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Sitting is the New Smoking

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Times have certainly changed.  Smokers were “cool” in the early days of movies, and they were even hailed by doctors in media ads. 

Smoking became so popular that anyone who didn’t light up at work was considered “anti-social”. 

 Today, the few remaining smokers are kicked out of the building.  

So smoking is in decline.  It seems the old generation of smokers have killed themselves off faster than new recruits can be found

But just as we have turned back one self-inflicted threat to public health, we see another take its place.  SITTING is now the new smoking.

 In my practice of urban millenials, almost all earn their living by sitting all day long.  Those that commute will sit even more in their cars or trains.  Then, by the time they have eaten, they are too mentally exhausted to do much other than sit in front of their screens.  (That explains part of our fascination with professional sports: it is a lot easier to sit and watch somebody else exercise than it is to do it ourselves!).

Our bodies were carefully evolved for movement, but the new workplace denies all but a few finger strokes on a keyboard or screen.  As a consequence, we are seeing a host of self-inflicted medical complications, from obesity to neck and back pains, and from insomnia to attention deficit disorders. 

Our ancestors never had to think about exercise; they got plenty working the land, rowing the fishing boats, chopping the firewood, walking miles every day.  But today, we need a strategy for movement.  This needs some time management, and some creativity to pull it off. 

One can join a fitness club, buy a bike, or take up a sport like tennis, soccer or ultimate frisbee. For those who find these options impractical, be creative.   Remember that exercise doesn’t need to be formalized as a solid hour, it could also come in random short bursts.  Any kind of movement is better than finding a new place to sit as your day goes along.  Here are a few examples my patients have found useful:

  • Add a few extra minutes to your commuting schedule to allow for some movement.  Get off at the wrong stop on your bus, train, or subway, and walk the rest of the way.  Park your car a long walk from where you work, and walk or jog the rest of the way in. If you are in a huge parking lot, try to find a spot in the most remote corner. 
  • If you work or live in a tall building, get off at the wrong floor, and take a few flights of stairs up and down.  If you see an escalator, make a point of not taking it, but try the adjacent stairs instead. 
  • When you get a break for lunch, take it in a different building, so you need to incorporate some walking.  If you want to catch up on lunch conversation with friends, invite them to walk and talk once the food is eaten. 

If you absolutely have to sit, consider sitting on a Pilates ball, instead of a chair. 


With a chair, you can stay at your place without moving a single muscle.  Indeed, you could even fall asleep at your desk.  Can’t do that on a Pilates ball, or you’ll roll right out of the cubicle.  Like riding a horse, sitting on a ball requires great core strength, good posture, and the constant adjustment of muscles from your toes to your neck.  If the actual ball looks too silly to use at your work, consider rigging your work station for standing.

If all else fails, use the front few inches of your chair seat as a “pseudo-ball”, keeping well away from the back rest and arm supports. 

So if you have joined the ranks of the sedentary, don’t despair.  Sitters don’t need to be Quitters!

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Stress - Use It Wisely and Stay Younger

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Are you at that "golden" age when retirement is looming, or has already loomed?   For years, we have all thought of retirement as the reward for a lifetime of work, but the reality is quite different. 

To be sure, we all know how much we enjoy a surprise day off during a blizzard, or our routine free days on the weekend or on summer holidays.  Well, an idle retirement is not just an endless multiple of these marvelous mini-holidays.  The lack of stress leads to boredom, and a lonely sense that all your working friends have forgotten you, which, after a while is quite true.  Soon one day blends into the next, and, with the absense of any time pressures or deadlines, tasks that you used to do quickly in the middle of a busy schedule now drag on for weeks.  The sense of purpose or mission is gone, paradoxically at the time in life when one needs little sleep, and has the greatest levels of intellectual and experiential resourses. 

