Many of my patients want to lose weight quickly, and I can’t blame them. But rapid weight loss is difficult to sustain; in fact, it’s usually followed by rapid weight gain. Here’s more on the importance of losing weight gradually. 

A lot of people trying to lose weight often start fast, dropping pounds at a rapid pace. But losing weight too fast can be detrimental to your health and sabotage your overall goals. Rapid weight loss is often followed by rapid weight gain. Or worse: Rapid weight loss can put your health at risk.

Research shows that rapid weight loss is rarely sustainable over the long haul. When you lose too much body fat in a short duration of time, your metabolism slows down as your body goes into high alert survival mode. It holds onto fat stores, the nutrients it needs from the foods you eat, and slows down the calorie-burning process.

In a 2020 review of weight-loss studies, people whose weight loss was more gradual had greater reductions in fat mass and body fat percentage than those who lost weight more quickly. They also maintained their metabolism better. An earlier study found that gradual weight loss was more favorable to body composition than rapid weight loss.

Your body also starts to battle your accelerated weight-loss efforts by increasing the release of hunger hormones, making you crave food.

Although you should always talk to your primary care provider before trying to lose weight, experts generally recommend you aim to lose just 1 to 2 pounds per week, depending on your gender, age, and activity level. That will make your weight management effort more sustainable and ongoing, and help avoid harm to your health.

Losing weight rapidly can impact more than fat. It can mean you’re also losing muscle mass. Muscle mass is important for sustained weight loss.

For healthy muscle strength, bone density, energy, and immunity, our bodies need certain amounts of fat, carbs, protein, minerals, and vitamins. Rapid weight loss from dieting can also mean we’re not getting the right nutrition.  

Slashing calories can also cause fatigue, memory loss, irritability, dizziness, digestive problems such as diarrhea and constipation, and even hair loss.

Rapid weight loss can also lead to gallstones—the formation of hard material in the gallbladder. Your gallbladder’s job is to release digestive juices that break down foods and maximize the nutrients and energy they provide. When you quickly decrease your food intake, your gallbladder takes a vacation, releasing significantly fewer digestive juices that start to back up, sit in your gallbladder, and create the hardened masses commonly called stones. 

It’s mid-summer, 90 degrees and humid, but you want to work out and you prefer doing it outdoors. Treadmills really aren’t your thing – you feel like a hamster walking or running on one. 

You’re probably aware summer heat raises your risk for sunburn, heat cramps, heat exhaustion and heat stroke, so it’s important to talk to you doctor before you work out in high temperatures. If you get clearance, there are strategies that can help make summer workouts more enjoyable. Try these five tips.   

Wait for favorable conditions.

If you exercise regularly, you probably prefer a certain time of day. But during the summer, you may want to adopt early morning workouts because it’s cooler -- temperatures are lowest just after sun rise. And during the summer, unhealthy ozone levels are usually higher in the afternoon and evening. 

Or wait until after the sun goes down. Just make sure you exercise in a well-lit place and make yourself visible to motorists.

Dress for summer workouts.

There are so many options, you’re going to have to do some shopping (and soul searching).

Let’s start with fabrics. Generally, natural fibers such as bamboo, Tencel® and cotton are breathable and more comfortable than synthetic fabrics. They also don’t trap sweat and body odor. However, some synthetic manufacturers weave anti-microbials or silver nanoparticles into their workout gear to prevent clothes from smelling. Some synthetic brands also produce clothes that are breathable, water resistant and able to wick sweat away from your body. 

Your next decision is loose- vs tight-fitting clothing. Loose-fitting clothes will allow for better air circulation over your skin, compared to tight-fitting clothes. But excess material, including cargo pockets and wider legs can cause drag, slowing your performance time. The purpose of your workout, whether it’s training for a race or going for a recreational workout, will help guide your choices.    

Ideally, summer workout gear should be light in color to help reflect heat. Select visors with mesh inserts and bicycle helmets with deep vents to help body heat escape through your head. 

