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### Human:\nhow can i convince the medical insurer to pay for newly on-the-market drugs (re cancer patient stage 4)? . my sister has metastasized breast cancer. afinitor appears to be the drug treatment option with the most hope. how can i convince the medical insurer to ok (and pay for) this drug treatment? what are the most likely to succeed methods to put the pressure on them for the purpose of extending my sister's life with these new medical treatments?\n\n### Assistant: insurance companies pay for medications when a drug has received fda approval for treatment or there are advanced clinical trials (phase iii and above) which show that the treatment is effective. what is hard for patients and families to sometimes understand is that insurance companies only pay for proven therapies not experimental therapies. this is especially hard when the disease is cancer. fortunately the national institute of health and drug manufacturers are very involved in clinical trials for new cancer drugs or new indications for cancer drugs. clinical trials are very important because cancer drugs are generally very toxic and expensive and we need scientific evidence to decide on the best treatment options not anecdotal successes. because each cancer patient’s situation is different we want to make sure that a drug works for a particular patient. not all breast cancer patients are the same. some have limited disease some have advanced disease some breast cancers occur before menopause some after and hormonal and genetic characteristics can vary from patient to patient. afinitor (everolimus) is fda approved for breast cancer in combination with aromasin (exemestane) for certain postmenopausal women. the breast cancer must be advanced hormone-receptor positive her2-negative and in patients who experienced a recurrence or progression of their cancer after treatment with hormone therapy using femara (letrozole) or arimidex (anastrozole). if your sister fits in this category then her cancer doctor can write a letter to the insurance company citing her qualifications. another important avenue to pursue for cancer patients is clinical trials. you can look up clinical trials on the web site <link> by cancer type and features in your zip code or state. there are several ongoing breast cancer trials using everolimus (afinitor) that may be applicable to your sister. talk with her cancer doctor about clinical trials and assistance in working with the insurance company to get the best treatment for your sister.

### Human:\nis it possible to get breast cancer after a complete hysterectomy?\n\n### Assistant: this is a little complicated. i think it will help to go over the terms that doctors use for female pelvic surgery. a hysterectomy is the surgical removal of your uterus. a “total hysterectomy” means that the entire uterus and cervix are removed. having a hysterectomy does not increase your chances of getting breast cancer. a “complete hysterectomy” is a non-medical term that is sometimes used to refer to surgery that removes the uterus as well as the ovaries and tubes. removing the ovaries can reduce your risk for breast cancer. if your ovaries are removed (oophorectomy) along with your uterus your doctor may suggest hormone replacement therapy. this is usually estrogen-only rather than combination therapy. according to the american cancer society this type of estrogen-only replacement does not increase the risk for breast cancer. in fact it appears to decrease the risk. i hope this answers your question. here is a webmd article that discusses some recent research concerning hormone replacement after hysterectomy and breast cancer risk.

### Human:\nmy period stopped two weeks ago and i now have a light brown discharge. it's 24 days between periods. what’s happening?\n\n### Assistant: i am assuming that you are not using a hormonal form of birth control (e. g. pill/patch/ring/shot). if this is correct then my best guess is as follows. your normal cycle is usually 24 days from the start of one flow to the start of another. this month it sounds like you started the light brown discharge on cycle day19 or so. this might represent premenstrual spotting. this type of spotting can begin as much as a week before flow. some women will get it every month a few days before flow. the usual cause is a missed ovulation or a decline in progesterone level that month. this is not an uncommon or worrisome thing unless it happens every month. of course if you have any risks for pregnancy that should be ruled out. a reliable pregnancy test done on cycle day 28-30 should be done if you are sexually active. if the test is negative and you have no risks for a new chlamydia infection you could choose to self monitor through the next cycle. hopefully your "normal-for-you" pattern will reset it self naturally. if erratic bleeding persists see your gyn or local family planning clinic. lastly if you are using hormonal birth control then this would likely represent breakthrough bleeding from the hormones in your birth control method.

### Human:\ni have very dry hands that are cracked. what should i use on them?\n\n### Assistant: your first step is to exclude any underlying medical causes such as a thyroid condition connective tissue disease or an infectious process. when you wash your hands avoid cleansers that contain alcohol. this will further dry your hands. your next step is to focus on moisturizing and hydrating your hands.

