when you are full. Consider the potential of this hormone to lead to a major medical breakthrough in weight management. It is one of many other factors that lead to overeating.

Sugar cravings happen for 3 primary reasons:

unstable sugar levels
emotional imbalance
habit

UNSTABLE SUGAR LEVELS

Eating food that is high in sugar and carbohydrates creates a quick, sharp rise in the level of sugar in your bloodstream. Insulin – a hormone secreted by the pancreas – kicks in to control blood sugar levels. As a result, blood sugar levels drop. Then the cravings start and that tiramisu is looking better and better. The sugar/insulin rollercoaster is dangerous. Besides the damage it does to our bodies, it wrecks havoc on mood and energy levels.

EMOTIONAL EATING

Any type of unbalanced emotional state can lead to sugar craving. Stress, anxiety, anger, and sadness can trigger a need of food, for comfort. Sugary desserts produce a serotonin and dopamine rush, neurotransmitters associated with mood-elevation. Feeling unusually happy can also incite cravings. A seriously great mood makes me want to celebrate with my favorite, marshmallows ;).

HABIT

Habit is a big one. If you grew up in a house where every meal ended in dessert, you may have simply developed the habit. Dessert follows dinner, no questions asked. It may be part of a tradition in your culture. This habit is now programmed in your mind.

A habit is still a choice and that choice is yours to make.

WHAT TO DO

The dangers associated with excessive sugar intact are documented facts. Sugar has been well studied. This is not one of those findings you can rationalize by saying “one day they say eggs are good for you, the next day they are bad”. FACT: High sugar is associated with obesity, tooth decay, accelerated aging of the skin, impaired cognition in children, diabetes, cancer, heart disease, depression and dementia. Type II diabetes is an epidemic in the western world.

I am not advocating cutting out all dessert. Stressing out over dessert is also unhealthy. If you need a little something sweet keep it little. A tiny dessert will relieve the craving with way less harm than the big dessert.

Stopping Antidepressants

Fran, a 36-year-old teacher, initially presented with symptoms of major depression with anxiety. She responded well to an antidepressant and I saw her twice a year for medication management. Nine years later, we discussed stopping the medication. I gave my usual spiel, recommending a one month long taper period.
Fran called a few weeks later on the emergency number. She was sobbing – feeling terrified and anxious. She was nauseated and fuzzy. Her body felt sick, like electrical shocks were zapping her brain and limbs. She was terrified she might have MS.

These were symptoms of withdrawal. We devised an immediate plan for a slower taper. By the end, she was taking small thumbnail “chips” of the pill. It took months until she was comfortable without the medication.

While some can stop antidepressants no problem or with minimal discomfort, more than half of the patients experience withdrawal effects similar to Fran’s.

Psychiatrists knew antidepressants could not be stopped “cold turkey”. We just didn’t know how to stop them. If patients were really miserable, we simply restarted the medication, misinterpreting symptoms as a sign of relapse. Patients hated it so much they wanted the medication back, thinking this was a sign of true need. Discontinuation horror stories are all over the Internet.

Guidelines state that withdrawal reactions are self-limited and last one to two weeks. Simply untrue. Recent studies show that withdrawal reactions can be longer and more severe than initially thought. Restarting medications has lead to a dramatic increase in the length of time patients are on these drugs. How much do we know about long-term risks?

This is not unique to antidepressants. How many of you have tried to stop proton-pump inhibitors (PPIs) for acid reflux? After a few days of heartburn you reach desperately for that omeprazole without giving the body time to adjust. Furthermore, long term use of both PPIs and antidepressants are associated with neurologic diseases like dementia.

Finally doctors are paying attention. There has been a new focus on withdrawal from antidepressants which will hopefully be generalized to other drugs. Research is surfacing about how to manage a safe discontinuation.

When I prescribe antidepressants we discuss withdrawal risks from the beginning. The taper must be super slow – it can take months or years. Dr. Mark Horowitz at University College London says many people “have to pull apart their capsules and reduce the dosage bead by bead”.

I was involved in the first clinical trials for SSRIs. Those were exciting times! Finally we had safer and better tolerated weapons to beat depression. These medications have saved lives. Now we need to be just as skilled at de-prescribing as we are at prescribing them.

Ask Dr. Annie K: How Mental Health Can Affect Relationships

 

I’ve (34M) been with my girlfriend (40F) for 3.5 years and very much do still love her. I suffer from severe anxiety and PTSD but have been active in therapy for well over 15 years. My girlfriend suffers from BPD or bipolar (hasn’t been fully diagnosed yet) and unlike myself, is just starting to go through therapy and seeing a psychiatrist as well. I love her to absolute death but she’s become a very difficult person to be in a relationship with and have it not be a miserable ride.