If you’re working out in the sun, you may want to invest in sun-protective clothes. You’ll also want to liberally apply sunscreen with UVA and UVB ray protection and an SPF between 30 and 50 before going outside to workout. If you sweat a lot during your workout, you may need to reapply. If you’re a swimmer or involved in water sports, a wide array of water-resistant sunscreens is available. And consider using zinc oxide on areas that easily burn, like your nose. 

Be strategic about your workout route.

Asphalt and concrete get much hotter in the summer than dirt, gravel or grass. You might find some relief from the heat if you move your walk/run/ride from a sidewalk or bicycle lane to an unpaved park trail.  

Altitude training (exercising uphill or at a higher elevation) also is more difficult during the summer. The air quality may better at a higher altitude, but it’s also thinner. Less oxygen causes your heart and lungs to work harder, as can higher temperatures. If you live in an area with a higher elevation and still want to exercise outdoors, you may have to taper back on the intensity to prevent feeling sick. And if you’re routine workout includes hills, you may want to find a flatter route for the summer. 

Stay hydrated

Rehydration is an essential part of recovering from a workout -- it helps lower temperature and heart rate, lubricate joints, repair muscles, ward off muscle cramps, ease fatigue and keep the digestion process working properly. And of course, it helps prevent dehydration.  While water is the go-to drink for everyone before, during and after physical activity, enhanced water, sports drinks, coconut water, chocolate milk and tart cherry juice also have value. Which beverage is right for you? Your activity and intensity level will dictate your choice. Although it’s not an exact science, some guidelines exist. Here’s what you need to know about the best post-workout drink options.

Listen to Your Body 

Don’t push your body to the point of feeling sick. Working out in the heat isn’t easy and raises your risk for heat-related illnesses, such as heat cramps, heat exhaustion and heat stroke. If you feel faint, dizzy, confused or nauseous and/or experience breathing changes (e.g., shortness of breath or rapid breathing), muscle spasms, vomiting, headache, changes in your usual sweating pattern, (e.g., excessive sweating or lack of sweating), you should rest, move to a cooler place and hydrate. You should see a doctor if you think you’re experiencing heat exhaustion or heat stroke.  

Keep in mind that some medications might make you more susceptible to heat stroke. Medications used to control blood pressure or an enlarged prostate have a tendency of making you feel dizzy in the heat. And diuretics can cause dehydration in hot, humid weather, so talk to your doctor before exercising outdoors in the summer.

If you’re not taking medications but still have a tough time dealing with heat or plan on running or cycling long distances, some experts recommend a pre-workout cooldown such as a cold shower. You can also place an ice pack on your neck for a few minutes to help lower your core body temperature.   

Talk to your doctor before working outdoors in the summer. If you don’t have a primary care physician, consider partnering with an MDVIP-affiliated physician. MDVIP doctors have the time to work with you and develop a wellness plan. Find a physician near you and begin your partnership in health » 

Gut health is a relatively new line of research. As more and more studies are published, experts realize that gut microbiota function like an organ. And like other organs, it’s affected by what you ingest. While you’re probably aware your diet can affect biomes, you may not have thought about medications.

“Medications can be an important component in managing and treating health conditions,” says Bernard Kaminetsky, MD, medical director, MDVIP. “However, they can have side effects, including taking a toll on gut bacteria.”

Antibiotics are perhaps the most notorious medication for disrupting healthy gut bacteria, but they’re not the only ones that can cause havoc. Here’s what you need to know about a few common drugs that may influence your gut flora. 

Antibiotics
Antibiotics are very misunderstood. If you have a urinary tract infection, bacterial pneumonia or strep throat, they’re not only necessary, they can be lifesaving. But every time you take round of antibiotics, good and bad strains of bacteria are killed, which can lead to yeast infections and gastrointestinal distress. And taking them too often or unnecessarily raises the risk for leaky gut syndrome, Clostridium difficile colitis (often called a C. diff infection) and antibiotic resistance. This is why it’s not a good idea to take antibiotics for viral infections like colds, flu and some coughs, unless a secondary bacterial infection has developed.