Those who are married note that their spouses have to make considerable adjustments to their partners constant proximity, many throwing up their hands in frustration, saying "I married you for better or for worse, but not for lunch".  Arguments increase, and, in many cases, eventually conversation itself becomes extinct.  I have been in many holiday resorts such as in Las Vegas, where thousands of retired couples take vacations, and have observed them in restaurants.  Those who are with friends are quite animated, while an alarming number of those couples who are eating alone will sit in silence, each person eating their meals as if there was no one else at the table.  This is in direct contrast to newly-weds, who are in animated conversations discussing their dreams, aspirations, and the stresses that they face each day.  The retired folks, having reached their dream of stopping work, having aspired to endless free time, and having not one stress or challenge left worth talking about, have simply run out of things to say.  The particularily sad part of this scenario that happens to those who retire idly is that the consequenses are far more dangerous than simple boredom or lonliness.  The medical statistics are truly alarming.  Within a few short years, these idle seniors will become  senile, or even dead.  I've seen it happen time and time again with my patients. 

Count Otto von Bismark was the man who arbitrarily picked 65 as the age of retirement, primarily because few people reached that stage in his era.  But many, such as  Winston Churchill, George Burns, Bob Hope, and Sister Theresa,  have ignored this tradition, and continued to work and face considerable stresses long after this age. As a direct result, they all stay young in spirit, and in body, long after their idle peers have passed on or become senile.  Stress makes us think.  Stress makes us react.  It gives us a mission to achieve.  It gives us the fullest possible range of emotions, from  moments of exhilaration to moments of sadness.  In other words stress makes us feel alive, and when it is removed from our lives we suddenly feel and look old.  For centuries man has looked for ways to prolong our lives, and Ponce de Leon, for one, thought he found it.  But the real fountain of youth has been with us all along, and we have not only ignored it in our elder years, but we have actually sought ways to protect ourselves from it.  It seems that even in this age of miracle cures and laser surgery, common sense isn't very common after all. 

Here's an action tip. 

Benjamin Franklin once said "there's nothing wrong with retirement, as long as it doesn't interfere with your work".  

Wise words.  If company or government policy force you from your job, get busy finding new challenges.  If you are voluntarily  dictating your retirement, think again.  Whether it is in the form of taking courses, learning a new language, sport, or skill, or starting up your own small business, stress, as long as it is handled competently, will keep you younger longer

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A Personal Financial Crisis May Affect Your Health

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As evidenced in the stock market crash of 1929, a financial crisis can evoke a lot of ledge-jumping. The detrimental effects of having the financial “alligators” snapping at your heels are seen both in the acute fall from wealth and the chronic oppression of poverty. A financial crisis may also happen to those between the two extremes--people who are working hard and making a good wage, but lack perspective, discipline, and organization in managing their money. The seductive lure of credit cards and “no money down” purchases of cars, holidays and furniture also lays a trap for the unwary. The ease of refinancing one’s home in recent markets also provided cash that was temptingly squandered.

image of a financial crisis

Recently, in survey after survey, people say that they are either financially distressed, or already in a financial crisis, and dissatisfied with their personal finances. Close to 25% of working adults are seriously financially distressed or already experience a financial crisis. This amounts to about 30 million workers in America. 

In some cases, a financial crisis develops from a poor relationship, where excess spending is thought to “buy” improved self esteem, whether for oneself or one’s spouse or kids. People experiencing a financial crisis  are often living paycheck-by-paycheck with no money for extras. They struggle with money and debt and fret over bills. They worry there will not be enough money to live on once they retire. Perhaps most worrisome is that many do not even have hope that they might one day be able to catch up financially.

The difference between spending 5 percent more than you earn and spending 5 percent less than you earn separates living comfortable from a financial crisis. Money that is wasted on frivolous purchases could often be enough to finance stress reduction measures such as vacations, treats, or part-time help around the home. Without making time and priority for financial stress reduction, burnout is the likely result. In health, this burnout can be disastrous or even fatal; at work it can lead to an even worse financial crisis, and, ultimately, ruin.

A likely consequence of experiencing a financial crisis is a negative impact to one's health as a result of all the mental stress that is also experienced. Disagreements with friends, family members and co-workers, a restricted social life, and reduced job productivity are all possible when in the middle of a financial crisis. Often distress over health care costs and medical bills can further unveil or aggravate a depressive or anxiety disorder, which can affect:

  • coping skills
  • attention and concentration ability to the point of decreased job attendance
  • reduced workplace performance and hamper job retention for employers. 