She’ll pin me down for 2+ hours trying to explain and get me to side with some of her destructive relationship behavior. It’s very exhausting and it’s hurting our relationship. I try to give advice, but it usually doesn’t get absorbed or even listened to at all. I don’t look forward to seeing her anymore and I hate that feeling but I’m not sure how or if I can get back to the excitement of being around her again.

What do I do? Establish that we need to take a break? Break up completely? Toughen the heck up and quit being a wuss? I’m at a complete loss because even though we love each other, being her boyfriend while she’s in this state is bringing the most unhappiness I’ve ever felt in my life…

Sincerely,
A guy stuck between a rock and a hard place.

Love+Medicine

Dear Guy,

Thank you for consulting me. It is always difficult to assess the entire picture when having only one side of the story but I will offer my observations.

I am sincerely happy to hear about your own personal progress with your anxiety. You are clearly invested in treating your illness and realize how valuable it is to stay in therapy. You do not want your illness to prevent you from having a healthy, loving relationship.

If you read your letter to yourself again, you will see that the answers are there. You are clearly in love with this woman. Yet you describe yourself as experiencing “the most unhappiness I’ve ever felt in my life.”

This is understandable. Anyone who has a relationship with someone suffering from bipolar disorder knows the challenges. Your girlfriend is just now starting the healing process. It can take time to reach stability.

In the meantime, you are unhappy and this can impact your own mental stability. Giving the relationship a break may be the way to go for both sides. Your partner needs time to get healthy.

You would not be splitting because she has mental health issues. You would do it because you are miserable right now and appropriately concerned about the future.

After a period apart, you can both reassess how you are feeling. A couples counselor can be helpful particularly when confronting painful emotions – especially when facing the possibility of an end of your relationship.

Ask Dr. Annie K: B12 Injections

Love+Medicine Vitamin B12
 

Should I get a B12 shot weekly @ 65 years old?

Love+Medicine

B12 injections have been popular for decades. This is the most fun part of my job as a writer – I learn new things. While researching for this article, I have learned that I am borderline B12 deficient. Enough about me (more later). Let’s get to the facts.

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Ask Dr. Annie K: Ovulation

 

How do I know when I am ovulating?

Love+Medicine

Your question is a very good one.

There are many reasons why someone would want to know about ovulation. These can be women and their partners who are trying to get pregnant, those who are trying to avoid getting pregnant, and anyone who is curious to know more about how women’s bodies work.

Ovulation is when an egg is released from the ovary.  This happens every month in women with regular cycles. Ovulation usually happens around day 14 in women with regular 28-day cycles. But it can happen any time between day 11 to 21, day 1 being the first day of the last menstrual period. The egg lives for 12 to 24 hours after leaving the ovary, while sperm are viable for several days. If sperm enters the egg during that “fertile period” pregnancy can happen.

When you ovulate can change from month to month. It is not an exact science. Predicting when ovulation is happening is the basis for Fertility Awareness. Fertility Awareness-based methods are not reliable forms of contraception but may be helpful for women trying to get pregnant.

The body goes through changes during ovulation. Getting to know these changes can help you figure out if you are ovulating. 

Basal Body Temperature (BBT)

Prior to ovulation, body temperature falls. After ovulation, a woman’s body temperature rises as a result of an increase in progesterone. Because temperature changes can be influenced by things like stress, illness, poor sleep, inaccurate readings, etc., this alone is not a reliable method to predict ovulation.

Changes in vaginal discharge

During ovulation, the consistency and look of vaginal discharge is noticeably different in most women. Normal discharge is white, cloudy and not stretchy. During ovulation it is more like egg whites – it is clear and when stretched out, it will not break.

Mittelschmerz (German for “middle pain”)

Happens in about 20% of women. There may be a twinge or cramp in one side of the lower abdomen, close to the ovary where the egg is released. If you pay attention to your body mid-cycle, you may feel it. Sometimes it is subtle pain but for some women, it is very painful. 

The cervix never lies

“The cervix never lies” is an old medical school phrase. It can tell you a lot! In the case of ovulation, the cervix softens and opens a bit. This may be nature’s way of preparing it for the entrance of sperm. It is closed and more firm at other times. Some women can feel these changes by using their fingers. 

Increase in sex drive

Some women notice an increase in their sex drive during ovulation as a result of a surge in hormones. This may be evolution’s way of priming women to feel most aroused when they are most likely to get pregnant. 

There are apps, (many apps!) that claim to predict ovulation. Most of these apps are designed for women trying to get pregnant. 

I have done some research regarding which apps are most reliable. The American College of Obstetricians and Gynecologists (ACOG) recently published a review of cycle-tracking apps and have determined that they cannot 100% accurately predict ovulation. However, ACOG did offer suggestions of apps they comfortably recommend at this time: Clue, Glow, and Pink Pad Period Tracker Pro are the top three. 

Understanding the fascinating process of ovulation is essential for all women and their partners. The basis for most contraceptive methods is to stop ovulation – now you know why. Learning when you ovulate is part of knowing and appreciating the female body. 

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