Monthly Archives: August 2016

Will Sugar Take Away the New Baby Blues?

Eleanor, the daughter of a close friend, apologized for still wearing her maternity clothes when her mother and I went to her home to ooh and ahh over her adorable newborn.

“It’s crazy!” she said, pointing to her baggy pants and shirt. “In the two weeks since giving birth, I think I have gained 12 pounds. I can’t stop eating and I know it is not just because I am breast feeding. I don’t want any good stuff to eat, just doughnuts, cookies, ice cream and waffles drenched in syrup.”

When she left the room, her mother confided that her daughter had been very moody and complained of exhaustion, feeling overwhelmed, and worried that she would not be a good mother. “She is also so irritable…When I offered to take care of the baby so she could get out of the house, she told me to stop giving her advice!”

The mother then whispered, since she heard the daughter returning, “She must have the Baby Blues.”

Postpartum blues, or baby blues, are not the same as postpartum depression, although some of the symptoms are identical. The ‘blues’ affect about 80% of mothers during the first week after giving birth, and the symptoms peak between days three to five. The mood swings, food cravings, fatigue, and depression are blamed on a decrease in serotonin activity due to the new mother’s estrogen and progesterone levels readjusting. In some ways, the symptoms are similar to PMS, which occurs at the end of the menstrual cycle when hormone levels are shifting. The postpartum blues disappear about two weeks after childbirth, but the exhaustion and fogginess may continue much longer until the mom and baby sleep through the night.

Postpartum depression, in contrast to these postpartum blues, can last for months; the symptoms are much more severe and require medical/ psychiatric interventions. Women with postpartum depression are usually treated with SSRIs, the antidepressants that increase serotonin activity, along with talk therapy and assistance in taking care of the baby and the household.

Postpartum blues are not treated with antidepressants because of their temporary nature. But this doesn’t mean that the new mother has to suffer the unwelcome feelings of sadness, fatigue, lack of focus, not feeling like herself, anxiety, or irritability even for a few days. Sleep helps with all of these symptoms.  One does not have to be a nursing mom to feel the effects of too little sleep and when it goes on for days? The confusion and mood swings that follow can be very distressing.  Waking every two hours to nurse during the night, and then getting up in the morning to carry on the tasks of taking care of the rest of the family is sufficient reason to exacerbate these ‘ blues’.

Women in our culture are given little or no time off to rest from childbirth and the demands of a family and even work. Other cultures, such as the Chinese, insist that a woman be secluded for 30 days with little to do except keep warm, eating high fat, nourishing soups and stews to sustain nursing, and sleep when not feeding the baby. In our culture, the postpartum blues can be minimized by helping the new mom with her family and household tasks so she has time to sleep, making opportunities for her to leave the house, and participate in a healthy, non-baby-centric world… and when she feels physically able, to exercise.

Eleanor’s appetite for sweet carbohydrates led her to yet another quick and effective way of improving her postpartum blues.  The foods she consumed were acting like edible tranquilizers, because their consumption increased the level of the good mood chemical, serotonin.  She was eating sugary carbohydrates to increase serotonin activity, but starchy carbohydrates such as  instant oatmeal, a bag of popcorn, or baked potato are just as effective.  The path from eating carbohydrates (except fruit sugar) to more serotonin is a little complex, but the end result is that after the food is digested, more serotonin is made and the edge is taken off all those distressing symptoms.  Eleanor was probably eating larger quantities of carbohydrate than she needed to; about 30 grams (120 calories in a fat free food) would have been enough to raise serotonin levels for about three hours. Two or three small carbohydrate snacks during the day and evening would have made her feel less edgy and depressed.

One caveat: the carbohydrates must be eaten on an empty stomach or at least two hours after eating protein.  When protein foods are digested, their amino acid contents prevent serotonin from being made by preventing one amino acid, tryptophan, from getting into the brain.

Eleanor must of course make an effort to eat the nutrient packed foods her body needs to recover from giving birth and to nurse. A diet of cookies and brownies is incompatible with the nutritional demands of her body. But eating carbohydrates should, by increasing serotonin, decrease stress and induce calmness and tranquility. Which is exactly what the mother and infant need.

Are Baby Boomers Becoming the Walking Disabled?

We were at a museum in the Berkshires whose overflow parking lot was about a 12- minute walk to the entrance. The couple we were with were somewhat dubious about whether they could walk that far. They did, but, after a couple of hours strolling very slowly throughout the museum, asked if they could ride back to the parking lot on the museum’s golf cart.  They were not sick, and neither have any disabilities that would have prevented them from walking further….the weather not too hot to make being outside for long unpleasant. But they were not young and gradually, almost imperceptively, over the years they had decreased the amount of time and distance they could walk. So to them? The additional 8th of a mile to the car was more than their stamina and legs could handle.