It should also be no surprise that anyone in a financial crisis spends time at their place of employment worrying about personal finances and dealing with financial issues instead of working and that this behavior interferes with their work. Obvious ways in which a personal financial crisis can negatively impact productivity is:

  • talking with co-workers about personal financial problems
  • communicating with creditors about past due payments
  • paying personal bills
  • balancing a checkbook
  • talking to a lender about a debt consolidation loan

This can also easily turn into a nasty negative cycle of being unable to carry out normal responsibilities, having to cut back on a normal workload, and not being able to accomplish as much as usual. This cycle further interrupts employee performance, workplace attendance and poses greater financial burdens which only increases stress and financial pressures. In the worst case, a personal financial crisis may lead to losing one's job and takes the financial crisis from the frying pan to the fire, so to speak!

When I see a patient with chest or stomach pains, headache, depression, or other signs of stress related conditions, I always ask how things are going financially. Very often the rest of the medical history will be negative, but the health crisis will be caused by too much month left at the end of the money.

In a case like this, a good financial planner can often help more than a doctor.

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Having Difficulty Giving Up Smoking? Don't Be Depressed!

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Are you smoking more and enjoying it less?  Well, researchers may have found the reason why.

smoking can cause depression, making it that much more difficult to quit

It's been known for years that smokers develop permanent facial lines radiating out around their lips, from years of sucking on rolled up vegetable leaves.  Well, in addition to associating smokers with puckered faces, it seems we can also associate them with long faces. 

There are thousands of chemicals other than nicotine constituents in cigarette smoke, of which one, or several, may affect mood in much the same way as a group of antidepressant medications called monoamine oxidase inhibitors or (MAOIs). These MAOIs effectively increase levels of specific neurotransmitters involved in the regulation of mood. Smoking, therefore, may be a way for depressed individuals to self-medicate depressive symptoms.

Dr. Alexander Glassman, of New York State Psychiatric Institute, discussed his findings in the Journal of the American Medical Association.  He notes that people with a history of depression are more likely to smoke, and 40% less likely to quit for good. It seems that even smokers who aren't now depressed, but have suffered major depression at some time in their past, are just as likely to have trouble as those who are currently depressed. 

It just goes to prove the old adage, that it is not enough for a doctor to discover what kind of an addiction each patient has, but one must find out what kind of a person each addiction has.  In other words, by just using generic treatments for smokers without heeding the rest of their health problems, doctors and patients alike can fail, in spite of the best intentions. One of the common features of these cases is that the ex-smoker becomes very depressed after stopping cigarettes.  Because of this Dr. Glassman is studying whether anti-depressant drugs can help such smokers quit successfully. 

If you are planning to quit smoking, by all means do it now.  But if you have had a history of depression, make sure you see your doctor for advice, and, if indicated, for short term antidepressant medications.

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Depression and stress: More than meets the eye

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In a recent post, we discussed common stress complaints from real patients in our clinic. (see Top 10 Ways Stress Can Hurt You).  Over half of our stressed patients admitted to depression as one of their problems. 


But, contrary to what the Prescription Drug Cartel would like us to believe, not everything is caused by the lack of a 

brand-name drug.  On the other hand, drugs certainly do belong on the overall menu.  Let's take a look at the big picture of what might make us depressed. 

1.  External Stress:   This is depressing (the adjective).  The rescuer could come from many disciplines.  A wardrobe makeover could be the key (see What Not To Wear).  A lawyer could spring for bail, a trucker could pull one's stranded car out of a snowbank.  If sadness comes from winter darkness (see  Seasonal Effective Disorder ) then a travel agent could offer just the cure.  If the stresses are financial, a financial planner could solve the problems, albeit much more slowly.  In any event, this is not a disease unto itself, but simply a normal reaction to unhappy circumstances. 

2.Internal Stress: This is depression (the noun).  Nothing in the external world makes any difference.  For example a person could be financially secure, in good health, and have good relations with family and friends.  But they could also be feeling a crushing daily sadness.  This is the chemical imbalance inside the brain that deserves full consideration of medical science. The rescue menu here is much different, involving a medical work-up, councelling, and often medications.   

The problem arises when the public assumes that all who are depressed should start with drug therapy.


Here are a few areas to review before seeking medication:

1. Diet: Depression is made worse by the inappropriately named "comfort" foods.  It would be counterproductive to have an antidepressant pill in one hand, and a bag of cookies or a soda in the other.