Best Defense: Take a probiotic supplement along with the antibiotic and add fermented, high fiber and prebiotic foods to your diet. Skip grapefruit juice and calcium fortified products while you’re on an antibiotic because they can block its absorption, possibly causing you to need another cycle.  

Antipsychotics
Antipsychotics help patients with bipolar disorder control mania, depression, delusions and hallucinations. Because there are different classes of antipsychotics, they tend to be a mixed bag in terms of side effects, effectiveness and overall safety. And some subclasses seem to slow the growth of gut bacteria, affecting overall gut biome diversity, according to a study published in Nature. For example, psychotropics (a drug class that includes anti-psychotics, antidepressants, anxiolytics, antiepileptics and mood stabilizers) have an antibacterial effect that can lower the microbiome diversity among patients with depression and anxiety, finds a study published in the International Journal of Neuropsychopharmacology.

Best Defense: Recent studies suggest that a probiotic supplement and foods high in probiotics and prebiotics such as fruits, vegetables, whole grains, nuts and legumes might help. Just talk to your doctor first. 

“There are a few studies suggesting probiotics might help control certain mental illnesses. This fairly new concept is called psychobiotics and it combines using probiotics and prebiotics. If your doctor thinks taking a probiotic supplement might be helpful, try it. It might help balance your gut biomes and control your condition,” says Kaminetsky.

Calcium Channel Blockers
Calcium channel blockers are commonly used to treat high blood pressure, irregular heartbeats, chest pain and coronary artery disease. But like some antipsychotic medications, seems to inhibit microbiota growth.

Best Defense: Try eating a diet high in fruits, vegetables, whole grains, nuts and legumes. Information isn’t available on the effects probiotic supplement can have on taking calcium channel blockers, so if you are interested in trying a supplement, discuss it with your doctor. 

Proton Pump Inhibitors  
Protein pump inhibitor (PPI) is the clinical term for acid reducers and are used to treat ulcers and gastroesophageal reflux disease (GERD). They’re found in the over-the-counter section of most grocery stores and pharmacies and have generic names that end in “zole.” Generally, they’re safe and effective. However, they work by lowering gastric acid secretions, which can decrease microbiome diversity. When used regularly, these drugs can can a bacterial imbalance, according to an article published in the World Journal of Gastroenterology. Too much gut bacteria is associated with SIBO (small intestine bacterial overgrowth), a condition which interferes with healthy digestion. 

Best Defense: If your doctor instructed you to take PPIs on a regular basis, add fermented foods to your diet to help balance your gut bacteria and ease heartburn and GERD. If you’re self-medicating to relieve heartburn and GERD, fermented foods can help, as well as cutting back on coffee, tea, dairy products and citrus fruits. A probiotic supplement can interfere with the effectiveness of a PPI, so check with your doctor before taking one.

It’s important to talk to your MDVIP-affiliated doctor before taking any supplement or making dietary changes. Looking for a primary care physician? Find an MDVIP affiliate near you and begin your partnership in health »

In my practice, I talk a lot about heart disease because it’s been the leading cause of death in the U.S. for more than a century. Despite public health efforts to lower the rates, they continue rising. Here’s an overview of a recent report on heart disease, along with tips to help you keep your heart healthy.

It’s not news that heart disease has been the leading cause of death in the U.S. for more than a century. And despite public health efforts to lower heart disease rates in the U.S., it continues to lead in mortality causes. In fact, within the next 30 years, heart disease and stroke rates will rise high enough to affect at least 60% of American adults, according to two presidential advisories published in Circulation, the flagship journal of the American Heart Association.

“Over the years, the medical and public health communities have made meaningful headway controlling cholesterol and reducing smoking,” says Bernard Kaminetsky, MD, medical director, MDVIP. “But we haven’t conquered other significant heart disease risk factors like obesity and type 2 diabetes. These advisories forecast the burden cardiovascular disease will have on the U.S. in just a couple of decades and provide insight as to the root problems.”

