Healthy Looks Great on You

'Tis the season to be sneezing

Seasonal Allergies: Immune System Battles and Lifestyle Medicine Solutions
In Episode 118 of 'Healthy Looks Great On You', host Dr. Vickie Petz Kasper explores the theme of seasonal allergies and the immune system. The episode delves into the high prevalence of allergies, detailing symptoms, the economic and health costs involved, and the biology behind allergic reactions. Dr. Kasper contrasts seasonal allergies with perennial allergies, discussing the impact of regional flora on allergy patterns. The podcast further discusses the role of the immune system in allergies, offering insights into lymphoid organs and the production of antibodies. The episode then transitions into lifestyle medicine, examining the relationship between allergies and lifestyle choices, including exercise, stress management, and diet. Dr. Kasper emphasizes the importance of understanding allergies from a medical standpoint and presents practical advice on managing symptoms, the potential of allergy shots, and the significance of dietary choices in mitigating allergic reactions. Additionally, the episode underscores the necessity of distinguishing allergies from infections like colds or COVID-19 and touches on the broader implications of allergic conditions on mental health and cognitive function.
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00:00 Welcome to Allergy Season: Understanding the Yellow Tint00:22 Meet Dr. Vickie Petz Kasper: From OB-GYN to Lifestyle Medicine01:15 Diving Into Seasonal Allergies: Symptoms and Suffering05:29 The Immune System 101: A Mini Medical School Session06:40 Allergy Anatomy: Exploring the Lymphoid Organs11:16 The Physiology of Allergies: How Your Body Reacts14:07 Identifying and Managing Allergies: From Symptoms to Solutions22:40 Lifestyle Medicine and Allergies: Exercise, Stress, and Diet25:44 Nutrition's Role in Allergy Management: A Deep Dive29:48 Closing Thoughts: The Importance of Medical Advice

Questions and answers about menopause and hormone therapy

Navigating Menopause: Myths, Medicine, and Lifestyle Choices
Hosted by Dr. Vickie Petz Kasper, 'Healthy Looks Great on You' delves into the complexities of menopause, debunking misconceptions and exploring symptoms, treatments, and lifestyle adjustments. Dr. Kasper, with her vast experience as an OB/GYN and her journey through health challenges, offers insights into the benefits of lifestyle medicine in preventing and treating diseases. The episode covers various facets of menopause, including hormonal changes, symptoms like hot flashes and mood swings, and the impact on women’s health post-menopause. It also touches on the concept of andropause in men. Dr. Kasper discusses the importance of diet, exercise, stress management, and social support in managing menopausal symptoms, alongside the pros and cons of hormone replacement therapy (HRT), guided by the latest research findings. The objective is to equip listeners with knowledge to make informed decisions about menopause management with their healthcare providers.
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00:00 Introduction to Menopause Misconceptions and Journey Ahead00:22 Dr. Vickie's Personal and Professional Journey01:15 Understanding Menopause: Symptoms and Experiences02:58 Navigating Perimenopause and Its Challenges04:23 Exploring Different Types of Menopause07:51 The Impact of Menopause on Health and Lifestyle12:45 Lifestyle Medicine and Coping Strategies for Menopause17:14 Addressing Men's Experience: Andropause18:11 Sexual Health and Pelvic Floor Function Post-Menopause23:28 The Science and Debate of Hormone Replacement Therapy33:59 Making Informed Decisions on Hormone Therapy36:11 Conclusion: Navigating Menopause with Knowledge

How to get started with group fitness without being intimidated

You might be surprised to learn that motivation doesn't get you very far when it comes to fitness. Learn how to get started with group fitness without being intimidated. The more you do, the more you'll want to do. Get fit and get healthy, because healthy looks great on you. 
Recommended reading: Atomic Habits

Learn the secret to reading a food nutrition label

Don't be fooled by marketing gimmicks. Learn the secret to reading a food nutrition label. It's important to understand food labels so you can make healthy choices. There's a little bit of history, and a little bit of science in this episode. Whole foods are the key to nutrients that impact health. Read a label like a pro and know how to interpret nutrition facts, ingredient lists, and all those claims on the front of the package. Then you'll go to the grocery store ready to make informed choices and not be confused by misleading claims. 
Episode 115: Mastering Food Labels for Better Health
In this episode of 'Healthy Looks Great On You', Dr. Vickie Petz Kasper dives into the intricacies of reading food labels, providing listeners with the knowledge to become savvy shoppers. She shares her personal journey from a board-certified obstetrician-gynecologist to a lifestyle medicine advocate after experiencing health issues. She emphasizes the importance of a plant-based diet, informed by the recommendations of the American College of Lifestyle Medicine and other health organizations, highlighting the benefits of a Mediterranean diet. Dr. Kasper discusses the history and evolution of food labeling regulations in the U.S., introduced by the FDA to help consumers make informed choices. She breaks down the standardized Nutrition Facts Panel, updated in 2016, and teaches how to interpret serving sizes, calories, and the percent daily values of nutrients, adhering to the '5-20 rule'. The episode also covers the misleading nature of front package labeling and how to scrutinize ingredient lists, ultimately guiding listeners to make healthier food choices. Dr. Kasper concludes with practical advice on navigating grocery store aisles, debunking common marketing gimmicks, and choosing foods that truly benefit one’s health.
00:00 Decoding Food Labels: A Guide to Healthy Eating00:22 Meet Dr. Vickie Petz Kasper: From OB-GYN to Lifestyle Medicine Advocate00:50 The Power of Lifestyle Medicine: Preventing, Treating, and Reversing Disease01:12 The Basics of Reading Food Labels01:36 Understanding Food Processing and Its Impact on Nutrition02:54 The Importance of Eating a Variety of Whole Foods04:05 A Brief History of Food Labeling Regulations06:50 Navigating the Nutrition Facts Panel and Ingredient List07:54 Deciphering Front Package Labeling and Marketing Claims24:31 Practical Tips for Smart Grocery Shopping25:17 Closing Remarks and Disclaimer

How to prevent and reverse type 2 diabetes

Reversing Diabetes with Lifestyle Medicine
In episode 114 of the 'Healthy Looks Great On You' podcast, titled 'Reversing Diabetes,' Dr. Vickie Petz Kasper introduces listeners to the critical issue of diabetes—specifically, type 2 diabetes—that is affecting millions of Americans, many of whom are undiagnosed. Dr. Kasper shares her personal experience with diabetes following high doses of prednisone and how it led her to discover the benefits of lifestyle medicine. The podcast delves into the causes, risk factors, and long-term effects of diabetes on health, including its link to conditions like dementia, kidney failure, and heart disease, while emphasizing that prediabetes serves as a wake-up call for prevention. Key topics include the significance of understanding glucose metabolism and insulin's role, the impact of lifestyle factors such as diet, physical activity, and sleep on diabetes management, and the relationship between diabetes and other health risks like obesity, family history, and stress. Dr. Kasper encourages adopting a whole-food, plant-based diet, increasing physical activity, and managing other lifestyle factors to not only prevent but potentially reverse diabetes, highlighting the power of lifestyle medicine in combating this pervasive disease. The podcast concludes with reminders that lifestyle changes are crucial and encourages listeners to subscribe for more insights on health and wellness.
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00:00 The Alarming Reality of Diabetes in America00:36 Meet Your Host: A Journey from OB-GYN to Lifestyle Medicine01:32 Understanding Diabetes: Types, Symptoms, and Risks06:31 The Science of Sugar: How Our Bodies Process Glucose10:09 Turning the Tide: Preventing and Reversing Diabetes13:30 Dietary Do's and Don'ts for Diabetes Management23:17 Exercise, Sleep, and Stress: The Other Pillars of Diabetes Control31:28 Final Thoughts: Taking Control of Your Health
 
 

