http://www.newsminer.com/extra/alaska_pulse/fashion-and-your-health/article_3cc435d2-d391-11ea-9589-0bd5e93cbc8b.html

Clothing developed out of utility and ability at least 200,000 years ago. Initially naturally and readily available plant and animal products were used. Eventually the technology to improve those products developed into the clothing and textiles industry we know today. Clothing most likely had no aesthetic purpose initially; but was a barrier from weather, minor trauma, UV damage, bugs, parasites and even microbes (though they may not have realized it at the time). 

Over time, as societies developed and communities evolved, people began to use clothing to communicate. It was used both as an art form and as a way to identify status in society. Personal protective gear and athletic/sportswear, both rooted in utility, have influenced fashion. However, in all of our self expression and trend following, there are health risks that may outweigh the general benefits of some clothing. 

Tight underwear have been associated with lower sperm count in men, increased risk for jock itch and other dermatoses in both genders, bacterial vaginosis and vaginal yeast infections in women, and urinary tract infections (mostly in women).  Thongs and G-strings are obvious culprits, but bikini and brief style underwear are generally problematic due to anatomic and physiologic reasons to both sexes. However, if going without underwear for the reasons above; a skirt, sarong or kilt is healthier for the crotch than pants. Friction from clothing against the body can be irritating.

Tight clothes and athleisure gear can increase heat and moisture retention, increase friction of fibers against skin, limit mobility and create neuropathic pain. Some fibers like nylon or lycra may exacerbate this problem. Wearing clothing too tightly exposes skin to detergents, fabric softeners, irritants, microbes or dyes that may be in or on those clothes. People are commonly sensitive to some fabrics, wool for example, so wearing it closer to the skin may be more uncomfortable. On the other hand, compression is appropriately used to treat various vascular and lymphatic complaints- usually to reduce swelling.

Corsets can improve posture and reduce the pressure that a bra puts on the shoulders, stabilizing the back and reducing some pain. If used for waist slimming, as they were for centuries, they could cause or worsen gastrointestinal problems, bowel pain and pelvic floor prolapse.  They can also cause rib distortion and injury to internal organs. They can certainly lead to restricted depth of inspiration and associated respiratory complications. Long term use, may reduce core tone as the corset is relied upon for stability.   Body shaping garments can have similar effects. 

Bras have shortcomings as well. Though not known to be associated with breast cancer, underwires and bras in general are a frequent cause of discomfort and a mass effect in breast. Ill fitting bras can cause breast pain, back pain, or shoulder pain. They can cause the same problems that other tight fitting clothes do and can cut into the shoulders or torso, leading to skin compromise.  A well fitted bra is worth the investment.

Fibers found in elastics can also be irritating. Thread tourniquets or elastic band tourniquets can form due to friction within a garment. This usually occurs in small children – they present with irritability and a swollen finger or toe (or genitalia in some cases). Loose fitting clothing is generally better except that wearing loose clothing to bed has been associated with higher risk during a fire (especially in children).  Some fabrics may be associated with worse burns than others, but fabrics containing halogenated fire retardant materials may be associated with reproductive and neurodevelopmental toxicities.  

Walking barefoot causes athlete’s foot through direct contact with the causative microorganisms.  At the same time wearing footgear that doesn’t allow for ventilation increases moisture and heat entrapment and will exacerbate athlete’s foot by contributing to skin breakdown and providing a favorable environment. Footgear is important protective equipment, but it is also important to rotate frequently and occasionally take breaks from entirely. High heels and platform shoes can lead to serious musculoskeletal lower extremity and back injuries either chronically or acutely. They can also lead to falls. Tight toed shoes and gravity can worsen bunions; lead to corns and calluses, nerve pain, or bony distortions. 