2. Sleep: Rest is a weapon for the next day's battles.  Insomnia can be beaten (see Insomnia: Is It Worth Losing Sleep Over?).

3. Exercise: Runners speak of the endorphin "high" that comes with their daily exercise, and of feeling depressed when they stop for a few days.  Exercise in any form is excellent for mood elevation. 

4. Time management: If you are feeling overwhelmed and depressed by today's time "famine", then get a grip on your time management.  Start writing things down in one trusted place (organizer book or cell phone).  Learn to prioritize, and be selective about which of tomorrow's activities are really important.  The lesser items could be put off, or done if time emerges.  Then when you do get a ten minute gap, you won't fritter it away. 


If you are feeling depressed, don't assume that relief is only a pill away.  Take a look at your circumstances, and consider your responses to diet, sleep and exercise.  If you are still blue, by all means see your doctor for further advice.

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Top Ten ways Stress can Hurt You

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For the past year, I have been working in active Family practice, including busy walk-in clinics, as well as my private office.  Having seen thousands of new people in these past months, it is clear that Stress is still one of the major factors in our Health Care Crisis. 

Stressed Worker

Our headlines have never been more stressful, and are all about issues that are beyond the grasp of the individual reader, even though the effects are felt by all.  For example, the gulf oil spill, the worsening economy, the jobless "recovery", and, not to forget, our two wars that are claiming more lives, more treasure, and seem to be generating more corruption from the governments we are supposed to be saving.  To paraphrase the old saying: "if it weren't for bad news, we'd have no news at all". 

But bad news preys on the human body and mind.  Especially because we are bombarded with these disasters dozens of times a day (newspapers, emails, talk radio, 24-hour TV news, cell phones, twitter etc).  Granted, stations now try to lighten up with idiotic stories, like "Skippy the Squirrel Learns to Water Ski...with film at 10".  But the omnipresence of bad energy leads to predictable results.  The following is the result of a survey of over 500 patients whose health drove them in to see me in the last three months, and asks the question "What does Stress Do to You?".  Each patient could mention more than one choice, depending on their body's responses.

Let's take a look at the Top Ten Ways that Stress Hurts:

1.  Insomnia  (71%)  From having difficulty falling asleep, to having troubles staying asleep, this was the most common complaint.  Waking up refreshed was rare.

2.  Anxiety (65%)  Bad news contaminates our conversations, our dinner hour, and our "down time" that we try to carve out of our busy days.  People are developing white knuckles on their Blackberries and I-phones, consuming the latest iterations of horrible news.

3. Depression (52%) With so little control over these stressful stories, no wonder people are depressed.  Sales of Effexor have never been higher! (note, antidepressant medications are rarely the best line of defense here, but more about that in other blogs!) 

4.  Skin reactions (acne rosacea, excema etc) (38%) Breakouts of acne, including rosacea, as well as itchy patches of excema are very common as a manifestation of stress. 

5.  Cardiac effects: racing beat, increased blood pressure.   (23%)  Many people can "hear" their heart pounding, as the internal carotid arteries pump close to the ear mechanisms.  Palpitations are often felt in the chest, and people will often break into a sweat.  Blood pressures can also rise, along with heart rates.

6. Indigestion, stomach pains. (22%)Sales of medicine for heartburn, stomache aches, and acid reflux have never been better. 

7. Change of bowel habits (constipation or diarrhea)  (22%) Some respond to stress with diarrhea, while others seize up and get constipation. 

8.  Headaches (including tension, migraines)  (20%) Lasting anywhere from a few minutes to a couple of days, headaches are a powerful reminder of the mind-body connection. 

9.  Fibromyalgia  (17%) When you have pain in a joint, it is called "arthritis".  When you have pain between the joints (in the muscles and soft tissues) it is called "fibromyalgia".  No blood tests or X-rays will pick it up, but millions of Americans know it is sure real.

10. Obesity.  (60%)  While some respond to stress by cutting down their food intake, the majority are seeking comfort with "comfort foods".  Obviously badly named!  The "white death" of white sugar and white flour contributes to our epidemic of obesity, especially in our children.

While the Prescription Drug Cartel wants us to all believe that each of the above symptoms is caused by the Lack of a Brand-Name Drug, there are a host of ways to defend ourselves before reaching for a prescription pad.  We will discuss each of these in upcoming articles!

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