Practical tips for caregivers and friends of people with dementia

Chances are, you know someone with dementia. Whether you're the caregiver, or a friend of the family, or a friend of the patient, this episode is for you. You're going to learn about some resources that you did not even know existed
that can help you keep the home safe, keep the patient safe, or just minister to your friends.
  ,  
You're listening to Healthy Looks Great On You, a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper. For two decades, I practiced as a board certified obstetrician gynecologist, navigating the intricate world of women's health. But life took an unexpected turn when my own health faltered. 
Emerging on the other side, I discovered the transformative power of lifestyle medicine. And now I'm on a mission to share its incredible benefits with you. 
So buckle up because we're going on a journey to our own mini medical school. Where you'll learn how lifestyle medicine can help prevent, treat, and sometimes even reverse disease.  
This is episode 113, 
the Heartbreak of Caring for Someone with Dementia.  And today I have a very, very special guest. My guest today is Haley Buller.
Haley lives in Illinois where she is an occupational therapist one of the areas that she specializes in is helping with patients who have dementia. 
  Welcome, Haley. I'm so glad you're here with me today. I can't wait to talk about caring for Alzheimer's patients and also caring for the caregiver. I think that's something you have quite a passion for. 
Thanks for having me today. , yes, I am an occupational therapist, and I work in outpatient neuro. I, help run the outpatient portion of our dementia program here at our hospital.
 That's great. So tell me exactly what you do if someone has dementia and they come to your clinic. You're doing an evaluation to make sure that they're safe in the home and that they can age in place, right? 
Yes. So our primary goal is to keep them at home as long as possible and to keep them as independent as possible. So we do an assessment as an OT. I'm mainly looking at their daily activities. Can they bathe, dress, take care of themselves at home, , function within their home and then making their home. a safe environment. 
We also initially will always do a caregiver assessment. It's a caregiver burnout assessment to see how the caregiver is doing in their own life with dealing with caring for the patient.   
So I think that is super important, and honestly, there is a void in that space. Caregivers are burned out. It's a lonely disease, isolating, and really just heartbreaking. So first of all, talk about what it looks like when people are burned out, and also what you can do about it, or even how you can prevent it. 
So the main thing that I hear is loneliness,  especially if the caregiver is  caring for someone who is their spouse, because that's been their partner. They've been living life together for a long time, and then all of a sudden that person is still there, but who they are is gone. So a lot of caregivers are experiencing a deep loneliness because of this void that they have.
That was once their partner.  A lot of times their friends  isolate them as well, and that's always unintentional, but we see  people not being invited to things because  it's a lot of work to get out of the house or people stop coming over because maybe they don't know what to say.  
That's a really good point and I think it's important for us to talk about what friends can do. And you know, I think traditionally what we do is we take a meal, but we don't stay and eat.
Or we send a card, but we don't have a conversation. And so there are multiple opportunities for people to minister to their friends who are dealing with this by just being there for them. Not calling and saying, Hey, if there's anything I can ever do, give me a call, but truly continuing to do life with them. 
Yes. So there are two different approaches to look at this. And one is being there with them in the home. So just going over, this is so important for the patient as well, that you can listen to their stories, even if those stories aren't making sense, just being in their world, giving them, , some friendship and some companionship that also may allow the caregiver to have some time to themselves, some time to not listen to those stories that they've heard several times. ,  but just to give a little reprieve. The other thing you can do is to take them out. So if they have someone else who can give them an hour off, ask them to go to lunch, or like you said, take lunch and then also stay.  
 So you brought up the stories and living in their world. One time I heard someone say, fall with them. Don't try to prevent them from falling, but fall with them. Because I think the tendency is to sort of correct when someone tells something that's not true, or if they're trying to tell a story that's really not plausible. 
 And you want to say, no, no, you're at home, you're not at the store, or whatever. And so, can you talk a little bit about that? 
This is an area that I am so passionate about. Whether someone has a cognitive disability or a physical disability, as we age, the one thing that's in common with all human nature is we want to preserve our dignity. We want to still be ourselves and we want to have something to give. So the thing we want to avoid doing is correcting, ,  to make someone feel belittled because  early on, especially in the diseases, , of dementia and Alzheimer's,  they're a little bit aware that something is going on. They have some awareness that they have this diagnosis, that their memory or their functions are slipping. And so they want to hang on to who they are and their dignity.
  It's interesting that you would say that because yesterday I was in Bible study and we were studying 1 Timothy and how to take care of widows and one of the things that it said is that you need to meet their needs. And I spoke up and said one of their needs is to have purpose. But how do you see that playing out in a practical way with patients who have dementia? 
It really depends on the stage. So early on,  people want to still have something to offer. So even asking advice when maybe that advice you take lightly is so important or things that they've always worked on or that they're an expert in. So take someone who  you mentioned Bible study, you know, knows the Bible well, continuing to ask them about those things.
Hey, tell me what you think this verse means, or tell me what, uh, you know, about the story of David. And just asking them a thing that they're an expert in so that they still feel like they have something to contribute  Later on that looks a little different because communication is different. So, even a stuffed animal or a baby doll later on, it might look like giving that to them and making them responsible for that or a puzzle or just something to hold so that this is what I want you to keep up with for today. Anything to do with their hands can be helpful. 
  That's beautiful. And I know that your grandmother had a sister who had Alzheimer's and she would go and visit her in the nursing home and just sing hymns to her sister. And her sister really couldn't do anything else, but when she started singing those hymns, she would join in. And I think that's just a beautiful way to connect with someone. 
It's amazing. Just as a side note in my experience,  I have seen people sing hymns  and pray long after I thought that they shouldn't be able to anymore. And it's really a beautiful thing to see and hear.  
It is. I feel like they're just reaching deep into the recesses of their mind and the things that are deep in their soul and it's really touching. But let's talk about home safety. I mean, we can't ignore the fact that sometimes people don't need to be driving or if they're at risk for falling in the home.
How do you go about evaluating home safety? 
Sometimes I will go into the home. , the first thing I always do with patients is to talk about,  or with caregivers rather, is to always talk about the unsafe things in the home. So we start at that very top level of guns, knives, what could be weaponized in the home. Even if you're not to a point where you think that the, the patient, will use those inappropriately start early, get a safe, get them out of the house. Whatever has to be done.  The 2nd thing we would look at would be things.  That are a fall hazard, so simplifying the layout of the house, what furniture can be  moved to make a walkway wider. If the person shuffles their feet, making sure we pull up throw rugs.  , as a side note, and I think someone mentioned this in a comment on the Facebook post,  sometimes throw rugs can  seem like a black hole.
So any kind of surface change can really throw someone off. So the less, , The less surface changes throughout the home, the easier it's going to be for that person to navigate, , the floors.  
The problem is people love their throw rugs. People never want to get rid of throw rugs, right? 
That's right. You, , mentioned my grandmother earlier. , I tried to simplify her home at one point in time. And the next time I went over, she had a throw rug on top of a throw rug. So you just never know, but we can do our best.    Another thing I want to mention is a lot of. dementia and Alzheimer's patients have visual perceptual issues. So some kind of visual perceptual deficit, whether that be, , a visual scanning. So just being able to look, think of your pantry shelf. Can you look back and forth across the shelf and find what you're looking for? , it can also be a depth perception, , or something like a visual memory.  Something that can help is again to declutter. So if you're looking in a drawer, only putting what is necessary and maybe that top drawer so that they can find things more easily, you can also do a high contrast background. So making sure there's a, if it's a white object, putting it on a dark background, Or vice versa, 
 Wow, who knew there was so much medicine and science to taking care of just the home environment. I think after this episode, everybody's going to want you to come to their house and help out. And I think we need a service, you know, where you could take an iPad around and show people the home and have a full home evaluation to make sure that it's safe. 
That's something to consider for sure.  
 Anything else for home safety? Do you recommend things like a life alert type device? 
Yes. So going back a little bit, we were talking about kind of the different stages and how care looks different in those different stages. While we don't want to call someone out for their mistakes, those early stages, we definitely want to keep them as oriented as possible. So orientation daily is important. And what I have recommended in the past is something like an Alexa or a Siri  that you could ask the date. So if you have an Alexa in your home, you can say,  Hey Alexa,  what is today?  And she'll tell you, or you can say, what do I have on my schedule today? And she'll tell you.  Siri and Alexa also have capabilities to call a caregiver. So if you were  to fall and need to call a caregiver, Those devices can be helpful for that later on. I would definitely recommend the life alert.  It's easier. , it can detect a fall.  It can be pushed  in an emergency and those are great devices, 
 You know, an Apple Watch has that feature as well, and if you fall and you have service on your watch, it can call 911. 
Which is also nice early on because a lot of people don't want to look old. Let's be honest, in an age of Botox and, , hair dye, no one wants to look old. And the life alert from the commercials of, help, I've fallen and can't get up, , we think of that as elderly. So the Apple Watch can be a really nice, , younger person  device.
 Yes, I think it has the connotation of not only elderly, but just the dependents. You know, if I've lost my independence and now I have to have a device in case I can't get up by myself. 
yes. The Apple Watch also has,  GPS capabilities. So if you're worried about someone getting lost  and someone not carrying their phone with them all the time,  the watch can be a nice option.
 Yeah, and the phone has tracking devices, so you can share your location. And I wanted to mention something I think is important for everyone, not just people with dementia. You can go into the health app on your phone, it looks like a little heart on an Apple phone, and enter all of your health information there.
And you can put in there, dementia as a diagnosis, and you can put all of the medications. And then if there's an accident or any kind of emergency. When emergency personnel come, they can actually open that app, if you set it, right, without having to use the unlock feature on your phone, so then they can have access to understand all of your medical history.  
You make a good point there too. We think a lot about what happens if something happens to the person with dementia. But another thing with home safety that we have to talk about is what happens if something happens to the caregiver,  if something happens, , can the patient figure out how to call, is there an emergency button like the life alert that they could push, , or is your information somewhere so that when emergency services come, they don't have to rely on the person with dementia. To give your history and your contact information. 
There's so much to think about. It's almost like you need a handbook that starts at the very beginning and walks you through every step because there are so many facets of life that are affected at different times and in different places and have different needs.
It's part of the reason I think that this disease is so very challenging for caregivers. 
What I would say when someone is early diagnosed  is  find support.  It is not  a taboo disease. So it's okay to talk with your close friends. It's okay to talk with your church family or your blood family as well to talk with them, let them know what's going on, be open about it. And that will allow for a lot better communication, a lot better teamwork moving forward. The other thing is support groups. , some people don't like support groups. And so online has become a great resource, whether that's through Facebook  or finding other online groups, , finding community support groups. Support is so important. 
 
It is important, but it really isn't that easy. I mean, you may tell your church, and you may tell your friends, and your family, and honestly, you may be disappointed. I think when I was sick with a rare disease, I needed people who understood what I was going through. And I found really great support in Facebook groups.
And so, you know, we talk about how social connection  in social media doesn't take the place of in person connection, but when you have a common experience or diagnosis that brings you together and you're truly engaged with those groups, it's actually very good for your mental health. 
And the caregiver just needs as many resources as they can get, and unfortunately, there aren't as many support groups and support programs as we need. 
Another barrier would be being able to leave and go to this support group. So  online groups can be accessed anytime. And. they're they're a great option. 
That's true, because if you're going to a support group meeting, who's going to take care of your loved one who has dementia? And if you do have someone to take care of your loved one with dementia, wouldn't you rather go to lunch?  
And let's talk about driving. 
Oh, driving. , 
this is something that I do in my practice. So, an occupational therapy referral can be a good place to start.  In my practice, I do off road driving assessments. So, I go through a battery of tests as well as using a driving simulator to figure out Are there any red flags for driving? , I do not get behind the wheel with a patient, nor do I really want to, but there are occupational therapists who are driving rehab specialists and will get in the car with someone and see, are they really safe to drive?  , so an OT can be a great starting point because we can do a screen and then what we will typically do is ask the family member or the caregiver to do supervised drives.  If we don't see any red flags,  , one thing I will look for is I always try to watch the caregiver's face while I'm doing  off road driving assessments to see, do they have concerns? Do I need to maybe look a little deeper into the cognition? , Also, you can feel free to send your provider, whether that's a therapist or your doctor,  a message or give them a phone call ahead of time.  Let the medical professional be the bad guy. I know in my practice, I am happy to tell someone they can't drive so that it preserves the relationship with their caregiver.  
That's a big deal, taking away someone's privilege to drive. But it's important not only for their safety, but for the safety of others on the road. Even strangers and other people with their family and their children that may be in the car. It's a huge deal. 
So some things to watch for would first be  if they're getting lost, that's a big one, but also  taking a look at the car regularly. Usually, as someone is starting to lose their ability to drive, there will be unexplained scratches, unexplained dents, evidence that they might be having some trouble.
 I think a lot of people don't realize the resource that you are. I would imagine that referrals to an occupational therapist for people with dementia are terribly underutilized. 
Thankfully, in our hospital system, we have a great program  because it has been funded by a family. And we have really good education to our neurologist, but I would guess that in the grand scheme of things, you're right, that it is underutilized.  
You know, I think a lot of people don't even see a neurologist. I think a lot of people just see their family practice doctor who may or may not understand the benefits of medication and the need for evaluation and support and education. And I imagine the average family practice doctor doesn't have the connections or the resources that you're providing.
And that just leaves people more on an island, trying to navigate this all by themselves. And it's, it's sad really. It's a tragedy that we don't have more support networks. And I think you're bringing up a good point that someone funded your program. And we can always give back out of the struggles we've been through.
If something has affected you or your family, sometimes that's just an opportunity to increase awareness. If you don't have money to fund a program like that, Then start your own support group or if you can be an advocate for education and connecting others with resources. 
you mentioned being an advocate, advocate for that neurology referral. There are memory clinics all over the country. I know there's one in Little Rock close to you  And one here in Illinois, that's about an hour from where I live. , but there are memory specific neurologist out there.
You just may have to ask for it, look it up and advocate for that referral.
 That's really good advice, and I think it's super important.
Wow, I think there's so much more we could talk about, about all of this. And I'm just going to encourage anyone that's listening to this to connect with others who are dealing with the same issue. On my Facebook page, there's been a lot of discussion and several people have chimed in that their loved ones have had dementia.
And sometimes it's a grandfather who's already passed away and sometimes it's a spouse that they're currently caring for. But when people are just in the throes of it, If you're one that's on the other side of it, be there for those people who are still in the middle of it. Because I think connection is super important, and I just really commend the work that you're doing, and I think there's such a need for this, 
and I appreciate you taking the time out of your day to talk to our listeners about it. 
Thank you for having me.
People have shared a couple of resources with me, so I'm going to put some helpful links in the show notes. Check it out.  
the information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or healthcare provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change. 
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Alzheimer's support groups
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Coach Broyles Playbook on Alzheimer's
The 36 hour day planning guide
Mobile Medical alert device
All episodes of Healthy Looks Great on You
 
00:00 Introduction to Dementia Care and Resources00:28 Meet Dr. Vickie Petz Kasper: From OB-GYN to Lifestyle Medicine Advocate01:16 Special Guest Haley Buller: A Deep Dive into Dementia Care02:37 Understanding Caregiver Burnout and How to Support Them04:21 Embracing the World of Dementia Patients: Compassion and Connection08:36 Home Safety and Adaptation for Dementia Patients11:46 Leveraging Technology for Safety and Orientation15:27 The Importance of Support Networks and Advocacy17:25 Driving Assessments and Safety Considerations19:31 Expanding Access to Dementia Care and Support21:59 Closing Thoughts and Resources