Buttons, beads, sequins, zippers, strings and cords can be dangers as choking or strangulation hazards. Anything not well affixed to the garment (or any jewelry) can be a choking hazard to a child. Zippers, beads and buttons may all be made from metals to which people are sensitive (like nickel). Kids also put buttons, beads and sequins in their noses, mouths, ears, butts and vaginas.   These, as well as earrings and other jewelry, can also lead to problems such as infection, inflammation or obstruction.  Rings on fingers have led to serious hand injuries, including skin avulsions and amputations.  Zippers lead to numerous penis and scrotal injuries yearly from using them appropriately, but absentmindedly.

There are, of course, psychosocial consequences to the clothes we choose. These are subtle and subjective. The way we present ourselves affects how people interact with us: whether they even choose to interact with us sometimes. They can make us feel like part of a group or like outsiders: can be the cause for our acceptance or rejection relative to who we are and who we are with. There is no doubt that fashion can affect our happiness. Indeed there are many tales throughout history in which the outfit, uniform, disguise or costume makes all the difference. While they can promote hygiene and protect us from the elements, we should not overlook the common ways our wardrobes could threaten our health and safety. 

http://www.newsminer.com/extra/alaska_pulse/exercise-during-pregnancy-is-beneficial/article_e07c54b6-bfb9-11ea-accc-63d89df4f5d7.html

Exercise is a major modifiable risk factor that has one of the greatest effects on our health and longevity. Aerobic exercise and strength training both play roles in overall fitness. There is no upper limit to the duration of daily aerobic exercise that positively affects cardiovascular fitness. Men who can do a minimum of 40 push-up exhibit a significantly decreased risk of heart attack. Resistance training has been found to decrease risk of developing osteoporosis, it is the method of choice to prevent bone loss in astronauts. Aerobic and resistance training decreases dementia risk and progression in old age, and reduces depression and anxiety. Sedentary lifestyle is associated with obesity, metabolic syndrome, type 2 diabetes, chronic inflammation, cardiovascular disease and many cancers. 

During pregnancy, however, the benefits of exercise have not always been emphasized. In addition to the benefits noted for non-pregnant adults, exercise in pregnancy decreases risk of excessive weight gain (and subsequent postpartum weight retention) and may reduce the risk of gestational hypertension, gestational diabetes, preeclampsia, large-for-gestational age newborn, pelvic pain, and associated urinary incontinence. 

There are pre-existing conditions that require reduced or limited exercise in pregnancy and if you have reason to believe your pregnancy may be of above average risk, you should definitely consult your doctor, but in general women with uncomplicated pregnancies and no pre-existing reason to preclude participation are encouraged to perform both strengthening and aerobic exercises. The same minimum standard of thirty minutes of aerobic exercise most days of the week is recommended in pregnancy as in the pre-conception and post-partum period (also recommended to men!). The anatomy and physiology of the body changes in pregnancy, so modifications to your normal routine may need to occur. 

Reasons to stop exercising and contact a healthcare provider may include amniotic fluid leakage, abdominal pain, fainting or dizziness/lightheadedness, difficulty breathing prior to exercise, vaginal bleeding, headache, calf pain or swelling, chest pain, and fatigue or muscle weakness. Exercise should be discontinued if regular painful contractions are occurring (especially if preterm) until evaluation by a healthcare provider. Pregnancy increases risk for thromboembolic events due to it being a hypercoagulative state.  Being sedentary further increases this risk.  Bedrest is not routinely recommended for pregnant women with intact membranes. however women with known increased risk for miscarriage or preterm labor may be asked to reduce their physical activity by their healthcare provider. 

Movement during active labor is likely beneficial, though may be limited due to use of epidural anesthesia. Being upright during labor may shorten duration and may reduce risk for cesarean. Being more cardiovascularly fit, with fewer health problems before and during pregnancy generally foreshadows a smoother labor and delivery. This should be no surprise. Yoga, stretch and incorporation of Kegel exercises can be beneficial before and after delivery in reducing long term effects of pregnancy and vaginal delivery on the pelvic floor (prolapse and incontinence). Women who undergo cesarean are less likely to have postoperative postpartum complications if they started with normal prepartum weight and didn’t gain excessively or develop metabolic or cardiovascular disorders. Morbid obesity alone makes a cesarean more high risk. 

