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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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The Big Three in the Devil's Kitchen

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Medicine is supposed to be a precise science.  One set of symptoms means one disease, usually with one treatment.  At least in the text books.  In the real world, all bets are off.  Just because a patient has one disease does not mean they couldn't have another, and another.  When patients complain of fatigue, general achiness, stomach cramps, headaches, and lack of focus, Doctors are often baffled.  They are basically flipping through one chapter after another in their mental database, trying to find one disease that will expain all.  A hundred years ago, we just made up a word, and called it "liverishness".    Nice way of ducking the question.  Now, with patients quick onto Google, that bluff answer won't work for long.

So what can we do about these multi-system complaints?  After a routine physical examination, and tests to rule out hidden dangers, I often consider a therapeutic trial of diets.  The patient needs a pencil and paper, to record daily diet intake, as well as symptoms.  

We now turn our attention to the most common offenders in today's diet: The Big Three in the Devil's Kitchen:

1. "White Death"  

Otherwise known as white sugar.  White flour also turns to sugar in minutes.

Because neither comes with its original equipment of whole fibers, then both are instantly absorbed and cause inflammatory results right away.  As inflammation is the basis of all disease, this means that virtually all symptoms can be flared up, from hyperactivity and depression to muscle aches and colitis.  In their whole form, sugars and starches that are still encased in their fruit or grain bodies are fine.  They come with lots of fiber to fill the stomach, and slow the rate of absorption.  Once all the fiber is "refined" away, then the body is vulnerable.  As a simple illustration, our stomach can probably only hold three apples and a glass of water.  But if we remove the fiber from the apples, and boil off the liquid from the juice, we get a sugar-filled concentrate, or eventually a powder.  Now we could fill up the stomach with the sugar of fifty apples, and still have room for more!

Action Item: Because "white death" is junk food, it doesn't need replacement in our grocery carts.  Just removal.


2. Dairy 

Brilliantly marketed as "Nature's Perfect Food", milk is only perfect if you are a three-hundred pound heifer.  One should note that even cattle are smart enough to quit milk once they grow up; it is only humans who persist after they become adults.  And we drink the milk of a different species.  Dairy products taste great, and in many cases cause no immediate or obvious side effects.  But in the case of "liverishness" symptoms, it is one of the likely offenders, causing unnatural challenges to the human imune system.  Remember, there is twelve pounds of milk in a pound of cheese, so that means trying your pizza with "extra-no cheese".  Also note that singers never drink milk between songs, as the mucous thickens immediately in the throat; so avoid all dairy the next time you have a cold, cough, or earache.

Action Item: If you are having vague symptoms, try excluding all dairy for four weeks.  Then try and introduce it for an occasional meal; take a look at your records to see if there is a connection.  If your symptoms are connected, then leave the dairy alone; otherwise bon apetit!


3. Gluten 

 Now this one is tricky, as it is found in lots of excellent foods, like whole grain pastas and breads.  But there is a significant number of people (quoted as high as 40%) that can have some reaction to it.  It may be as simple as a bit of gassy bloating after a meal, but for many it can mean abdominal pains, muscle aches, headaches, and insomnia just for a start. 

Action Item: Once you have spent a month on your "dairy diary", you may already have your answer.  If your symptoms are still present, however, you can elect to go back to the milk products, and move on to the exclusion of gluten for the next month.  This requires some persistence, but you can find "gluten-free" labels on pizza crusts, sandwich wraps, breads, pastas and even pastries.  When in doubt, just stick to fish, eggs and green vegetables as a mainstay.  At the end of the month, see if your record shows any improvements.  If not, then you can return to full diet.  For more info on gluten, see



Note that the above is simply an adjunct to the process of investigation.  If symptoms persist, and your record shows food intake is irrelevant, then your doctor can escalate the investigations as needed.  Better to solve your symptoms back at the grocery store, before needing to involve the hospital! 

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Stress Alarms: Are any of Yours Ringing?

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Just like a car has its "check engine" light, the human body has its panel of stress-alarms.  With times as turbulent as they are now, it is good to review our three lines of stress defense, before something breaks down.