Preventing Dementia and Cognitive Decline: The Power of Lifestyle

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Save the Brain: Lifestyle Medicine and Dementia Prevention
In this episode of 'Healthy Looks Great On You,' Dr. Vickie Petz Kasper delves into the critical issue of dementia, a condition affecting millions worldwide. She emphasizes the importance of early detection and lifestyle changes in preventing and managing dementia, including Alzheimer's disease. Dr. Petz Kasper, drawing from her transformation through lifestyle medicine, shares the potential of exercise, restorative sleep, and dietary modifications like the MIND diet in preventing up to 40% of dementia cases. She highlights the dire need for social awareness around dementia, which currently impacts over six million Americans, with rates doubling over the past 20 years. The episode also dismantles misconceptions surrounding dementia, informs on recognizing early symptoms, and underlines the significance of modifications like hearing aids and engaging in regular physical activity. Moreover, it offers a deep dive into the evidence-supported MIND and Mediterranean diets and their role in neurodegenerative delay, alongside strategies for stress management, enhancing sleep quality, and fostering social connections to bolster brain health.
00:00 The Shocking Truth About Dementia Prevention00:38 Welcome to Healthy Looks Great On You!01:29 Understanding Dementia: More Than Just Memory Loss03:24 Breaking the Stigma: It's Time to Talk About Dementia07:04 The Science Behind Dementia: Types and Causes14:59 Lifestyle Changes: The Key to Preventing Dementia15:17 The MIND Diet: Your Brain's Best Friend22:49 Exercise and Other Pillars of a Healthy Brain25:56 The Don'ts: Avoiding Risk Factors for Dementia28:02 Final Thoughts and Caregiver Support
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How Not to Diet by Michael Gregor
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TRANSCRIPT:
Did you know that lifestyle modifications such as exercise and restorative sleep and controlling blood pressure can prevent up to 40 percent of dementia cases in the world?
Dementia is one of the most dreaded diagnoses, along with cancer. And just think, breast cancer and prostate cancer can be treated if caught early. But listen, it is just as important to treat and prevent dementia. Save your brain! Now is the time to make changes that may prevent the development of this terrible disease., ,
You're listening to Healthy Looks Great On You, a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper. For two decades, I practiced as a board certified obstetrician gynecologist, navigating the intricate world of women's health. But life took an unexpected turn when my own health faltered.
Emerging on the other side, I discovered the transformative power of lifestyle medicine. Now, I'm on a mission to share its incredible benefits with you, so buckle up because we are embarking on a journey to our very own mini medical school, where you'll learn how lifestyle medicine can help prevent, treat, and sometimes even reverse disease.
This is episode 112, Save the Brain.
When someone is diagnosed with dementia, it doesn't just affect the patient, but the caregivers and the entire family as well. It's likely you know someone with dementia because 1 in 3 seniors has been diagnosed with this. And when people think of dementia, they think about memory loss. But it's really much more than that.
 It's also fatal resulting in the death of more people than breast and prostate cancer combined. In fact, it's the seventh leading cause of death in the United States.
And do you think it seems like more and more people have dementia? Well, it's true. Over the last 20 years, deaths from dementia have doubled. By contrast, death from heart disease, which by the way is still the number one killer, have decreased over that same period of time. If you or a loved one is experiencing symptoms of dementia, don't feel alone.
Right now, more than six million Americans have been diagnosed with dementia. And the numbers are rising sharply. About 33 percent of people over the age of 85 have some form of dementia. It's not part of the normal aging process and it doesn't affect everyone, but it is more common. Back in the old days, people said, they're just getting senile, but now we know so much more.
10 percent of the people over the age of 65 have symptoms of cognitive decline. Progress is slow and affects different people differently. Most people with dementia over the age of 65 live 4 to 8 years, but others live as long as 20.
Typically, older people are affected, but not always. There are rare cases of early onset dementia that occur in midlife, which is particularly tragic, isn't it? But, people often don't seek treatment. Why do you think that is? Well, for one thing, there's a weird stigma associated with dementia.
I mean, like, if your heart is failing, you'd tell your friends, right? But if your brain is failing, somehow that's embarrassing. But dementia is literally brain failure. Second, there's a misconception that nothing can be done. Ready for some good news? There is. While dementia cannot be cured, it is possible to slow progression.
And prevention is also possible. And obviously, most important. How do you know if you're experiencing symptoms of dementia versus just being forgetful? Which can happen for a variety of reasons. Memory loss is a hallmark sign of dementia, but it's so much more. It's things like poor judgment. And this one is really dangerous, especially if people continue to drive.
It can be dangerous in other situations as well. And I may or may not have a story about fireworks, catching a field on fire, and the fire department coming and, um, we really weren't sure who to blame, but we won't talk about that. Another symptom is confusion. People may think they're somewhere that they aren't. Or they may call people or their pets by the wrong name. And they may have trouble finding the word they need.
Along with trouble writing. and understanding what they read. They may wander or get lost and have difficulty handling their finances, paying the bills and keeping up and writing checks. I mean, that's hard for everyone, but it can be so much worse if you're experiencing cognitive decline. Some people repeat the same question over and over.
They may say, “When is my hair appointment?” And then five minutes later, “When is my hair appointment?” Sometimes they'll use unusual words to refer to familiar objects. Another key feature, which has only recently been brought to the forefront, is slowing down. People who used to walk really fast, suddenly walk slower.
People who used to eat very fast, eat slower. And everyday tasks, like getting ready in the morning, take forever. Also, there can be a loss of interest in normal, everyday stuff. A change in appearance because the person may quit caring so much about their hygiene.
For instance, someone who was meticulous about their hair suddenly quits brushing it. There can be hallucinations, delusions, or paranoia. A common one is, they took my money. And then they tell their friends and at first their friends don't notice that they're having problems and so they believe that someone took their money.
Another thing is not caring about other people's feelings. They might say, “Look at that woman, she's ugly and her baby looks just like her.” That can be really embarrassing for the family members.
 One thing that can help is to get little business cards that say, “Thank you for your patience. The person I am with has dementia.”
I created a little template and I put a link in the show notes for you.
Another thing that can happen is impulsiveness and this can be worse than a teenager. They may have trouble controlling their emotions and may experience a personality change. Someone who is usually really sweet may become mean and vice versa. They may have problems with balance or movement and this can be really dangerous because it can make them more likely to fall.
And a lot of times the symptoms are not noticed by the person who has the cognitive decline but by their friends and family members. But nobody wants to talk about it. And that's unfortunate because this disease has a huge impact and it needs attention. Before I give you some good news about what can be done to prevent dementia or possibly even slow progression, we need to review some science.
You didn't think you were getting out of mini medical school today, did you? First of all, what causes dementia? Well, that depends on the type. There are several different types of dementia, and the most common and most familiar is Alzheimer's. Now, pay attention closely. It's not Alzheimer's. It's AllTimer's.
Well, that's a weirdly spelled word, isn't it? Turns out, it's somebody's name. A German man, to be exact. Alois Alzheimer was a psychiatrist who first described the disease in 1905. Good job. Think I would hate having my name associated with such a terrible disease. So if you insist on saying All Timers, I'll forgive you.
Maybe. Not all dementia is Alzheimer's, but Alzheimer's is always dementia. Did I just hear you say, huh? Let me explain. Think of it this way. A poodle is a type of dog. And while all poodles are dogs, not all dogs are poodles. Got it? Alzheimer's is a type of dementia, but You're welcome. But not all dementia is Alzheimer's, there are other types. So what are the other types of dogs besides poodles? Well there are German Shepherds, Beagles, Dachshunds, oh wait, never mind, we were talking about types of dementia. But I hope that analogy helps you remember that not all dementia is Alzheimer's. Alzheimer's is a type of dementia. The others are things like frontotemporal dementia.
Now that may sound familiar because of Bruce Willis, you know, the actor from Miami Vice who starred in the action packed Die Hard movies? His family announced that he had Frontotemporal Dementia. There's also Lewy Body Dementia that looks similar to Parkinson's Disease with shuffling, tremors, and hallucinations.
It can be particularly devastating and it's rumored that that's what Robin Williams had. Vascular dementia is caused by disease in the blood vessels, like little mini strokes. And then there's mixed, where dementia is attributed to multiple causes. How do you determine which type of dementia is present?
Well, it's not that easy. Lewy bodies are really specific, and they're a clump of protein that is found inside the brains of people with this type of dementia. The problem is, you can't see them, except on autopsy. And since it's related to Parkinson's There are clues to the diagnosis, like the inability to draw a clock face.
This is a fascinating thing. Certain parts of the brain are responsible for certain cognitive tasks. So there are neurologic tests that can help your doctor make the right diagnosis. It starts with a complete medical history and physical exam, and there are specific memory and psychological tests that evaluate certain areas of the brain.
 Some of these can take hours to complete, and that's exhausting. So a lot of people don't want to pursue it. But the doctor should check your reflexes, watch you walk, check for balance and sensation. Didn't you always wonder what that tuning fork was for? It's to see if the patient can feel vibration. And patients are sometimes diagnosed with depression.
There are also mental performance tests that check memory and thinking skills. Imaging studies like MRI may be helpful, but they're not usually conclusive. The definitive way to check for Alzheimer's is a spinal tap because there are amyloid proteins in the cerebrospinous fluid. Now I know that sounds awful, but it's really not that bad.
If you had an epidural when you had a baby, that's a much bigger needle than the one used for a spinal tap.
Another symptom that some people have is confabulation. That's a really big word that means making up stories. But the tricky part is that some people are really good storytellers.
 So good storytellers who get dementia may be able to tell fantastic stories. The trick is to know when they're telling the truth or not. At first, with dementia, the symptoms often wax and wane. And it's super easy to attribute it to something else. So, why do the symptoms come and go? Well, think of it like tangles in your hair. The neurons in your brain get tangles in them sometimes.
Other times, thinking may be clear. Don't you wish we could just spray some no more tangles on the brain? Although, I'm not really sure that stuff worked well anyway. I remember it still hurting when my mom brushed my hair when I was little now, for people on Medicare, the annual wellness visit requires an assessment of cognitive function.
And it can be very brief and simple. There are several different questions to choose from. So that may explain why sometimes your doctor is asking you weird questions. So, what's the point? Well, it's to identify people with cognitive decline in the earliest stages so that interventions can be made. And guess what the most effective interventions are?
I hope you guessed lifestyle changes. There are medications that slow progression and there are some promising treatments on the horizon too. We'll talk about both later, but first just a little more terminology. MCI stands for mild cognitive impairment. And this is usually the first thing noticed by the patient, family, or friends.
Don't panic, but this is stuff like losing your keys or your cell phone.
Now, don't talk to my husband about how many times I lose my cell phone. But it's also forgetting important events or appointments, trouble coming up with words and forgetting names. Another thing is a loss of the sense of smell can happen with early disease.
And of course that's become a lot more complicated in the era of COVID. But the
key time for intervention is early disease or mild cognitive impairment. Oh wait, there's one thing even better, and that's prevention. Whether you are trying to arrest or slow progression or minimize your own risk, the treatment is the same. I promise we'll talk about that soon, but let's discuss who is at risk first.