“Even when all is known, the care of a man is not yet complete, because eating alone will not keep a man well; he must also take exercise. For food and exercise, while possessing opposite qualities, yet work together to produce health.” – Hippocrates

‘Intermittent fasting may have health benefits for some people’ Alaska Pulse; Vol. 1 No. 5 May, 2020

Fast, exercise, and limit sugar 

The Covid-19 pandemic and call for social distancing, isolation and quarantine presents a kind of hell to persons with addictions, eating disorders or other compulsive habits. Gyms are closed and deliberate attempts to exercise may be inconvenient or even dangerous. Comical social media memes warn of the dangers of weight gain for the isolated and bored. However, this is anything but funny. Most adults in this country are trending toward weight gain even while working daily jobs. During quarantine, eating may be a convenient hobby. 

Intermittent fasting is the practice of prolonged fasting. This can be either for 24 hour periods on occasion (3-4 days weekly) or engaging in daily fasts of upto 20 hours (time restricted feeding). The scientific basis for this is the understanding that having high levels of blood glucose increases the insulin output that leads to insulin resistance, weight gain, aging and diabetes. Benefits of caloric restriction have been observed in the past in both human and animal models, but it appears that prolonged fasting has additional benefits even when the same number of calories is consumed and when those calories come from foods high in fats or carbohydrates. Benefits of low carbohydrate diets have been demonstrated consistently as well (this includes sugar, grains, potatoes, corn and various other starches) in reduction of weight and risk for diabetes. 

Many people in this country will have prediabetes ( a hemoglobin A1C of 5.7% or an average blood glucose of 120+mg/dL) by their thirties or forties. The number of children with diabetes or prediabetes has also increased over the last decade. Signs that a person might be at risk for diabetes include being overweight, having thickened and hyperpigmented skin on the back of neck or under arms, and feeling ‘hypoglycemic’ or shaky/fatigued with even short fasts and at technically normal blood glucose levels. The more commonly noted and concerning signs of poorly controlled diabetes are increased thirst, hunger and need to urinate. 

The benefits of intermittent fasting go beyond reduction in risk for diabetes. They include weight loss and maintenance of a healthy body mass index, improved cardiovascular endurance, less fatigue during the day, possibly increased lifespan (but certainly healthspan). Fasting decreases general inflammation and increases clean up of damaged cells, shrinking some tumors and making them more susceptible to treatment. 

A fairly strict ketogenic diet does work for weight loss, but is difficult for most people to adhere to compared to simply not eating. The fasting for > 18 hours puts the body into ketosis and initiates the body using it’s fat stores for energy. If one does this every day and exercises most days, (especially if combined with a whole foods diet when one does eat), that individual should enjoy prolonged health at a normal body mass index. 

I started time restricted feeding (the daily fast for upto 20 hours daily) during my third pregnancy as my weight got away from me and I was experiencing nausea, vomiting, appetite loss and diarrhea. At first, my fasting was to limit my gastrointestinal symptoms. Gut rest reduced all of these symptoms. I had already gained (and mostly lost) about 50 lb each during the other pregnancies, more than that recommended in pregnancy. I had run for exercise off and on since I was a teen, but didn’t do much else that was active and didn’t watch what I ate (with the exception of a brief 1-2 weeks of the Adkins diet back when I was in college). Postpartum, I rapidly lost weight on the fast with breastfeeding. By the time my third child was a year old I weighed much less than my pre-pregnancy weight. I weighed less than my high school weight. At 5’,8.5” I had achieved a BMI around 20-21. It had previously been closer to 25-26, the borderline between normal and overweight. I couldn’t attribute this weight loss to breastfeeding alone. I had breastfed with my other children and hadn’t lost as much, by about 15-30 lb. I’ve now seen patients lose upto 30 lb in a month at the beginning of intermittent fasting. These patients will often have reduced hemoglobin A1C values after several months of the diet, indicating improved glycemic control. 