Mary (not her real name) mentioned that she had started to record her daily steps and some days was managing to approach 5,000. Her goal was to double that amount, but she admitted that she was so unaccustomed to walking that she tired easily.

Unfortunately, our friends are not unique. As people age beyond their sixties, many are losing the ability to walk for more than a couple of blocks. If they cannot walk a quarter of a mile, seven blocks, without assistance, their lack of mobility is termed walking disabled.

The consequences of being walking disabled have been studied by Dr. Thomas Gill, professor of medicine at Yale School of Medicine. He and his associates followed about 640 people age 70 and older for 12 years and assessed their ability to carry out what is called activities of daily life. Their results, published in the January 2012 Annals of Internal Medicine, found that as people lost the ability to walk, they lost their independence, too. If the inability to walk follows an inability to drive, the effects on quality of life are obvious.

How does someone who can no longer drive and no longer walk more than a block or two manage to go anywhere? The supermarket, library, pharmacy, movies, restaurants, shops,  a local park, museums, and concerts are all out of reach. Even public transportation such as buses that can be boarded by someone with a walker are inaccessible if an individual can’t walk to the bus stop or do errands when reaching a destination. As Dr. Gill points out, the effect is social isolation, dependence on family and friends, and often depression and possibly cognitive decline due to lack of conversation and contact with others.  The walking disabled become shut-ins and, in a sense, shut away from the kinds of casual contact that those of us who are able to walk take for granted.

But physical immobility need not be an inevitable aspect of aging.

The proliferation of devices and apps that measure walking distance or steps should allow everyone to learn just how active or sedentary they are. Day-to-day variations are averaged into weekly totals, and these data are stored so the wannabe walker has a record of steps or miles walked over a long period of time. Variations can occur, of course, because of weather (too hot or cold, rain, ice, or snow) or other factors  such as lack of time.  But daily variations eventually smooth out and offer a good record for the individual, as well as a medical care provider, of average daily activity and how much it changes over time. For example, if Mary continues her walking regimen, she should find herself walking further simply because her increased muscle strength and stamina will allow her to go longer distances without getting tired.

But what caused Mary, an otherwise healthy individual, to be unable to walk to the parking lot from the museum, a distance that presumably was considered close enough for most visitors to cover without needing transportation?

One answer is the national attitude toward walking: why walk if you can drive? Why have sidewalks in suburban communities if everyone drives or is driven? Why enable anyone to walk across a highway to get to a shopping mall if everyone drives to it? Why have children walk to school when they can be bused or driven or eventually drive themselves? Why get out of the car to go to the bank when you can go to a drive-through teller?

A few days ago in the gym I watched a television program featuring prospective house buyers.  A woman, in her early forties, was shown what seemed to be a lovely property and told that a beach was a mile away. She said, “I am not going to walk a mile to the beach. It is much too far.”

“Really, lady…” I wanted to say, “If you can’t walk a mile when you are in your forties, you may not be able to walk around the block 30 years later.”

Fortunately, attitudes are changing.

Urban planners are developing walkable cities and towns. Properties located in walkable areas are considered desirable, not just because the sidewalks and parks provide opportunities for exercise but, just as important, they provide the opportunity to connect with neighbors and with the community. Walking groups are becoming popular now, so someone for whom walking is a boring solitary activity can interact with others in a moving vertical social group. For people like Mary, it is possible to regain the ability to walk long distances by walking in a pool or on a treadmill. Treadmills allow the emerging walker adjust the time and speed and obtain an accurate display of distance. Walking in a park or on sidewalks with available benches upon which to rest, in case of fatigue, removes the fear of not having the energy to get back home.

Changing the walking disabled into the walking enabled may take time, but doing so has benefits far beyond walking to a parking lot.

Might Covering the Skin Cause Vitamin D Deficiency?

It was a beautiful summer day, and the Boston Public Garden was filled with walkers, people feeding the ducks and squirrels and/or listening to the weekend saxophone player near the Swan Boats. But mostly? People were soaking up the sun to remove some of the pallor from six months of relatively sunless days. Most women were wearing typical summer outfits: sleeveless or short sleeve shirts, shorts, or short skirts. These outfits exposed enough skin to allow the ultraviolet rays to catalyze the process of making vitamin D.  Vitamin D is essential because it supports calcium absorption from the intestinal tract into the body. Without calcium, bone tissue cannot be made. In fact, insufficient vitamin D is responsible for rickets, a childhood disease first described in the 17th century. Bones fail to grow and mineralize sufficiently and as a result, they are soft and deformed. Adults need vitamin D as well to prevent osteomalacia, a weakening of the bones and the muscles to which they are attached. Osteoporosis, a disease in which fragile bones break extremely easily, is also linked to insufficient amounts of this vitamin.