1. First Alarm: "How do I Feel ?"

Do you hate your work and live for the weekends?  If so, your current attitude will be a good indicator of your future health.  People who love their work tend to have far less heart disease, have greater self-esteem, and good relationships within their immediate family as well as friends.  People who are negative, and say "TGIF" instead of "TGIM" ("Thank Goodness Its Monday!") have the opposite scenario.  These are the ones most likely to harbour health issues, and actually carry home their negative work energy so that it ruins their sleep, and distracts them from enjoying their time off.  If you hate your job, do not dismiss the longterm dangers to your health.  At least try to develope a plan to upgrade your skills, and to seek other opportunities.  Or find a passion to follow in your spare time.  Also ask yourself how you feel when you are actively moving.  Does it feel like you are carrying the same weight as you did in your younger years?  Does it feel as if you are out of shape? 


2. Second Alarm: "What is my Feedback ?"   

Even if you feel great, don't ignore the feedback that others give you.  At work it may be obvious if your boss sees your performance numbers slipping.  It could be a co-worker who might comment that you seem "a little off your game".  Customers or employees might ask "are you sure you are alright" if you look distracted or pale.  If you are getting comments like "its not like you to make so many mistakes" then your "check engine" light is on.  Just like a driver beside you who is pointing to your tire: ignore these comments at your peril.  They can be a great signal that it is time to come in from the track for a pit stop, and review your stress strategies.

3. Third Alarm: "The Silent Signals"

Here is the tricky part.  There are a whole series of stress alarms that don't appear in your feelings or your feedback.  These are the ones that your doctor can find for you.  Blood pressure, blood sugars, levels of cholesterol, iron, and vitamins can all be measured.  Levels of hormones, and other predictors of disease can also be tested.  The cardiogram can be checked, under stress as well as at rest, and troubles can be spotted long before they surface as a pain (or, worse yet, as a sudden last breath!).  Ultrasounds and other scans can detect enlargements of prostate, lymph glands, and blood vessels, while X-rays can rule out bone or lung diseases.  More sophisticated scans like MRI's and CT scanners can pick up tumors before they are palpable, and can alert us to other diseases at the earliest possible stage. 

While stress is inevitable, bad consequences are not.  At least we can shave the odds in our favor by paying attention to all three levels of stress alarms.  If we don't, then the first warning of our next heart attack could be our last breath.


To recap:

1. Feel better: be in tune with your body, and match your fuel intake to your exercise needs.  Also, for your mental health, keep your brain in shape and prepared for your current job, or to train for a future one.

2. Listen better: Don't ignore or reject unsolicited comments from others.  Like the guy pointing to your tire as you are driving. 

3. Look better: Or in this case, have your doctor look.  A simple physical exam can pick up a great deal of hidden information about your response to stress.  If you have insurance, or can afford to dig a little deeper, consider additional tests, such as are offered in executive physicals at specialty centers like the Mayo Clinic, or Med-Can.  The peace of mind can be most reassuring!

For more information, see your doctor for a check-up soon.  If you wish further information in the US, contact  In Canada contact


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Is Your Stomach Feeling Stressed? Try Eating Slower!

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One of the common complaints I hear in my offices is about effects of stress on the stomach. These can include acid reflux, upper abdominal pains, waking up with gas or wet "burps" full of acid.

eating too fast

Doctors are trained to take a history, examine the patient, then take images (X-rays, ultrasound or MRI's) that could shed light on the diagnosis.  Even blood tests are helpful, to rule out anemia from blood loss in the stomach, to checking for an antibody to the bacteria H. Pylori, a  cause of ulcers that can be found in the stomach.  But once such steps have been taken, the usual direction is to take medication, such as the proton-inhibitor Nexium.  A good drug, but before it is given, I always like to look at one other very important factor: the speed of eating.

Aerophagia , or, literally "air-eating" is a huge problem when people are under stress.  It can be insidious, or it can be obvious.  Gulping audibly is one obvious form of air-eating, another is "slurping" drinks through a straw.  A third way is to drink fizzy liquids, like beer or carbonated waters.  But even if all these are avoided, then a major factor can be speed.  When food is taken quickly, it almost always involves a huge intake of air. 

That's why our parents admonished us to eat with our mouths closed, and to chew our food "twenty times" for good measure.  Actually the latter suggestion increases the pre-digestion of food by mixing it with amylase from the salivary glands, to start to digest the proteins before they even hit the stomach.