Researchers analyzed data from the National Health and Nutrition Examination Survey between 2015 and March 2020 and the Medical Expenditure Panel Survey between 2015 and 2019 to estimate future levels of cardiovascular disease. Their report compared the prevalence of risk factors in 2020 and to what they believe it will be in 2050:

•    High blood pressure will increase from 51.2% to 61.0%.
•    Diabetes will increase from 16.3% to 26.8%.  
•    Obesity will increase from 43.1% to 60.6%.
•    High cholesterol will decrease from 45.8% to 24.0%.
•    Poor diet, sedentariness and smoking are expected to continue to decrease. 
•    Sleep deprivation will worsen.

They also found an upsurge in the prevalence of cardiovascular diseases between 2020 and 2050.
•    Coronary artery disease will increase from 7.8% to 9.2%.
•    Heart failure will increase from 2.7% to 3.8%.
•    Stroke will increase from 3.9% to 6.4%.
•    Atrial fibrillation will increase from 1.7% to 2.4%.
•    Total cardiovascular disease will increase from 11.3% to 15.0%.

“From what I understand, researchers feel the problem stems from changes in our demographics. The overall US population is aging, raising the risk for heart disease and its risk factors. And the ethnic makeup of our country includes more African/Caribbean, Latino and Asian Americans; these ethnic groups have higher rates of heart disease,” says Kaminetsky. “Another problem is our younger generations are exhibiting heart disease risk factors at much younger ages.”

A second report focused on the economic burden heart disease will have on U.S. through 2050. Researchers used nationally representative health, economic and demographic data to forecast healthcare costs associated with heart disease and its risk factors, including high blood pressure, diabetes, high cholesterol and conditions such as coronary heart disease, stroke, heart failure and atrial fibrillation through 2050. After adjusting for annual inflation rates, researchers estimate that:
•    Costs to treat heart disease risk factors will triple between 2020 and 2050, going from $400 billion to $1,344 billion.
•    Costs to treat heart disease will almost quadruple, going from $393 billion to $1,490 billion.
•    Loss in work productivity related to heart disease will rise by 54%, going from $234 billion to $361 billion.
•    Stroke is cardiovascular condition that is expected to account for the largest amounts of costs.

“Escalating healthcare costs are problematic for many Americans. They cause people to postpone office visits, delay treatments and skip filling prescriptions. It also can affect the quality of healthcare,” Kaminetsky says. “Fortunately, there are steps you can take to help prevent and control heart disease.”

Lowering Your Heart Disease Risk Factors

Here are some steps to take to help lower your risk for developing heart disease and its complications.
•    Understand your heart disease risk
•    Prevent inflammation
•    Eat a heart healthy diet
•    Exercise
•    Get enough sleep
•    Quit smoking
•    Limit alcohol
•    Visit your dentist
•    Manage blood pressure
•    Watch your cholesterol and triglycerides 
•    Maintain a healthy body composition
•    Control depression
•    Handle stress

If you don’t have a doctor, consider joining an MDVIP-affiliated practice. They more have time to help you in your pursuit of a healthier lifestyle, which can help lower your risk for heart disease and its complications. Find a physician near you and begin your partnership in health »

In 1942, Wyeth Pharmaceuticals introduced the first hormone replacement therapy (HRT) for women going through menopause. Over the intervening decades, doctors have gone back and forth on the safety and efficacy of using HRT to treat symptoms like hot flashes and vaginal discomfort.

To get relief, women who worried about the safety of HRT — the therapy has evolved and is now considered a safe option for women younger than 60 — turned to dietary supplements instead of HRT to try controlling their symptoms.

Unfortunately, experts have little faith in the efficacy and possibly safety of these supplements, according to a 2023 position statement released by The Menopause Society.

“Menopausal symptoms like hot flashes, night sweats and insomnia can last for years, affecting the quality of a woman’s life. Menopause also raises her risk for heart disease and dementia. HRT is treatment of choice to help many women control moderate to severe symptoms,” says endocrinologist Dr. Andrea Klemes, chief medical officer, MDVIP. “Of course, HRT is not right for every woman, particularly if breast, ovarian or endometrial cancer, stroke or blood clots are a risk. However, leaning on supplements may not be the answer either.”