But why should vitamin D levels ever be insufficient? It is provided, at no cost, from the effect of sunshine on the skin.

But some, indeed many, cannot rely on the sun to make this important nutrient.

Consider again the scene in the Boston Public Garden. To be sure most of the people have their arms, legs, and faces (and a few torsos) exposed to the sun. But here and there women are walking about or sitting on park benches with only the area between the bridge of their nose and the top of their eyes exposed to the sun. They are wearing a niqab, a small cloth, that covers all of the face except the eyes,  in addition to a scarf that covers their hair and neck. A heavy robe (it cannot be see-through), or long sleeves and pants cover other parts of the body that otherwise might be exposed to the sun.  And it is not only the Moslem women who are so covered up. So are ultra-Orthodox Jewish women and their daughters enjoying an afternoon stroll. Thick tights or stockings, long sleeved, high-necked blouses, long skirts and wigs or scarves cover their hair and limit the amount of skin exposed to the sun only to the hands, small neck area and the face.

Such concealing clothing has a negative impact on vitamin D levels.  Several studies among Moslem communities whose women wear the most extreme style of Islamic dress have found them to be chronically deficient in vitamin D. (Mishal, A.A., Effects of Different Dress Styles on Vitamin D Levels in Healthy Young Jordanian Women. Osteoporosis International, 2001. 12(11): p. 931-935.)

The same deficiency has been observed in Dearborn, Michigan among the Arab-American female population. Veiled women had levels of vitamin D well below the minimum necessary to prevent rickets in their children (their breast milk would have insufficient vitamin D) and osteomalacia.  (Hobbs, R., et al., Severe Vitamin D Deficiency in Arab-American Women Living in Dearborn, Michigan. Endocrine Practice, 2009. 15(1): p. 35-40.)

In one study, 40% of ultra-Orthodox women whose vitamin D levels were tested in a Tel Aviv hospital were found to be deficient in the nutrient. (Siegel-Itzkovich, J, Ultra-Orthodox Jewish women at risk of vitamin D deficiency British Medical Journal 2001 ;323, 10). The effect of skin concealment on vitamin D levels was also found among adolescents in an ultra-Orthodox community in Brooklyn, due to a combination of their clothing, and that boys are indoors studying from early morning to evening.

Vitamin D deficiency can be found among many other groups as well, due to inadequate sun exposure in general. The elderly and others unable to go outside because of sickness or lack of mobility, workers with schedules restricting outside access during the work week, people with skin conditions necessitating avoidance of sunlight, and those who live in geographical areas with weather inhospitable to outdoor exposure…they also suffer. And of course, using sun block is going to prevent most ultraviolet rays from reaching our skin.  Interestingly however, most people (according to dermatologists) do not use enough sunblock, or do not put it so thoroughly over themselves so as to block out some sun exposure. Air pollution also reduces significantly the amount of ultraviolet radiation that reaches the skin.

How long one has to be exposed to the sun varies depending on who gives advice. Dermatologists will probably say avoid sun completely, but other medical folk more concerned with bone breakage and the effect vitamin D deficiency may have on immune function will suggest a spectrum of 5-10 minutes to half an hour daily. Time spent outside walking to the mailbox or walking your child to school does not fit into these calculations. And of course skin exposure to the sun is seasonal and weather dependent. The good news is that Vitamin D is stored in our liver, so try to think about it like banking money in July for Christmas shopping in November in that vitamin D made in the summer should be around in the winter.

Since it is unlikely that people with limited or even non-existent exposure to sunlight are going to be able to alter their situation, or that most of us will risk skin cancer by avoiding sunblock and frying ourselves on the beach? The alternative is to obtain vitamin D from food sources or as a supplement. Having your vitamin D levels measured might be worthwhile if you suspect that you are deficient.

The daily requirement is 600 IU until age 70 when the requirement increases to 800 IU. The best source is the worst tasting and smelling: cod liver oil.  Salmon and swordfish are pretty good sources, while canned tuna in water is marginally good. Vitamin D fortified orange juice, milk, yogurt and even ready-to-eat cereal are reliable sources, but may not be eaten in large enough amounts to meet daily needs. It is important to check labels to see how many servings are needed to get l00% of the daily quota. Supplements that provide the recommended daily allowance should be taken if neither sunlight nor food are going to give the body the vitamin D it requires.

Weakening bones are silent—until they break. Don’t let covering up the skin cover up vitamin D deficiency.