Women are at greater risk. Two thirds of people in the United States with Alzheimer's are women. For women at age 45, the lifetime risk is 1 in 5. And for men, it's 1 in 10. And not only are women at greater risk for developing the disease, they carry 70 percent of the caregiver burden. Older African Americans are at greater risk than older whites, and older Hispanics have a 1. 5 percent increase in rates of dementia compared to older whites. We often talk about modifiable risk factors versus
non modifiable risk factors. Those are the ones you can't control, like your gender, ethnicity, or genetics. When we see a parent or a grandparent experience dementia, it feels like looking in a mirror at our own fate. But it doesn't have to be that way. Lifestyle interventions for prevention should begin as early as possible, even in childhood.
In other words, if you're concerned about your family history, then make changes together with your whole family. Let's talk about modifiable risk. First of all, the number one preventable contributing factor to the development of dementia is wait for it. Hearing loss. Did you hear that? Now, you can't help it if you can't hear well, but by golly, you can get some hearing aids.
I've had them for about six years and my hearing isn't terrible, but I don't want that part of my brain that processes hearing loss - the spoken language to start shrinking. So I wear them. Well, I wear them most of the time. All right. Now let's talk about lifestyle modifications. Whew, finally, right? All six pillars of lifestyle medicine are important in preventing cognitive decline. Diet, stress management, exercise, social connectedness, minimizing harmful substances, and restorative sleep. First, let's talk about diet. Hmm, you probably knew that was coming. There is some evidence that the MIND, M- I -N -D, diet may prevent dementia and even slow its progress, especially in early stages.
This has been headline News in Forbes and U. S. News World Report. It was developed in 2015 by a nutritional epidemiologist named Martha Claire Morris and her team. Geez, I don't even know any nutritional epidemiologists. But anyway, MIND stands for Mediterranean DASH Intervention for Neurodegenerative Delay.
Whew, that was a mouthful. Let's try that again. MIND stands for Mediterranean DASH Intervention for Neurodegenerative Delay. That's a mouthful. Basically, what she did was combine two well-known diets, the Mediterranean diet and the DASH diet. If you listen to my podcast on hypertension, you know the DASH diet stands for Dietary Approaches to Stop Hypertension, and it focuses on lowering salt in the diet.
I'll put a link to that in the show notes.
The MIND diet is similar to Mediterranean with less emphasis on fish and fruit with the exception of berries. If you remember one thing today, remember berries. Now, let's go over the specific recommendations of the MIND diet. And don't worry about taking notes because I've put a downloadable printout in the show notes along with a smoothie recipe that helps you knock out some of these things all at once.
But here's the weekly dose. Six servings of green leafy vegetables every week. You know, Popeye never had any cognitive decline. Uh, maybe that's a terrible example, but hopefully it helps you remember. Spinach, kale, arugula, collard greens. Swiss chard, turnip greens are rich in folate, lutein, vitamin E, beta carotene, and other nutrients that protect cognition, especially as people get older.
You need at least one other serving of vegetables that aren't starchy, so not potatoes. Think more broccoli, squash, asparagus, beets, bell peppers, cabbage, carrots, eggplant, and okra. Also, five servings of nuts, or more, weekly, and I think just make it simple and eat a handful every day. Almonds, Brazil nuts, cashews, pecans, pistachios, or walnuts.
Nuts are good for the brain. And, they're a rich source of vitamin E, B vitamins, healthy fats, as well as minerals such as magnesium, potassium, and calcium. Now, I mentioned before, berries are important. Eat at least two servings a week? But I say more. Put some blueberries or raspberries on your oatmeal or eat strawberries for dessert.
Berries are great for making smoothies and you can drink all those antioxidants which are not only good for your brain but your body too. For Valentine's Day this year, I served Nice Cream. It's a recipe I got out of the How Not to Die cookbook. I'll put a link for that in the show notes too.
You need a minimum of four servings a week of beans. I know that's a lot, but they're so, so good for you. Lots of protein in a great source of fiber too, so you feel full and there's such variety. You can incorporate beans in creative ways like chickpeas in hummus or pinto bean dip. White beans, make a good salad mixed with cucumbers and olive oil and vinagerette.
Kidney beans go great in soups, and if you've never made lentils, look up some recipes. They're easy, versatile, and delicious. Black beans make a great meat substitute, and you can even make brownies with them. And don't knock it unless you've tried it. They're really yummy. I'll put a link in the show notes.
When cooking, always use olive oil instead of canola, vegetable oil, or safflower oil. When it comes to whole grains, you need three servings a day. The other recommendations are for the week, but this one's daily and it's hard to eat whole grains because most breads and cereals are processed.
So try quinoa, oatmeal, and brown rice. They're chocked full of vitamin B and vitamin E and a good source of fiber. I still think it's a challenge to get in three servings a day, but if you start your day with oatmeal, that works. You can add oatmeal to a smoothie by the way. At least one serving of fish each week is included on the MIND diet.
Now these should be fish that are high in omega 3s. Typically those are your fattier type fishes like salmon and tuna. Chicken or turkey twice a week, and I hope it goes without saying that we're not talking about chicken nuggets and we are not talking about fried chicken. And originally they recommended one glass of red wine a day, but there's been some uncertainty about whether or not this is beneficial, and certainly limit it to one.
Now, here's the what not to eat list. butter and margarine and gosh it kills me to even say that. You would not believe how much butter I like to cook with. Actually, I don't cook with it like I used to because the evidence is so good that diet can prevent dementia. I've cut back. The limit is however one tablespoon a day.
 Now you may not be slathering it on your bread or toast, but think about sauces. And such as that. And here's a good substitute. If you want to smear something on a piece of bread, try a mushy avocado. It tastes delicious. And if butter was hard, the next one's even harder.
Cheese. Ugh. Only one serving a week. Now, one thing I've done to help with this is swap it out for nutritional yeast. It has a cheesy taste and it's used in a lot of cheese free recipes to give it that flavor. Red meat on the MIND diet is recommended no more than three weekly servings. But we know it's not good for your blood pressure or heart and it increases the risk of cancer.
So I would skip this one. Last on the limit this list is sweets and pastries. It says no more than four times a week, but personally I think that's generous. For me, I need to go pretty much all or none. Once I start with sweets, I want them more and more. So I'd say limit to a very small amount on very special occasions.
And remember, you're going to have to define what is a special occasion. Do you think you could follow the MIND diet? How about a little more motivation? In one study of approximately a thousand older adults, there was a 53 percent lower risk of developing Alzheimer's in those who followed the MIND diet compared to those who didn't. 53 percent is impressive. The MIND diet has only been around for about 8 years, so there aren't as many studies on it as there are on the DASH and Mediterranean diets. But there was a really big study published in a British medical journal in March of 2023 that showed that the Mediterranean diet reduced the risk of developing dementia by 25%.
And that's even in people who were genetically predisposed. And when I say big study, there were 60, 000 seniors in this one. That's powerful data. And there are other benefits to following either of these diets too, such as prevention of heart disease, diabetes and cancer as well as lower blood pressure and improved digestive health.
If that's not convincing enough, then you should know that whole foods and those with high fiber also help you lose weight. Alright, maybe we can do without the cheese and butter, right? Now that we've talked about diet, let's move on to an equally important pillar of lifestyle medicine. Exercise. It is well known that physically active bodies have sharper minds.
We need 30 to 60 minutes of activity per day, but any amount reduces your risk and it's dose dependent. A Harvard study showed that even light activity such as running errands or getting up and cleaning the house is a lot better than doing nothing.
A lot better. According to an article published in the Journal of Neurology in 2022, The reduction of risk from just getting up off the couch is 21%. But aim for 150 minutes of moderate to high intensity exercise each week because that's associated with a 35 percent reduction.
This means you're exercising hard enough that it's hard to talk without being breathless. But again, every little bit helps, so just get started. And do something you like. Involve your kids or grandkids because the earlier you start, the better. Okay, now that you're motivated to eat healthy and get more exercise, you need to look at your sleeping patterns.
I covered restorative sleep in one of my earlier podcasts. I'll just put a link to that in the show notes. And what about stress? Does that affect our risk for dementia? Well, here's something particular when it comes to the risk. Recurrent negative thoughts. And that's a hard habit to break. So listen. If the news or the social media has you all riled up, then it's time to unplug.
 Complaining is another attitude that becomes routine. And you know what else? It is contagious. Be sure you don't get together with your friends and complain. Practice gratitude instead. It's the polar opposite. And you can't complain and be grateful at the same time. And think of this as a mental exercise to build a healthy brain.
You can work on some positive psychology if you want, but for me, I like to focus on the Bible verse that says, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable.
If there is anything excellent or worthy of praise, think about these things. I don't know about you, but I think nature is lovely. So get outside and enjoy the trees, the flowers, the mountains, or lakes. It is literally good for your brain. You might think about social connection being important in the prevention of dementia, but studies show that people who have engaging relationships with family and friends
are less likely to experience cognitive decline. One study showed that the type of people who talk to the checker at the grocery store have a lower incidence. You know the type, right? Yes, that would be me. I actually had a great conversation with an elderly lady who scanned my groceries. Her name was Barbie, and she walks her dog every day for exercise.
Tell her I said hello next time you go to the store. It'll be good for both of you. Now we've talked about the do's. Eat the MIND, diet, exercise moderately 150 minutes a week. Manage your stress. Make sure you have good sleep hygiene. And nurture your relationships with others.
Now let's talk about the don'ts. We know that the use of tobacco and tobacco products is bad for the heart and lungs, but what about the brain? Well, duh. It worsens hypertension and vascular disease, which clearly aren't good for you. The World Health Organization estimated that 14 percent of dementia cases worldwide would be prevented with smoking cessation.
That's the good news. If you quit, your risk diminish too. Listen, I know it's hard. If you need help, I put a few resources in the show notes. And I also have a link to the podcast that covered that
now, let's wrap up with the association between alcohol use and dementia. Heavy drinking can increase the risk of developing dementia
or, alcohol related brain disease. When I was a kid, I was told that alcohol damages your brain. And it turns out that's true. Alcohol can damage memory and speed up disease in the blood vessels in the brain.
 There is even a specific form of dementia associated with heavy alcohol use over a long period of time. It's called ARBD, alcohol related brain damage. There was a large study in 2022 of nearly 37, 000 middle aged and older adults with no major health problems. Those who consumed more than three units of alcohol per day had less white and gray matter in their brain.
In fact, it made their brains look three and a half years older. What's a unit of alcohol? Well, it's half a pint of beer or a small glass of wine. So the most prudent thing to do to protect your brain is to abstain altogether or at least limit your alcohol to no more than one drink a day. You know, drink a smoothie instead.
Cheers to your health.
If there's one change you can make on the do list, it's eat more berries. If there's one change you can make on the don't list, eliminate ultra processed foods. And in the end, say the serenity prayer, God help me to accept the things that I cannot change. To change the things that I can change, and the wisdom to know the difference.
 I also think it's important for us to address caregivers. I have an upcoming episode on that. But for now, remember, the MIND Diet, stay active, both mentally and physically, and be social, because a healthy brain looks great on you.
The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or healthcare provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change.