Nutritional Supplements

Common over-the-counter supplements used to ease menopause symptoms include:

Black cohosh – an herb native to North America used to treat estrogen-related conditions, such as easing hot flashes and night sweats. These claims lack scientific evidence. Further, black cohosh may increase the effects of estrogen in some parts of the body, while decreasing it in others, which may be problematic. It also increases liver enzymes, potentially causing liver damage in some users.

Dehydroepiandrosterone (DHEA) – a hormone produced by the adrenal glands. It’s prescribed to treat a thinning vaginal lining. But it’s also available as a synthetic over-the-counter supplement, derived from chemicals in wild yams or soy. It’s taken to reverse some of the physiological changes associated with menopause such as the loss bone density, muscle strength, sexual function and skin tone. Studies conflict: Some found that DHEA may improve bone density, sexual function and skin tone; however, not muscular strength. DHEA also is controversial because it’s suspected to raise the risk of hormone-sensitive cancers such as breast, ovarian and endometrial.        

Red ginseng – an herbal remedy used for centuries in Asian cultures to help manage menopause symptoms. Studies have found that it helped with sexual function and eased intensity of hot flashes, but it didn’t relieve frequency of hot flashes or adjust hormonal levels. Red ginseng also has been found to affect menstruation, heart rate, blood pressure and appetite, as well as cause headaches and breast pain. It also can interact with calcium channel blockers, statins and antidepressants.      

Red clover – a wild plant that belongs to the legume family. It’s credited with having a wide range of uses, including easing menopause-related issues such as hot flashes, heart disease and osteoporosis. However, studies regarding its value are mixed. Moreover, red clover contains isoflavones, plant-based compounds with a similar structure to estrogen. Some studies suggest isoflavones raise the risk for breast cancer in women who have a personal or family history of breast cancer, as well as thyroid problems. Red clover also is known for interacting with anticoagulants and Methotrexate, an anti-rheumatic drug.

Soybean – a legume grown in Eastern Asia that’s processed into soy products like protein, milk and fiber. Soy is recognized for easing some effects of menopause. For instance, it can help control the frequency and intensity of hot flashes, strengthen bones, lower bad cholesterol and possibly improve blood pressure. Soy supplements and foods are effective because they’re a good source of plant-based estrogen isoflavones, but they can interact with:

• Tamoxifen, a breast cancer medication
• Estrogen-based medications
• Osteoporosis medications including raloxifene, a post-menopausal osteoporosis drug
• MAOI antidepressants

Soy supplements and foods also can decrease the absorption of zinc and iron supplements and increase the risk of bleeding, particularly if you’re taking a blood thinner, (e.g., aspirin, warfarin/Coumadin, clopidogrel/Plavix).

St. John’s wort – a plant native to Europe that’s often used as a supplement to treat menopause symptoms, including depression and anxiety. Studies support its use to manage depression and seasonal affective disorder, and its effectiveness in controlling menopause-related anxiety when combined with black cohosh. However, studies are mixed regarding its ability to relieve other menopausal symptoms. More importantly, St. John’s wort interacts with a long list of medications, making it a debatable choice for menopause symptoms. In fact, the concern over St. John’s wort’s drug interactions led France to ban it and other countries to require a prescription.

Wild yam – a vine (not to be confused with the starchy vegetable yam) that has diosgenin, a plant-based estrogen that can be chemically converted into estrogen, DHEA, progesterone and cortisone. In fact, diosgenin also was used in the 1960s to make the first birth control. Wild yam has been used since the 1700s to ease numerous female ailments like morning sickness, menstrual cramps, nausea, menopause symptoms and menopause-related osteoporosis; however, there isn’t any scientific evidence to support its use for these issues. Furthermore, wild yam can induce side effects and interactions with medications and other herbs. It is a natural hormone replacer, you may need to avoid it if you have a personal or family history of hormone-related cancers such as breast, ovarian or uterine, as should women who are breastfeeding or pregnant and those with a protein S deficiency.    