Another positive about the fasting is that my endurance has increased. Studies have reported that fasting can have this effect on people. I can run for well over an hour at greater than 6 MPH, 5/7 days of the week. I can do pull-ups. Never in my twenties did I ever believe I could do these things regularly. I have never been an athlete. It is hard to believe that I have become one in my late 30’s.

There are a few drawbacks I have noticed over three years of being on 18-20 hour daily fasts. I become extremely tired after eating; especially with large, carbohydrate-heavy meals. I do tend to binge during my allotted eating period- often on calorie dense foods (which is not what I tell my patients to do). It is difficult to tell if this is different from my prior natural state. Afterall, I started the diet out of a sense of lack of control of my eating in the first place.  I eat whatever is available when it is time to eat, which is part of why this is a convenient diet for me. I am convinced that if I binged less and ate only whole foods, I would maintain an even leaner body mass. Some of the pounds do come back, usually when my food choices are less healthful, but BMI is still around 21. 

There are some relative contraindications to intermittent fasting. People with certain medical problems should be monitored by a physician before initiating this diet. People on medications that lead to hypoglycemia (like insulin) should consult with their physician prior to starting the diet. People who are underweight should not fast for prolonged periods. This diet is not appropriate for babies or young children. It may not be appropriate for those with certain mental health disorders, known eating disorders or nutritional deficiencies. People who have had bariatric surgical procedures or any gastrointestinal resections should consult with their physician before initiating this diet. 

Caloric restriction and fasting have been demonstrated to prolong life and decrease mortality in several animal models. But there is another secret to staying healthy and decreasing all-cause mortality. That is exercise. Aerobic exercise and improved cardiovascular endurance are associated with a decrease in all-cause mortality. Studies on men doing push-ups have also associated ability to perform more push-ups with decrease in all cause mortality. Those that perform better on treadmill stress tests, are less likely to die from cardiovascular causes. Performing regular aerobics limits spikes in blood glucose by improving utilization of glucose even at rest. This decreases insulin resistance and risk for diabetes. While even a little exercise is helpful, there seems to be no upper limit to the amount of aerobic exercise that one can get and still benefit the cardiovascular system. Exercise to one’s aerobic tolerance limit should, therefore, be encouraged. Intermittent fasting can help people reach their fitness goals.  

Being stuck at home and out of work can lead to unhealthy habits. Hopefully, this article has encouraged people to initiate healthy ones. Specifically: limit carbohydrates (especially processed) in diet and eat whole foods. If there are no medical contraindications, try intermittent fasting. Get at least thirty minutes of aerobics most days and remember there is no upper limit. 

https://www.newsminer.com/extra/alaska_pulse/intermittent-fasting-may-have-health-benefits-for-some-people/article_73c0011a-8e4f-11ea-9e7e-efaaa16a6161.html

 

We are Open! Here is our plan for our patients in the Mat-Su Valley:

If sick with cold and flu-like symptoms, especially acute cough or fever, please stay home. If symptoms are severe enough to require medical attention, please go to Capstone urgent cares in Palmer and on Seward Meridian. They are prepared to evaluate and test, if criteria is met. Testing is not widely available and will take days to result. Only go to the emergency department if symptoms are severe.

We are available to address all other medical concerns. We are seeing people in person and using telemedicine. We are spacing patients and cleaning frequently. Do not bring visitors or guests to appointments.

https://www.cdc.gov/coronavirus/2019-ncov/index.html

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We are now in-network with Aetna!

 

As many may know, I was working for The Healing Center from 10/16- 8/17 doing medical cannabis evaluations. I will no longer be affiliated with this organizaton. Please come to me directly for medical cannabis evaluations as needed.