What you need to know about post partum depression and baby blues

How could a woman feel overwhelming sadness when she ought to feel joy?  Trust me, that's the same question she's asking herself when it comes to postpartum depression, postpartum anxiety, or even the baby blues. Guilt is the  overarching emotion. If you are someone you love as a new mom or about to be, you're in the right place to learn more.
Whether you're a parent, a grandparent, an aunt, uncle, or a friend. There's always something to learn.  
You're listening to Healthy Looks Great On You, a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper. This is episode 111, "When a bundle of joy makes you feel guilty about not feeling joy." You're going to step into the thoughts and emotions of new moms so you can better understand what they are going through. And how to help. 
 
Congratulations! You just gave birth to the most beautiful baby on the entire planet and now he snuggles up to you and smiles, the birds sing, and everyone is blissfully happy.  Or, at least that's the script you had in your head. But then there's the reality. And it's not the pretty picture you envisioned, is it?
Postpartum depression makes you feel guilty about not feeling happy. You want to be happy. You feel like you should be happy. But you're struggling. Struggling with juggling all the things that come with a newborn and now you're supposed to take care of yourself and the rest of your family.  On top of that, you're cramping, bleeding, trying to heal from stitches either in the most private area or on your belly, which still rolls over beside you in bed.
And your breasts are so engorged they feel like they'll explode. Meanwhile, your grandmother's pastor comes to visit along with the neighbor you've only met once to, uh, you know, celebrate with you. Good grief, it's no wonder 
postpartum depression overwhelms new moms. And that's just the physical stuff. We haven't even gotten to the effects of hormones yet.  One woman described it like this.  Postpartum depression is locking yourself in your house because you're afraid something bad will happen to you or your baby if you emerge.
It's being a mom because you're obligated to and not because you want to. You want to want to, but you feel so disconnected and you don't know why.  Postpartum depression is being in bed all day with debilitating fatigue and lack of interest. It's isolating yourself from everyone and everything. You're merely existing.
Surviving, but nothing beyond that. It's unexplainable, relentless sadness. It's not uttering a word to anyone all day because you have nothing to say. It robs you of what should be the best moments of your life.  Zero out of ten recommend.  Postpartum depression is serious and it affects 10 - 15 percent of women in the first year after giving birth. 
The baby blues are much more common and experienced by 65 - 85 percent of women. What's the difference between postpartum depression and the baby blues? Well, both occur after delivery, but the blues are usually mild and go away pretty quickly. The onset is typically about 2 3 days after delivery. Peaks over the next few days and resolves within two weeks.
During that period of time, it can look very similar to postpartum depression with regards to a down mood. As Elton John sang, I guess that's why they call it the blues. Also,  the inability to concentrate, and you can't stop crying. And insomnia, but I hate to even mention that because who sleeps with a newborn in the house anyway?
You just slug through the day and don't enjoy that bundle of joy.  Sounds scary, doesn't it? It's actually very common to have big mood swings in that first week or two. Some people feel anger. Others describe debilitating fatigue. The baby blues are heavy, but the cloud usually lifts in a couple of weeks. 
One woman described it like this. I cried every day in the shower at 4 p. m. when the sun went down. It was a terrible guilt I felt for being sad when I should have been rejoicing in the goodness of God. Lasted about a month.  And that's typical of the Baby Blues. They come, they go, and life moves on.  What can you do to get through the Baby Blues?
Well, first of all, give yourself some grace. Your body has been through a lot. As much as possible, don't neglect taking care of yourself. You may think, but I don't even have time to eat, much less take care of me. I know, I know, but try to rest when you can. If your baby is sleeping and you can rest, do that instead of trying to get everything done around the house.
Unless, of course, you're taking care of other kids, then encourage quiet play. And if someone offers to help, this isn't the time to be independent and tough. Let your church family bring meals, let grandparents take older kids places, and don't turn down offers to help from family or friends.  Try and have some protected time for yourself, even if it's just a long, hot shower.
And remember, alcohol makes mood swings worse, so that doesn't solve anything.  If breastfeeding is a struggle, talk to your health care provider about a lactation consultant. Most hospitals and doctor's offices can provide resources. And connect with other new moms, preferably before you deliver.  And I'd also like to mention that there is a medication called Reglan, or metoclopramide, that is sometimes used to help with milk production.
Just be cautious with it because it can worsen postpartum depression.  But most of all, don't beat yourself up. What you're feeling is common and will likely resolve if it's baby blues.  But what if it's more than that? 
While the baby blues are pretty common, 1 to 2 out of 10 women experience postpartum depression. It's much more serious than the blues. 
It's characterized by difficulty concentrating and trouble making decisions along with bad mood.  One of the hallmark signs is loss of interest in things that should bring pleasure. The medical term for that is anhedonia. Women with postpartum depression often feel worthless or experience excessive guilt.
They may feel guilty about feeling depressed. Talk about a vicious cycle. 
At the extreme end of the spectrum, new moms may feel like their newborn and their family are better off without them.  That can lead to thoughts about ending their own life. One woman shared this story: "Drowning. That's what it feels like. The waters are constantly rising and you can't breathe and you don't know who you are or why you are feeling the way you are.
You're numb and also incredibly angry at the same time. I was just going through the motions of what I knew I was supposed to do, take care of my baby and family. But all I wanted to do was not exist anymore." If you or someone you know is experiencing thoughts of suicide, either go to the emergency room or call 9 8 8. 
You can even text the number to get help. Again, that's 988, and it's not just for postpartum women. It's for anyone contemplating suicide.  Now, I know that anyone with a crib in the house has limited energy and time, so I'm going to keep mini medical school pretty brief today. But, let's talk about the hormonal withdrawal that really does a number on a new mom's body and mind.
Just think about it. One day, you're carrying a little human inside your own body. It's uncomfortable during the day and  can significantly disrupt sleep at night.  Then one day, the little one makes her arrival and boom, you aren't pregnant anymore.  It's mind blowing to think about all that happens throughout pregnancy, delivery and the postpartum period.
 Hormone levels fluctuate during pregnancy. And when the little bundle of screaming, peeing, pooping, eating, I mean, I mean joy arrives, estrogen and progesterone levels plummet.  Other hormone levels change too, including cortisol, which is the stress hormone, melatonin, the sleep hormone, oxytocin, which is the love hormone, and thyroid hormone, which affects the metabolism at every level. 
Sleep is super important and those who struggle are more at risk for postpartum depression.  
 I have an episode about melatonin in sleep. I'll put a link in the show notes.   That big hormonal upheaval after delivery always happens. But  It doesn't always have the same effect on everyone.
Some women are just more sensitive to abrupt changes in female hormone levels in the bloodstream.  And then there's the placenta.
It releases placental corticotropin releasing hormone. And those levels have been correlated to postpartum depression too. And if that's not enough to start the downward slide, neurotransmitter levels can get out of whack too. The enzyme monoamine oxidase A in the brain metabolizes neurotransmitters like dopamine,  norepinephrine, and serotonin, all of which are associated with postpartum depression.
And we really don't know why some women are more affected than others, but there are some known risk factors. If you struggled with PMS before you got pregnant, or had anxiety and depression before your pregnancy, or with a previous pregnancy, you're definitely at increased risk.  
But even  if you've experienced postpartum depression before, it increases the risk, but it doesn't always happen, so that's the good news. There were times when I had patients who had really bad postpartum depression with one pregnancy. They didn't have it with the next, but they were so anxious that they were going to, that it almost looked the same. 
Big stressors open the door for postpartum anxiety and depression, like a rocky marriage, financial strain, poor social support, or other disruptions like, say, a pandemic.  The prevalence of postpartum depression appears to be increasing with an uptick to almost 20 percent during the pandemic. Yeah, that one threw us all for a loop.
It's not clear what other reasons are contributing to the rise, but we know that pre existing mental health issues are also on the rise, and they go hand in hand. 
One brave woman shared this experience. "Severe sadness, loneliness, angry, and just so exhausted. I lost myself. I let myself and my home go. No longer cared. My house was dirty. Laundry piled up. No one checked on my mental health. No one looked at my now ex husband and asked why he wasn't helping me. I feel like everyone looked at me for all the answers and it was my fault.
I felt alone."  It's heartbreaking to hear women tell their stories. Women with Seasonal Affective Disorder are more likely to develop postpartum depression too, as well as those with a pre existing anxiety disorder. As if there weren't enough already to worry about, now you're responsible for a fragile baby's life.
And by the way, they're not really as fragile as you think, but there are endless things you can worry about if you're so inclined. And we can't cover everything in this episode, but one woman described postpartum anxiety like this.  "I felt an insane connection to my babies and was loving postpartum life.
And it's my anxiety and lack of trusting others and need for control over my child's safety that would prevent me from using childcare to get a moment outside the home without my kid. I took him everywhere and I needed a break. And I would see others freely living their lives and truly questioned Why they weren't concerned about the things I was in regards to safety, and at the same time, I would also feel frustrated that my anxiety held me hostage.
I know for some, postpartum depression and postpartum anxiety can both exist, but for others, it's predominantly anxiety. While we truly love being a mom and love spending time with our babies, and don't have the majority of our days with low energy, motivation, or lack of connection with our baby."  I think that's an important distinction, 
but speaking of things to worry about, fear of childbirth increases the risk of postpartum depression. I took care of about 5, 000 pregnant women during my career, and some of them were absolutely terrified of the delivery process. And of course, you know, people love to repeat horror stories about labor.
Why?  I don't know. But they do.  And younger moms and single moms are more likely to be overwhelmed with the responsibility of motherhood, no matter how mature they might be. And that bumps up the risk for postpartum depression. And so does having a house full of kids or having an unintended pregnancy. And the past matters too.
A family history of depression puts you at risk for postpartum depression. And of course, a history of abuse.  You're more likely to have postpartum depression if your baseline health is poor or if you have body image issues.  The postpartum body is not for the faint at heart.  And if you already struggle with what you see in the mirror, then it may throw you into a downward spiral.
Motherhood is tough, but for some it's brutal. Women who have trouble breastfeeding or have a fussy baby also have a higher chance of postpartum depression.  When does it go away?  
Even without treatment, postpartum depression may go away, or it may turn into persistent depression.  It lasts about 12 months for half of women who experience it. And man, a lot happens in a year, especially in the first year after having a baby, and it can have a big impact. Women with postpartum depression may not eat right, which can further interfere with breastfeeding, bonding with their baby, or even caring with their baby.
And in extreme cases, it can affect the baby's development.  The relationship with her other kids and her husband can suffer, too. Depressed moms are less likely to read to their kids or play peek a boo with their babies. Here's the deal. It's not your fault. Please don't be shy about mentioning it to your doctor.
You aren't the only one, and it's important to get the treatment you need. One woman shared this: "I was feeling so alone and just the deepest sadness, maybe even hopeless. And I remember my doctor telling me that I needed to call him if feelings of sadness lasted more than a few weeks. But I was afraid to call because I didn't want them to think I was crazy and take my baby away." 
Listen, that's not how this works. If you're experiencing what you think may be postpartum depression, please let your doctor know. And your OB doctor may ask you questions to determine if you have postpartum depression. Normally, when screening for depression, we ask about things like fatigue and changes in appetite and sleep.
But I don't recommend asking any new mom these Captain Obvious questions. Who wouldn't experience that with a newborn in the house?  But remember that term anhedonia? 
It's an important marker of depression. Your doctor may ask if you have lost interest in things that should bring you pleasure even your sweet newborn. Your health care provider may ask if you feel down, depressed, or hopeless. 
One of the tools used to screen for postpartum depression is the Edinburg. postnatal depression scale. Let's step into the classroom for a minute and let me explain the difference between a diagnostic test and a screening test. When developing a screening test you don't want to miss anyone. So, think of it like one of those old timey fishing nets that they used to throw over the side of the boat.
And if you don't want to miss any fish, then you make the holes really really small. Now, when you pull the net up, you're going to have to sort through what's in there to get to what you need. So screening tests are designed like this to capture everyone who might have the condition. Then the physician or provider has to drill down to the level of a diagnosis to see which ones are caught in the net with the small holes actually fit the criteria.
Does that make sense? The Edinburgh Postnatal Depression Scale is a screening tool, not diagnostic. It's 10 questions to see who needs further evaluation for postpartum depression. It takes about 5 minutes to complete and there are 30 possible points. There's a link in the show notes. 
And if you score more than 10 or 11, you may have postpartum depression. Please just talk to your healthcare provider. Help is available. And be persistent. Some clinics have this down better than others. Here's another comment. 
"At what time periods do OB doctors check in with women? I filled out a form for baby blues in the hospital when I was still riding the hive giving birth. For I saw my OB at six weeks postpartum when my days were full of snuggles and I was binge watching my favorite shows and people were bringing meals.
Life was great. My postpartum anxiety hit at month three or four when I transitioned back to work and had to rip the band aid off of , having my kids at daycare with strangers."  So,  This brings up another point. There's a role for pediatricians because they continue to see moms long after the OB doc has released them to come back for their yearly exam.
Fortunately, there is a lot more awareness now, and I think that helps with those who feel embarrassed or uncomfortable bringing it up. So, if you do have postpartum depression, you probably need to talk to a mental health counselor. And don't let the term psychotherapy make you feel weird. It's literally just talking to someone who's an expert at helping you cope with your feelings, deal with your problems, set achievable goals, and learn to respond in a healthy manner.
Let's face it, everyone has difficult relationships and this is often magnified when a new baby joins the group. Talking to someone who is objective can be healing. Now before we move on to the lifestyle medicine recommendations, I want to mention something that will sound strange.  Unless, of course, you've experienced it.
And here's the deal, at least 70 percent of new moms do experience what's called intrusive thoughts.  And they're usually about infant harm. Half of moms have intrusive thoughts about intentionally harming their babies.  A leading psychiatrist attributes this to the mom's worst fears bubbling up uninvited to the surface. 
Hormones push them into consciousness and sometimes it's a struggle to push them back down. These are often disturbing visual images that make you feel like you're losing your mind. And if none of the 70 percent of new moms who've actually had it admit it, then you think you are broken. The most common examples are of the baby falling or getting dropped, flying out of their car seat, or suffocating.
But sometimes they're even violent, like throwing the baby against the wall and smashing their head.  That can trigger self doubt and make you think that you're an unfit mother. Insecurity already makes women doubt their ability to get this whole thing right.  But if these thoughts just pop into your mind and repulse you,  then definitely talk to someone, but don't think you have to have yourself committed.
While this may sound like an oversimplification, the recommendations are exactly what I said before about baby blues. Try and get enough sleep, ask for help around the house, take a little time for yourself to relax, reduce stress, and don't try to do it all alone. Sometimes you need to distract yourself. 
Play games on your phone, do brain teasers, puzzles, get out and walk, listen to music, , and again, talk to someone you trust. Here's the best advice I can give you. Remember this, it won't always be this way.  Women with postpartum depression may need to take medication, but sometimes they barely get through the day. It's a hard place to make decisions from, especially if you're worried about the effects of breastfeeding. Since this is a lifestyle medicine podcast, we are going to review how lifestyle interventions may help.
First, start with physical activity. I know, I know you're exhausted and you've got a baby on your hip, so do something that involves the baby and any other kids, like take a walk with a stroller. Get outside and move, even if you're just creeping along at first.  And if it's not your first baby, think about activities that involve your older kids.
When my second child was born, we watched Barney the Purple Dinosaur and marched and danced around to the songs. It was a way to involve my toddler while getting my heart rate up a bit, to avoid screen time for your newborn, put them facing you rather than the TV. 
To manage stress, you need time for yourself. It may not be much time, but grab moments when you can. Prioritize what you really need to do. The dishes and the laundry can wait. Let go of unrealistic expectations that you can do everything you're doing now and everything you were doing before. You aren't Superwoman. 
You have a deep need to feel human right now, not just a caretaker for a very needy baby. So, trust someone else to take care of your little one and get out of the house.  Read a book. Don't neglect a hobby you enjoy. Schedule a date night or an outing with friends. Go shopping, get coffee, see a movie.  Let me tell you about a movie not to see.
"Beaches." You're probably too young to remember it, but after I had my first baby, I couldn't stop crying. It wasn't postpartum depression, but it was serious baby blues.  I wanted to watch a funny movie. Now, this was way back in the day when you went to the grocery store and rented a VHS tape.
Okay, Google it if I just lost you. Well, he came home with the movie "Beaches" and swore it was in the comedy section. Listen, it's a movie about a mother who has a terminal illness  and she is handing her child over to her best friend, so no, it did not help me stop crying. The point is, be careful what you watch, or what book you choose.
This is a sensitive time, and you don't want to activate your triggers. And also remember, you're not alone. 
Admit your feelings to your spouse, mother, grandmother, or a trusted friend. Isolation only worsens your symptoms. They'll be more sympathetic and helpful if they know what you're going through. And they may have some advice about soothing a fussing and crying baby. So, listen, ask for help. Let me say it again, ask for and accept help. 
And you may not be eating for two anymore, but your diet has a huge impact on your mental health. So, eat a lot of fruits and vegetables, whole grains and olive oil, and avoid red meat and processed meat, as well as refined grains, anything that has the word enriched on it, sweets, high fat dairy, butter, potatoes, gravy, and fried foods.
Some say no eggs, meat, fish, or even low fat dairy. So, if you eat those, at least make it in small amounts. And fiber makes you feel full, so eat nuts and plenty of beans.  Time is premium with a newborn around, but Fast food does not make matters better, and in fact,  can make it worse. Mood can improve in as little as two weeks if you follow a strict vegetarian diet.
If you can't do without meat, at least increase your fruits and vegetables. There is statistical evidence that that makes a difference.  You may not be able to completely avoid the bad stuff, but it is dose dependent. So don't beat yourself up about that bowl of ice cream. Just try some mango next time.
 And here's why. Mango is high in that all important omega 3 fatty acids.  In pregnant women, there is a positive association between low omega 3 levels and a higher incidence of maternal depression.  Brain chemistry is regulated by levels of the neurotransmitters serotonin, norepinephrine, and dopamine.
Brain derived neurotropic factor, or BDNF, causes the membrane of every cell to be more or less fluid. which affects production of these chemicals, as well as reuptake.  Omega 3 fatty acids affect how the cell membrane allows for things to go in and out.  Besides mango, omega 3 fatty acids are also found in seeds, like flax seeds and chia seeds, lettuce, nuts, 
 especially walnuts and also beans. Kidney beans are the best. If you're eating fish, think salmon.  Studies have shown improvement in mood with intake of saffron, turmeric, probiotics, and carbohydrate rich evening meals., but think good carbs.  Among women of childbearing age, deficiencies of folate, vitamin B12, calcium, iron, selenium, zinc.
And Omega 3 fatty acids are more common among depressed versus non depressed women.  Vitamin B12 is not found naturally in plants. So if you're eating a plant based diet, you may want to add fortified whole wheat cereal or bread. And as far as supplements, just keep taking your prenatal vitamins.  Calcium is found in dairy products, but it's better to get it from fortified plant based milk like almond or soy.
But watch the sugar content because many are sweetened. Another good source is black beans. And did you know you can make black bean brownies and they're delicious?  Think green when it comes to veggies. Broccoli, bok choy, spinach, collard greens, and kale. Sesame seeds contain calcium too, so add those or use tahini, which is basically sesame butter. 
Zinc is found in pumpkin seeds and baker's yeast, and if I haven't convinced you to try black bean brownies, black beans contain zinc too. I'm going to put a link in the show notes to a recipe for them.  Selenium is found in Brazil nuts, and you don't need many. Oatmeal is good for breakfast. Add a little sorghum on your oatmeal for iron.
Lima beans contain iron too, but probably not on your oatmeal.  This mineral is also found in whole wheat pasta and brown rice, which is a good way to load up on those carbs at dinner, which may help you sleep better. Restorative sleep is so important in refreshing your mind. Try and keep your newborn on a schedule so you can get some rest, but realize  some level of sleep deprivation is inherent in motherhood.
This too shall pass.  Once you've arrived at the depression destination, you may need medication to fix the chemical imbalance inside your brain. Your doctor may prescribe it and listen, you don't want to miss this precious time. If you need it, take it. Don't try to gut it out. This is about chemistry, not about how strong you are. 
If you're prescribed a medication while breastfeeding, your doctor will take that into consideration when choosing the antidepressant. The bottom line is, do the benefits outweigh the potential risk?  And remember, folate or vitamin B9 can help in the production of serotonin and dopamine. And when used with antidepressant medications, it's been shown to improve the efficacy and shorten the response time. 
Food really high in folate includes legumes, asparagus, leafy green vegetables like spinach.  And if you don't like it, add a little to a smoothie. It turns it a very unappetizing color of green, but you can't really taste it.  Other sources include papaya, citrus fruits, and beets. And don't knock them if you haven't tried them.
But remember, they can turn your urine pink, and that can be alarming.  Broccoli, Brussel sprouts, nuts and seeds contain folate too. So does whole wheat, bananas, and avocados.  So pay attention to your diet, ask for and accept help, 
 That's a lot of information for a worn out new mother, so I created a download you can print that highlights the nutritional recommendations we've discussed. If you're taking a meal to a new mom, you could use this as well. 
 Feel free to pass this along so your friends and family don't bring you food that makes you worse. If you're fixing your own meals, remember, push the easy button. When you can, buy frozen, pre cut fruits and veggies, and give yourself a whole lot of grace during this time.
Restoring health may be slow going, but it's worth it. And healthy looks great on you, Mama. 
RESOURCES:Download postpartum nutrition guide
Edinburgh Postnatal Depression Scale
Black Bean Brownie Recipe
Call 1-833-TLC-MAMA (1-833-852-6262) for 24/7 free confidential support for pregnant and new moms.
 