“There’s a couple of red flags with most of these supplements. First, many studies conducted with these products have mixed results. Second, the active ingredient in many of them is plant-based estrogen, which are not safe for women who are not taking HRT for health reasons,” says Klemes. “If you can’t or don’t want to use HRT, I strongly suggest you consult your physician before taking a dietary supplement.”

Options Beyond Supplements

If you and your doctor feel HRT and dietary supplements are not the best choice for you, try these approaches to alleviate menopause symptoms.

• Anxiety
• Depression
• Weight gain
• Sleeplessness
• Hot flashes and night sweats
• Brain fog
• Weaker bones/osteoporosis
• Cholesterol
• Low libido

“Every woman’s situation is unique, that’s why it’s so important to work with your doctor, particularly someone who knows you very well,” Klemes says.

If you’re struggling to get a good night’s sleep, chances are you’re stressed. Stress is another public health issue plaguing America. In fact, more than 25% of American adults reporting being so stressed that they can’t function, according to a poll conducted by the American Psychological Association.

The combination of insomnia and stress is problematic for many Americans, particularly women under age 50, according to a recent Gallup poll. The poll also found that in general, Americans are sleeping less, are less satisfied with the amount of sleep they’re getting, and are more stressed today than 30 years ago.  

Stress is devastating on our health, causing inflammation and immune disorders. It can exacerbate arthritis, asthma, heart disease, inflammatory bowel disease and many other conditions. Sleep deprivation is also a major public health problem in the U.S. About 70 million Americans have chronic sleep disorders — and poor sleep can lead a wide range of health issues, including heart disease, dementia and obesity. It also can affect your job performance.

How Stress Interferes with Sleep

Stress affects the quantity and quality of your sleep by prolonging the time it takes to fall asleep and interferes with the length of time you stay asleep. This is because stress initiates a psychophysiological response that activates the HPA axis, a communication system between the hypothalamus, pituitary gland and adrenal glands. Triggering the HPA axis is like pressing on a gas pedal in the sense that it revs up the body.

The hypothalamus is a gland located in the brain that’s responsible for maintaining homeostasis in the body. It’s known for regulating body temperature, but it also manages hormones and has control (or at least some control) over involuntary processes like heart rate, hunger, thirst and mood. It also houses a group of nerve cells that affect sleep and arousal. When stressed, the hypothalamus signals the pituitary gland and adrenal glands.

The pituitary gland, a pea-sized gland situated at the base of the brain, serves as the master gland for the body. It produces hormones and directs other glands to produce hormones. Stress causes the pituitary gland to release cortisol, a hormone that interferes with circadian rhythms and sleep cycles. A higher level of cortisol keeps you on high alert, leading to restlessness, insomnia and fragmented sleep.          

Stress also prompts the adrenal glands -- two small, triangular shaped glands positioned on top of the kidneys – to release dopamine, a chemical messenger that raises alertness. They also secrete epinephrine (often known as adrenaline) and norepinephrine, two hormones behind the “fight or flight” response we experience when we perceive a threat. Epinephrine and norepinephrine increase your breathing rate, heart rate and blood pressure, heighten your sense of awareness, promote hyperactivity and can possibly set off a panic attack.

Managing Stress to Get Enough Sleep

Fortunately, stress is usually a controllable problem. You can divide your stress management efforts into two timeframes – daytime and bedtime.

Daytime Stress Relief  
To ease stress throughout the day, try to:

• Exercise  
• Eat foods that help ease stress.
• Engage in a hobby.
• Socialize
• Limit caffeine.

Bedtime Stress Relief
Practice good sleep hygiene and establish a good bedtime routine includes one or more of the following.

• Meditation
• Deep breathing exercises
• Progressive relaxation
• Bedtime Tai Chi
• Consume sleep-friendly foods two to three hours before bed.