So take a look at your plate when you finish eating, and compare it with those of your meal-mates.  If you are finishing first, you are probably wolfing down your food, and will likely be paying the consequences later. 

So take time to relax during eating, and don't treat meal times like the Formula 1 race cars' 9 second pit-refueling binge.  Place your food in an artistic fashion on the plate (don't eat out of the bag or box), and set the table for civility, even if only with paper napkins and water glasses.  Take time to converse, if company is available, or to listen to relaxing music.  If you are alone, reading can also relax your meal time. 



Further advice from our grandparents might also include never talking about politics or religion during meals, as it can certainly lead to arguments unless you are sure your table-mates share your opinions.

When you are under stress, don't assume you will therefore get an ulcer or heartburn, and will therefore have to take drugs.  Its easier to operate on your eating style than to operate on your stomach.  Bon apetit!


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Vegetarian Foods: Not always a ticket to health!

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Vegetarian Foods: Always Good? Not So Fast!

When we are under stress, we often are distracted from what we eat.  That's why we are seeing obesity and heart disease increase as our daily lives get more challenged.  Paradoxically, our fuel intake is even more important to our health during times of stress. 

A growing trend now is for people to embrace vegetarianism.  It is better for our ecology, can produce better health, and it can make us live longer. All true statements. But before we assume this is an automatic panacea, let's consider the full picture, and be aware of some caveats.


1. Vegetarianism is Better for our Ecology:

Point: It can take as much as 14 pounds of cattle feed (wheat/grass/oats) to produce a single pound of meat.  Not to mention 5,000 gallons of water.  Purists will point out this great efficiency if we eat the grain instead of feeding it to animals, then eating them.  

Counterpoint: With organic or free-range animals and fish much of the "factory" syndrome can be avoided: the animals are in their natural state, and in fact are meant to be culled to preserve their species.  If no hunting was ever allowed, many species would die out because they would out-populate their given food supply.  Also consider that vegetables that do not carry the "organic" adjective can be raised with a lot of pesticides, and other obnoxious chemicals, and be raised in ways very unfriendly to the environment.

2. Vegetarianism is Better for our Health?

Point: Dr. Dennis Burkitt, an English surgeon who worked in Africa last century, noted that the Europeans he treated had a litany of diseases that he rarely saw with natives: for example, appendicitis, gall stones, varicose veins, heart disease and cancers.  Burkitt was aciduous in his pursuit of science, which extended to weighing human stools at the roadside between villages.  He concluded that the European diet produced stools of only a quarter the weight and volume of the native diet, which was largely vegetarian.  He concluded that the people that have the smallest stools have the biggest hospitals.  (I have previously referred to this as a Turd World Study). 

Counterpoint: Even a vegetarian diet could have been ruined by bleaching or "refining" all the ingredients, like we do to flour and sugar.  The main protection was the presence of fiber, not the absence of animal protein.  Today it is possible to be a complete vegetarian and still have absolutely no fiber.  For instance, the obese ten-year old often only eats candy, cookies, french-fries or chips, and soda-pop. All vegetarian, and all a disaster. 

3. Vegetarianism is Better for Longevity?


Point: Long living vegetarians, like George Bernard Shaw, pictured, (who died in 1950 at age 96) attributed their lack of cancers or heart disease to the absence of animal proteins and fats in their diets.   Certainly most centenarians are thin, and vegetarian fiber helps prevent over-filling the stomach.

Counterpoint: The wino that I see in a street clinic is typically young (often just thirty-something), yet looks incredibly old and wizened. Basically they die very young, yet their diet was purely vegetarian: the fermented juice of the grape, and packets of chips. 


Conclusion: Consider the truth from the tooth: 


 Vegetarian animals like the Hippopotamus have flat teeth (in this case looking like foot-stools).  Carnivores like wolves and cats have sharp cutting teeth.  Both perfectly designed for their respective diets.  Humans have a combo: cutting teeth in the front, and vegetable grinders in the back.  So Humans have choices. 


But remember, you can find both good and bad foods in the vegetarian world, so be selective, and select vegetables that don't have insectisides or other chemical treatments.  If you enjoy some meat, poultry, fish etc, be sure to select from organically grown, with no added hormones or antibiotics,  Also remember to add good fiber content from the vegetarian universe in order to fully balance your diet.  Putting good fuel into your body will only make its engines perform better under stress.  Bon apetit!


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