 The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medications as prescribed. Though the information in this podcast is evidence based, new research may develop  and recommendations 

Childhood Nutrition and Lifestyle: Combating Obesity, ADHD, and Type 2 Diabetes

 When should kids start eating healthy? The answer might surprise you.  We all know the rates of childhood obesity are increasing, along with the rates of childhood diabetes and fatty liver. Did you know the rate of childhood obesity has quadrupled in recent years?  But how do you get picky kids to eat their vegetables?
What about Attention Deficit Disorder? Does diet affect that? 
Learn more in my interview with Dr. Angela Black. 
You're listening to "Healthy Looks Great On You," a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper, and this is episode 110. What Should Kids Eat?  I'm so excited to introduce to you today my guest, Dr. Angela Black. Dr. Black is a board-certified pediatrician on a pathway to become board-certified in lifestyle medicine. She received her medical degree from the University of Texas Health Science Center in San Antonio and completed her pediatric residency in Miami, Florida. She currently practices in San Marcos, Texas and has a strong interest in promoting excellent nutrition for her patients. She recently discovered the subspecialty of lifestyle medicine and her long term goal is to shift her practice to a lifestyle medicine model and incorporate food as medicine to help families add more produce into their diet.
She's also the host of a great podcast called "Eat Your Greens with Dr. Black."
Welcome to the show, Dr. Black. I am so excited to have you here today, and I think we're going to have a really big challenge before us because there has been so much interest in the things you have to say. 
Dr. Angela Black:
Thank you so much, Dr. Vickie, for having me on "Healthy Looks Great On You." I'm really excited to Be here and talk to you today. And I was really impressed by your listeners,  questions that they had and, really appreciated some of their questions. 
Dr. Vickie:
Yeah, I think they're going to have to tune in to your podcast, I've listened to several episodes and I think my daughter subscribed and it's just very interesting and it covers a lot of topics and I'm not an expert on pediatrics, so we needed you here today. 
Dr. Angela Black:
Oh thank you. And  I hope people enjoy it. I hope they find it and, and like it.
Dr. Vickie:
 So I have to start out by telling people how we met. And that was at the Lifestyle Medicine Conference in Denver. And we literally just sat down at the table and had dinner together one evening and kind of hung out together the rest of the conference.  
Dr. Angela Black:
 I had met your hotel roommate. And basically I crashed your dinner with her. You guys were going into the restaurant to have dinner and I just invited myself along and we got to know each other and discovered how much we had in common. 
Dr. Vickie:
That's right, and that was awesome. I'm so glad you did that.  Well, I think I'd like to start out by talking about attention deficit disorder. There was so much interest in that on my Facebook page, and specifically about red dye, and there was a little bit of interest about autism as well. So, could you just start by outlining your approach to treating a patient who has ADD or ADHD? 
Dr. Angela Black:
Well, my approach has definitely evolved over the years, and I would like to just start by saying that there's a lot of misconception about what ADD or ADHD actually is.  It's been taken over a little bit in the pseudoscience community, the lay community as being not necessarily a real syndrome.  And it definitely is.
There are patients whose brain, and if we want to get nerdy, we can talk about the prefrontal cortex and the areas of our brain that are involved in planning, organization,  maintaining attention, resisting impulses, things like that. And, definitely there are people,  both children and adults who just have a dysfunction of that part of their brain. 
So, it is a real entity. It's not just bad parenting. It's not just too much TV. Definitely electronic media has its role in contributing to the development of it and the symptoms. So, just to start out by saying, it is a real entity.  I do treat it with medication. But my approach to doing that  has evolved over the years where we start out with an in-depth evaluation.
We,  look at the symptoms in the home, we look at the symptoms at school, and in other settings. Can the family go to restaurants, or do they never get to go out and enjoy time in public settings because of the behavioral issues? The impulsivity that goes with ADHD, things like that. Can they go to church or their, or their local religious organization and participate? So we want to see that the symptoms occur in multiple settings. The symptoms need to have started before the age of seven. So we really want to make sure that the child meets the diagnostic criteria. And then we also want to see that they've been evaluated for learning disabilities, intellectual disabilities, other diagnosis that may be affecting their ability to  pay attention in class, and follow along. Because if it's a matter of not being able to understand the material and the child is bored because they just can't follow along, it's going to look like ADHD. They're not going to pay attention. They're going to be bored. They're going to get up out of their chair. So we want to make sure we're ruling out other diagnosis and really doing a good job that the child meets the diagnostic criteria. And then we talk about treatment, and that's either going to be pharmacologic medication or non pharmacologic, and both have their role. 
Non-pharmacologic treatments definitely work best in the younger child. So we write a letter for the school and the parent can sit down with their educational team and develop what's called a 504 plan. 504 is under the Americans with Disabilities Act, and it applies to children with any diagnosis that affects their ability to participate and learn in the classroom setting that's not intellectual disability. So they may have Asthma; asthma would qualify for a 504 plan if the child has to have frequent absences or  has such a severe disease that they can't learn in the classroom and they need some change to their plan that would help them do that.
So,  the parents will sit down with the educational team and develop a 504 plan so that the child has accommodations to their educational plan that help them reduce those impulses, maintain focus, stay on task. And that's individualized from child to child. There are some tips and tricks that we tell families that they can do at home, for instance, helping them get through homework time, things like that.
And then when available, if we can get them in with a child psychologist who specializes in behavior to help the families develop a positive discipline plan to help reinforce the desired behaviors and minimize the undesired behaviors. But as we know, mental health care in this country is another health care crisis. 
You know, accessing that is simply not  realistic for many people.  So that's all of the non- pharmacologic treatments. I do also talk about some dietary changes that we can make and I know that's what many of your listeners had questions about - the dietary recommendations. And then, when appropriate, we do prescribe medications. There are both stimulants and non stimulant medications available.
Dr. Vickie:
  You know, I think that's important to say because medications definitely have a place. And this can be a debilitating disease. It can make a child completely fail.  And medication can mean the difference between success and failure. But I think the frustration is the knee jerk response to prescribed medication rather than to either trial other things, or to do the thorough evaluation to see if medication really is necessary and if that's really the diagnosis.
So I think that's the frustration, not just with the medication, but with the healthcare system in general. 
Dr. Angela Black:
Right, and unfortunately, it is faster, easier, more efficient to just write a prescription. Now, as you know, physicians don't get any, like I'm not selling the medication. I don't run a pharmacy. I don't get any financial incentive to prescribe medications. I do get some financial disincentive to do the right thing and really spend that time with the parents because unfortunately, insurance, especially Medicaid, just don't reimburse very well.
And so the amount of time that it takes as a primary care physician to really sit down, have those conversations, explore what non-pharmacologic treatments are going to work and what accommodations the child might benefit from, that that's my time. That's not really being reimbursed very well by the third party payers.
So there is actually a disincentive for me to practice medicine the best way. And it is true that with the high rates of physician burnout, many doctors just don't have the time, the energy to put into it. And it's just a lot easier to write a prescription. So it's not that they're, purposefully not practicing good medicine. It's the system is definitely, unfortunately weighted against primary care physicians.
Dr. Vickie
  Well, that brings up a good point, and I share that with my listeners often. It's not just the doctor, it's the patient too. As a patient, when you call, you want an appointment, and you want it soon because you've got an issue. And if the doctor is spending a lot of time with each of their patients, then it's going to take longer for you to get in and get an appointment. And then when you get there, you don't want to sit in the waiting room all day long while they talk to someone for an hour about lifestyle changes.  And I think that's why lifestyle medicine is really coming to the forefront, because it does need to be a subspecialty in and of itself because of the time constraint on other physicians and the shortage of primary care physicians. 
Dr. Angela Black:
Right. Exactly.  
Dr. Vickie:
So let's go back and talk about diabetes and fatty liver and childhood obesity. I love one of the things you said on my Facebook page today, and that was that healthy eating for a child starts..
Dr. Angela Black:
Before they're born. 
Dr. Vickie:
 Right, prenatally. So now you're touching an issue that's dear to my heart because I was an obstetrician.  And so, let's talk about the impact of prenatal diet, because there is some evidence that a mom who has obesity is more likely to have a child who has obesity  independent of how they eat afterwards. 
Dr. Angela Black
 Those nutrients or not nutrients are crossing the placenta and affecting the baby in those critical stages of development when the baby's brain nervous system are developing. So there's that. And then there's mounting evidence that the health of mom's gut microbiome also can affect baby's development. Not only do those bacteria that in mom's gut produce chemicals called short chain fatty acids that also cross the placenta and affect baby's development, but even the bacteria themselves. Apparently there is some evidence that they can leave mom's colon And cross the placenta and the baby starts developing their own microbiome, even in the womb. And for centuries, we thought that that was a completely sterile environment and there was no bacteria at all. And that may not be true. So there's a number of ways that the mother's diet affects the baby. And then last, again, I try to rein it in, but sometimes I get a little too nerdy about things, there's something called epigenetics, right? So our genetics is our DNA, it's the blueprint for everything, every aspect of our being, but epigenetics are the genetic switches that get turned on and off that dictate whether or not a gene will be expressed or not. And there are genes that impact our rates of obesity, diabetes, heart disease, and those epigenetic switches can get turned on or off based on the mom's environment, her diet, her stress levels, sleep levels.
You know, so many factors go into that and that's what really plays a big role in why  you're going to see certain diseases like obesity, heart disease, diabetes run in families.  
Dr. Vickie:
Oh, I love that you talk about the science. My listeners are used to me taking them to mini medical school, so they've come here to learn. 
Dr. Angela Black:
 Great. Well, I often talk about  the rates of things like diabetes. When I was in medical school and training, this was in the early to mid-nineties, they were just starting to recognize that children can have type two diabetes. Back when I was in training, we called it adult onset diabetes. And  there was a lot of skepticism about whether or not. children could get type two diabetes. Now, fast forward, I don't even want to say it - almost 30 years later, it's not in doubt. It's not even rare. I diagnose this in young teens. I have diagnosed children as young as 10 years of age with type 2 diabetes. And I definitely see pre-diabetes very often. Several times a year we'll have a teen in our practice develop actual type 2 diabetes. So the rates have really skyrocketed. The Lancet recently came out with a publication documenting that the rates of diabetes have quadrupled since the 90s, in children aged  12 to 19 year old, and they're continuing to climb. And so it's really becoming a healthcare crisis.  Not only because of the diabetes itself and the cost of care, the cost of insulin, the cost of blood sugar monitoring, but also the secondary effects of having a high blood sugar on the person's health over time.
Right? So if you're 60 and developing type 2 diabetes, how many years do you have to develop kidney damage, eye damage, damage to your blood vessels. Now we're talking about kids in their teens. So they're really going to have a shortened lifespan. The quality of life is going to be greatly impacted. They're going to be developing those other chronic diseases so much younger than what we have seen in previous generations.
Dr. Vickie: 
So what symptoms should parents look for if they're concerned about type 2 diabetes in childhood? 
Dr. Angela Black:
Type 2 diabetes specifically, now it is a myth that people who have a normal body weight cannot develop type 2 diabetes. Type 2 diabetes is caused by insulin resistance. So your pancreas, the organ that makes insulin, is working fine, but the cells can't use that insulin to take the sugar out of the blood and use it for energy.
So some of the signs that the insulin level is starting to rise are  Acanthosis nigricans. So that's darkening of the skin in the creases. Often it starts on the back of the neck, but you can also see it in the armpit folds, under the breasts, around the waist. So if you're starting to see what looks like dirt that doesn't wash off on your child's neck, you might want to talk to your doctor about having some blood tests.
Dr. Vickie:
 So when my daughter was probably in junior high school, we spent a lot of time out in the sun and we were in the pool and she had what I thought looked like acanthosis in her armpits. And I made her go in and have blood work done. And she was like, mom, you're always finding stuff wrong with me.  
Dr. Angela Black:
On the other hand, I did recently have a child come in whose parent was really concerned about diabetes because of some brown on their neck and it was on the front and usually acanthosis is on the back. And I was looking and I got a little paper towel and scrubbed it and yeah, it was actually just dirt.
So it's not always a bad sign, maybe they're just not scrubbing enough in the bath. Now  as it progresses what you're going to see that if the child is actually developing diabetes is the common symptoms associated with a high blood sugar will be increased thirst and increased urine output.
So if they can't be more than two feet away from their water bottle, they're waking up three or four times a night to pee, or they're having wetting accidents, That's another reason to consider getting their blood sugar checked. And that's true whether it's type one or type two diabetes because the increased sugar causes more water to be put into the urine. So they're peeing more and then as a consequence, they're more thirsty. Also, if they don't have energy, they're feeling sick a lot of the time. If they have some skin  infections that aren't healing well, even early in diabetes. I think the most common time that I've diagnosed kids with type 2 diabetes, they came in for an ingrown toenail that wasn't getting better. And I asked them about other symptoms and checked their blood sugar and sure enough, it was over 400. 
Dr. Vickie:
Wow, that's really interesting. Also increased hunger. I've actually been diabetic before when I was on prednisone. And then I had pre diabetes. And I'm normal weight, but it runs really strong in my family. 
But when your blood sugar is going up, your body is actually starving because your body can't move that blood sugar into the cells for energy. And so, it increases your appetite, which becomes a vicious cycle. And I reversed it with plant-based eating, and that's when I really became a believer in that.
And I'm not exclusively plant-based by any stretch of the imagination, but I try to get the majority of my calories from plants. And that's what I always try to explain to people. It's not necessarily vegetarian and it's not necessarily vegan. It's plant-based. And so if you can get the majority of your calories from plants, because I feel like there's some resistance among parents to try to feed their kids a plant based diet. 
Dr. Angela Black:
Right. And I did see some questions about how to do that, especially if your child is picky. How do you get a picky kid to accept healthier foods? And, I give my families a similar message to what you're saying, you don't have to go 100%. Now I do think that's the gold standard. Just like we would never tell somebody, "Oh, you know, just cut back to half a pack of cigarettes a day. That's fine. Just, you know, smoke every once in a while." We're not saying that for a reason. I do think that the more plant-based, the more plant-based foods that you can incorporate and the fewer ultra processed foods and high fat animal foods that you can put in your diet, the better. So I would hold out a 100 percent whole food plant-based diet as the gold standard. But I also know that that's not accessible to many people and it's not going to help them, make changes for me to say that. So I usually say, any movement you can make in that direction, you're going to get some health benefits. And then you build on it. So some tips for getting kids to accept more variety of plant based foods: Number one, sorry parents, but you're going to have to eat it yourself. You have to set the example. You have to have it in the house and with the meals every single day and that's a really good way. Kids will eat what the family eats often. So, I have plenty of parents that tell me, "Well, he keeps sneaking my soda." I'm like, well,  why are you drinking soda? You know, so they are setting the example. And then the other two techniques that are really effective are, getting the kids involved in the planning and cooking process. So let them go on the internet and pick some recipes that they think would taste good that include fruits and vegetables, and then let them at an age appropriate level, chop and prepare and, and work with you in the kitchen, and then make family dinner time a priority. Make it happy and fun and really make that part of the routine.
Those have been shown in the data, in the science. And I try to always look at the actual evidence to be some of the most effective ways of getting kids to actually accept and eat the foods that you're trying to make. So you don't have to sneak it in there and they won't even know those vegetables are in there. Well, that is a good technique that I recommend often while you're working on the other things, right? We want them ultimately to be on board with eating them and enjoy it without you having to hide it, or sneak it in their nuggets. But, definitely in the short term, being a little sneaky is never a bad idea.
Dr. Vickie:
I think it's important in developing the palate because both of my adult children eat fairly healthy and I think they just grew up eating that way and that's what they're used to but what I've seen in my grandkids and this is interesting because my oldest grandson is four and he just loved to eat vegetables. He just loved it and they did the baby-led weaning and so he just ate whatever they were eating and they ate healthy stuff. But then, he went to daycare, and at daycare they were feeding him pizza rolls and French toast sticks. And his palate changed, and suddenly he didn't want vegetables anymore.
He just wanted junk food because he had gotten a little taste of it at daycare. And that's a challenge, because what are you going to do? I mean, daycare is expensive, and food is expensive, and they're trying to take care of a lot of kids, and just keep costs down, so they're going to buy the cheap stuff, which unfortunately is the ultra processed stuff.
Dr. Angela Black:
Right. And it's a good point because those foods are designed to really hit that right combination of sugar, fat, and salt that releases that flood of dopamine and really lights up those pleasure centers in the brain. And unfortunately, broccoli just doesn't. does not do that. So when kids get introduced to those foods, it can be difficult, which brings up a few of the points.
First of all, going back to good nutrition starts before birth. Some of those flavor molecules from the food that moms eat also cross the placenta and babies can start tasting very early in gestation. So those receptors on the tongue are actually active. And then once they're ready to start solid foods, introducing a variety of different flavors between six months and a year, not only flavors, but textures. And make sure you include bitter things like kale and broccoli. And really those first thousand days, the first three years of life to the extent possible, lay a strong foundation of good, healthy eating with a variety of healthy whole plant-based foods. Even if they go through those picky phases later, they're more likely to come back around and accept those healthier foods later. 
Dr. Vickie:
 And I think it's so important because I've eaten healthy for a number of years even though, like I said before, especially years ago, I wasn't necessarily eating plant-based, but I didn't eat ultra processed food. And in fact, one year, I even put dried fruit in the kids Easter basket. And they were like, Mom, you've gone too far. We want chocolate bunnies. And I said, OK, OK, you're right. And, you know, today's Friday, but yesterday was Pie Day. And so, I said this on Facebook, Just go ahead, have a slice of pie.
Dr. Angela Black:
Have your pie on pie day. I already had mine and it was not vegan. I don't bake myself and so I'm not going to make a vegan pie crust. I just got a yummy, it was fruit based, at least there's that. But traditional cherry pie from my grocery store and I had my big piece of pie. 
One of your, listeners on Facebook asked, "How rigid should we be?"
When it comes to allowing kids to have foods at school, should you try to cut it out entirely? And that has really been shown to backfire. So if you are super rigid, we never eat this food, I'm going to send your special food to school with you. What about birthday parties? Things like that. You know, especially as they get a little older, preteens, teens, it's really important for them to be similar to their peers. And if you are too rigid in excluding those foods, they're going to rebel. They're going to hide it and sneak it. And they're also going to develop an unhealthy relationship with food that may set up feelings of guilt and shame and could even set them up for eating disorders. So again, what you do most of the time, what you do at home on a regular basis is really the important thing and having some flexibility, will ultimately lead to kids with healthier eating habits in the long run. So I would avoid being overly rigid.
Dr. Vickie:
So my kids were right about the Easter basket and the chocolate bunnies.
Dr. Angela Black:
They were right.
Dr. Vickie:
Darn it. 
Dr. Angela Black:
Right.
Dr. Vickie:
My daughter was the one that actually asked about daycare because that's an issue right now. Her youngest is going to be one in April. And she's like, what do I do? They're going to be eating what they're going to be eating. And she's tried to talk to them about, okay, if you're having pizza, mashed potato, and peas, eat the peas, eat the mashed potatoes, but skip the pizza. And you know they're not going to follow that. They have too many kids to take care of. So I guess she just does the best she can do when she's at home. 
Dr. Angela Black:
You do the best you can. Now, I have had families in a similar situation. I have written letters for daycare because the daycare director said, "Well, we can't feed them anything different without a doctor's note," meaning they have to have some medical diagnosis. And this is a perfectly healthy child with no lactose intolerance or something. So I have been known to write letters stating, this child must be allowed to have healthy foods brought from home and should limit intake of ultra processed foods. Like, it's stupid. But I have written that letter. Here's a note from my doctor stating my kid has to have vegetables. 
Dr. Vickie:
I think that just gives us a little insight, a little window into the mentality that we have. Like, I just think about it in the past, it seemed like kids could eat whatever they wanted and get away with it. And then you went to college and gained the freshman 15. And then there came a time when there was a day of reckoning and you had to make some changes because it sort of caught up with you. But now it seems like kids are just affected so much younger.  
Dr. Angela Black:
There are so many reasons. It's very complex, right? And it's not just bad parenting. It's not ignorance on the part of the parents. By and large, parents want to do what's right for their children. They want their children to be healthy. They want to feed them healthy foods. And we really have to be careful not to make judgments about why families aren't feeding their kids healthy. 
There is a significant problem with food insecurity in our country, especially in marginalized communities or in people of color. And paradoxically, obesity goes hand in hand with food insecurity because of access. They don't have access to healthy foods and they would love to feed their kids healthy foods if they could, or they're exhausted, working several jobs. They don't have the energy to put into cooking. And so they're resorting to ultra processed foods, fast foods, things like that. So we know that. Eating a whole food plant-based diet is the best way to ensure health, to maintain a healthy weight, and so the cause of obesity and these chronic diseases is not in question. It's definitely our diet. The reasons that we eat an unhealthy diet or feed our children a less than optimal diet are very complex, and they're going to require changes at really the national level, the community level, you know, ensuring that people really have access to healthy foods. And, that's a whole 'nother podcast episode, but so many changes need to be made.
I mean, it just shows what what doctors like you and I are up against. We're trying to promote lifestyle medicine and healthy lifestyle choices, but gosh, I mean, even at the daycare level, it's, it's very difficult.
Dr. Vickie:
And so it's part of a bigger complex issue. It's not just, oh well, everyone just needs to eat plant-based because that's so unrealistic. You have to make other changes to facilitate that. And, and some of those can be very expensive. It's much cheaper to go to the grocery store and buy a box of macaroni and cheese than it is to buy enough vegetables to cook, and then time is a factor before. And like you said, that's a whole 'nother podcast. 
Dr. Angela Black:
So it's like many things in life. You can actually make a plant-based diet cheaper than an ultra processed food diet. In fact, when they've studied it, it can be up to $500 per year cheaper for your grocery budget. People who follow a whole food plant-based diet actually spend less on their groceries. But what you sacrifice is the time for planning and cooking and prepping. So just like many things, you have to pick one. 
Dr. Vickie:
It's the convenience factor. We all live in a fast paced world. I mean, I'm semi retired at this point, and I can cook every day, and I can go to the grocery store every day, and it takes a huge chunk of my time. Huge. And you know, when you're raising a family and working a job, and your kids are involved in extracurricular activity, it feels nearly impossible.
I had a friend one time whose son was having significant GI distress at a very young age. He was 8 or 9 and just had constant stomach problems and acid reflux. And the doctor asked, "What do you eat?" And they said, "Well, we eat hot dogs at the ballpark every night because we're playing travel baseball."
Dr. Angela Black:
Right, right.
Dr. Vickie:
And it's so hard because we eat on the go and parents who have kids, especially with ADD, they want to know, can we just eat carrots or can we just eat blueberries? Is there something in particular that we can eat to make it better? Or does red dye make it worse? So, can we talk about that a little bit? Or autism.  
Dr. Angela Black:
There was a lot of questions about dye. And I really, that was the one question that I really appreciated because when I recommend dietary changes for ADHD, I do start by saying, unfortunately, there's not. One food or type of food that you can add or remove and expect to see a big difference.
There's a lot out there in the junk science world. You know, a lot of supplements on the market and people say, "Oh, I cut gluten out of my child's diet and they did better." You know, if your child doesn't already have a reason to be sensitive to gluten or not tolerate gluten, scientifically, the evidence does not support that gluten is a cause of ADHD. So you really do have to do a whole food plant-based diet and variety is key. And again, that goes back to the microbiome, including a variety of different plants and their associated different types of fiber supports a higher diversity of gut bacteria. And that in turn can affect a lot of things, including brain health, cognitive health, memory, focus. Even they're looking at some studies on Alzheimer's, things like that. Having said that, the reason I was very grateful to your listeners, I had never actually looked to see what the science says about dyes specifically, because if I'm going to advocate for a whole food plant-based diet, that's automatically going to cut dyes out.
So I hadn't looked. And my assumption was that there was no evidence to support that. And I was wrong. There are good, randomized placebo controlled trials showing that dyes not just red, also blue, and so I suspect, by extension, any of them. Children can have worsening ADHD symptoms, and, conversely, an improvement in their symptoms.
When those are removed, so there is actual data supporting that dyes can contribute to ADHD symptoms, but again, it's not changing my recommendations because I recommend a whole food plant-based diet with a variety of diversity of various plant based foods.
Dr. Vickie:
 Right. Apples are red. You don't have to add dye to make them red, and blueberries are already blue.  
Dr. Angela Black:
And you mentioned autism. There are some studies in rats where the female was fed a junk food diet equivalent to an ultra processed diet like humans eat here in the West, and the pups had behavioral symptoms consistent with autism. There is some evidence that the mom's diet can play a role in neurodevelopment and development of autism. It's very complex, though, again, because we don't really understand completely what causes autism. It's a complex disorder that likely has many causes, not just one.  So the evidence is emerging and it's being studied. 
Dr. Vickie:
 That's interesting.  Now, I want to be sure we cover all of the topics and the questions that we got on the Facebook page and one of them was about the food that kids are given if they're in the hospital. And this is something that I've recently experienced, I had a family member who had surgery and was given a breaded chicken patty that was so tough that I couldn't even chew it. And so, I really think it's more of a systemic issue. 
Dr. Angela Black:
It is, you're right. It's a systemic issue. You know, if it was a cardiac cath patient or somebody who was hospitalized for a heart attack, the doctor is going to write dietary orders, you know, low salt diet or whatever special diet for that disorder. But when it comes to children who don't necessarily have those diseases, they're going to say regular diet is the orders that they're given.  It's really up to the individual hospital, what kind of foods they have in their cafeteria, what they're offering. And I do think that is an area that the consumer has some input, you know, people can talk to their hospitals, they can ask for healthier options.
I have a special needs daughter.  She has a genetic syndrome with epilepsy and we've been in and out of the hospital a lot over her life. She's a young adult now, but we always were given a menu. So I could at least choose slightly healthier options if I wanted to, but, yeah, burgers and nuggets were always high on the list and the kids menu in the hospital. And so I do think that at the educational level for health care professionals, whether it's even dieticians, physicians, definitely, a big change needs to happen in education. My daughter has a G tube, so, she was having very active seizures and she couldn't really eat. She would have lots of seizures overnight, she would get lots of drugs to stop the seizures, and then she would sleep the whole next day and not eat. And it was very difficult and she wasn't gaining weight, so we ended up having a G tube placed so we could give medications and fluids and then feed her on those days when she wasn't able to just wake up and eat. 
G tubes, you know, it's a tube that goes directly into the stomach and you can put either formula or different foods. And one of the things that people do is what's called a pureed diet where you can take healthy food, you know, spinach, broccoli, healthy sources of protein, blend them up in your high speed blender and And give that as the meal instead of the commercially prepared formulas, which are often high fructose corn syrup and,  things like that. And there's families that want to do that. And I actually had a family whose dietician  refused to let them do that because it had never been studied. It's like, well, if the kid could eat by mouth, we would be giving them these foods. What's the difference putting it in the mouth and swallowing it versus putting it directly into the stomach through this little tube? There's no difference. But the dietician would not allow it. 
Dr. Vickie:
Protocols, protocols, and I also think if you're a patient, or if your family member is a patient, you have to be an advocate. I remember when I was in the hospital and I was a diabetic, they brought me chocolate cake. I was like, really? Chocolate cake? That's the last thing I need.
But really, to be honest, 9 out of 10 families would probably say, Bring me the chicken nuggets and the fries. But there's definitely an opportunity for education among healthcare professionals.
Dr. Angela Black:
Right. And they've, they've done studies, actually, it was at a presentation at the Lifestyle Medicine Conference that we went to in Denver where they went into communities and worked with some restaurants and they still had the nuggets and fries available, but on the menu in the kids section, they listed the healthy options and if the parents wanted nuggets and fries, they had to ask for them.
"Do you have this?" And then they say," Oh yes." And you know, they could serve it. But, when the healthy options were just placed on the menu in an area of prominence, people ordered it more often and the kids ate it.  But what we do is that the chicken nuggets and fries and burgers  you know, here's the kid's menu and that's all it is. And we just assume that's all they're going to eat, but it's not true. Kids will eat healthier food. Often when given the option.  
Dr. Vickie:
Yeah, and that's just marketing. 
Dr. Angela Black:
Yeah, that's marketing. So just making if we can, if we can, you know, go in and talk to our local restaurant owners and say, "I would love to eat here more. Have you considered making this change?" You never know. They might be willing to give it a go. And the restaurants reported that their revenues did not drop.
That was the important thing because initially there was pushback, like, "Oh, we're not going to make any money. People aren't going to come here." And that was not the case.
Dr. Vickie:
 I'm sure a contributing factor is just eating out in general and how convenient that is and so very bad for you. I know that's one of my weaknesses. I mean, I can be much more strict about eating plant-based when I'm home. But when I'm eating out, it's a lot more difficult to choose. Also the portions are so huge, so that's a problem. And also, you can eat plant-based and be very unhealthy. 
Dr. Angela Black:
 Right? Exactly. Yeah, processed plant-based diet is almost as unhealthy as a standard American diet and restaurant food is, terrible and expensive.
So I have one episode and I hope to do more where I find local restaurants in our community here in Central Texas where they offer whole food plant based options. It's not necessarily a vegan restaurant, but they have options on their menu. And I interviewed a local restaurant owner and it was actually one of my most successful episodes to date.  So I think people really want to hear about that. Where can we have the convenience of going out to eat but still be healthy.
And where can we go? We just don't know. So I hope to have more of those episodes where I look at local options here around the Austin to San Antonio area. 
Dr. Vickie:
 I like that. I love the community advocacy. That's so important.  
 I'm sure there are other things that we didn't touch on, but I think we could probably talk for six or eight hours. Hopefully, this will give you some ideas about things to feature on your podcast, "Eat your greens with Dr. Black," and of course I will put links in the show notes  can find Dr. Angela Black and her podcast.
Dr. Angela Black:
We could go on and on. So  I think we covered the bases and answered most of the topics that your listeners were asking. And it was great talking to you too. Thank you very much for inviting me onto your show.  
Dr. Vickie:
And I would encourage anyone to just talk to their pediatrician if they are interested in pursuing a healthier lifestyle for their kids.  Because I promise you, your doctor wants you to be well, and they're interested in your kid's health. Even if they're rushed, and even if they have a waiting room full of patients, they will welcome your input, and they will work with you. 
And like Dr. Black said, your kids will follow your example. So if you're ready to get started with a healthier lifestyle,
You can sign up to receive this podcast by email. And as a bonus, you'll get "Seven day Prescription for Change," which is a downloadable workbook and seven days of emails to help you identify what lifestyle changes you'd like to get started with and how to implement those. Just look in the show notes for a link.
The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or healthcare provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change. 
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7-Day Prescription for Change
00:00 The Urgent Need for Healthy Eating in Kids
00:35 Introducing Dr. Angela Black: A Pediatrician's Journey to Lifestyle Medicine
02:57 The Battle Against ADHD: Understanding and Treating with Lifestyle Medicine
10:42 The Prenatal Impact on Childhood Obesity and Diabetes
15:32 Confronting Type 2 Diabetes in Children: Symptoms, Causes, and Prevention
19:04 Embracing Plant-Based Diets for Kids: Strategies and Challenges
34:46 Navigating the Complexities of Healthcare and Diet in Children's Lives
41:36 Conclusion: Empowering Families for Healthier Futures
 
 
    
 
 
 
 
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Feeling Drained?

Lifestyle Medicine
In episode 109 of the 'Healthy Looks Great On You' podcast, Dr. Vickie Petz Kasper addresses the common issue of fatigue that affects a significant portion of the population. She explains the distinction between physical, mental, and emotional fatigue, as well as decision fatigue, highlighting their impact on productivity and wellbeing. Dr. Kasper discusses various possible medical and lifestyle causes of fatigue, stressing the importance of a proper diagnosis. Through lifestyle medicine, she offers insights into how changes in sleep, diet, exercise, stress management, and social connections can combat fatigue. The episode emphasizes the difference between acute, chronic, and subacute fatigue, examines the role of various conditions and deficiencies in causing fatigue, and offers practical tips and a seven-day prescription for making impactful lifestyle adjustments.
 
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Episode 102 Sleep
 
Episode 103 Fitness
 
Episode 104 Manage Stress
 
Episode 105 Time to quit
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 Have a problem with alcohol? There is a solution. | Alcoholics Anonymous (aa.org) 
Episode 106 Loneliness
Interesting People Dinner Series
Episode 107 Nutrition
 
 
00:00 Introduction: The Problem of Fatigue
00:46 Understanding Fatigue: Causes and Effects
03:08 Medical Perspective on Fatigue
03:43 Personal Experience with Fatigue
04:31 The Role of Stress and Depression in Fatigue
08:11 Medical Approach to Diagnosing Fatigue
14:16 The Importance of Rest and Connection in Combating Fatigue
17:07 Lifestyle Medicine and Fatigue: A Deep Dive
20:24 Practical Tips for Managing Fatigue
26:27 The Role of Physical Fitness in Battling Fatigue
30:12 Conclusion: The Journey to Overcome Fatigue