### Human:\nwhy do i get so tired after exercising? . i haven't gone out and done physical activity for about a month so i just went out for a nice and easy power walk for about 50 minutes. i come home and suddenly i just feel sluggish and exhausted. i don't starve myself. i eat when i'm hungry and when i need to eat. i get super tired and when i come home i just knock out. because i get so tired i don't like to exercise when i have school. it's been affecting my health and my body. i really want to exercise daily. help please <negative_smiley>\n\n### Assistant: maybe you could start with smaller bouts of exercise instead of 50 minutes. start walking for 5 minutes per day and as you feel stronger increase to 10 and so on. make sure you eat something about 30 minutes before exercising like a banana yogurt or granola bar. if you are low on glycogen (stores of carbohydrates in muscle) it could increase your tiredness after exercise. if you continue to feel tired without a good reason visit your healthcare provider for a full blood work-up. certain nutrient deficiencies like anemia can also make you tired. hey there can be a lot of reasons for all this happening to you 1. first of you should must adjust carbohydrate quantity and qualityin your diet 2. your muscles are also not strong enough as you dont do workout regularly 3. may be you are not well hydrated. take fluids with essential electrolytes before during and after exercise. 4. start working out regularly or alternatively one day rest and the next workout. 5. always do a little warm up before exercise and stretching after the exercise. 6. eat proteins a bit more than you normally eat so that your muscles can develop. 7. take at least 8 hours sleep a day which should must have a ciesta of 1 to 2 hours. 8. take a cup of coffee an hour before doing exercise this will boost your metabolism and keep you vigilant for a couple of hour at least. 9. and at last your tiredness can also be a result of some medical condition like hypothyroidism or some metabolic disease i am a 5 year med student i was skinny a 2 year before and same things used to happen to me then i started using the techniques that i mentioned above and it really improved my stamina my muscle size and my mood especially i gained 10 kg of weight without any increase in my waist. that was a just a brief overview of the solution to your problem if you want details of all this i am here to help you muhammad noman imtiaz cuba nomanimtiaz@ucmex. vcl. sld. cu i have chronic fatigue syndrome and exercising makes me worse. it's called "exercise malaise". i don't know if that's what you have but i would ask your doctor. i like yoga. i always feel rejuvenated after yoga.

### Human:\ncan antidepressants cause weight gain?\n\n### Assistant: most of the antidepressants and probably all of the mood stabilizer[s] can and do cause weight gain. bupropion -- commonly known as aplenzin wellbutrin or zyban -- usually does suppress appetite and can result in less weight gain than other antidepressants. within each family or class of meds there are some that are more weight-gain prone and others that are a bit more friendly. ask your doctor specifically about the more weight-friendly ones. also be careful in that weight gain may lead to diabetes and cholesterol problems. if you have gained ask your doctor to check on these and blood pressure too.

### Human:\ni was told by a doctor that the age spots on my hands are from hormones. i thought it was sun exposure. what can i use?\n\n### Assistant: there are several pigmented skin problems caused by hormones. age spots are very common. and you're correct they are caused by sun exposure. there are several agents that lighten them including licorice extract niacin hydroquinone and others. it's very important during and after the use of a brightening agent to apply sunblock or the spots will return.

### Human:\nwhat can i do about the dark circles under my eyes?\n\n### Assistant: hyperpigmentation discoloration or post-inflammatory hyperpigmentation (pih) on your skin can be attributed to a variety of disorders. i like to begin with excluding any medical reasons that may result in hyperpigmentation. hyperpigmentation may be attributed to renal disease diabetes or peripheral vascular disease. pih arises from an acquired excess of pigment related to an inflammatory process such as infection an allergic reaction a reaction to medication or a trauma. pih often occurs as a consequence of inflammatory skin disorders including acne drug-induced eruptions and eczema. once you have excluded medical causes there are multiple options to regain your even skin tone. a combination of glycolic acid aha and tretinoin-based products -- along with a traditional topical skin care regimen -- will work for skin brightening. hydroquinone-based products work well. however there are other alternatives such as bearberry kojic acid licorice extract and niacin. these compounds will work towards brightening your skin and correcting your skin tone. the key is to work with a physician that is very familiar with your skin type and color because incorrect use of these agents can lead to further hypo- or hyperpigmentation. i tell my african-american patients in particular that in order to get your skin in shape it has to be a gradual process similar to exercising. you would not attempt to lift 250 lbs on the first day of your workout; this attempt may lead to injuring yourself and disastrous results. the same holds true with your skin regimen a gradual approach is always best. once you get your melanocytes in shape and under control you can improve your skin tone.

### Human:\nif i have trouble gaining weight because of my low appetite would a higher intake of the hormone leptin help? . i grew up always considered "underweight" for my age height and sex. people tell me it's just genes or i'm just a small eater but i think it's more than that. i'd like to gain more weight without being unhealthy about it. i have a low appetite and i just read an article on this website about leptin and leptin signals the body's energy-nourishment.\n\n### Assistant: leptin actually decreases appetite and as far as i know it is not something that is given to increase it. for more on hunger hormones and how they work see this article. there are appetite stimulates that doctors can prescribe but before you would even consider this you should get help on diet and activity. i recommend seeing a registered dietitian who can examine your eating habits and history and provide tailored advice on when how and what to eat. to find one in your area go to eatright. org. this article describes some healthy ways to gain weight. good luck!

### Human:\nfoods to bring down your blood sugar naturally. i would like to know what foods to eat to bring down my blood sugar naturally. i do not want to take any of the shots as they cause cancer and there is enough cancer in my family line now.\n\n### Assistant: by shots i assume you mean insulin. the key to bringing down your blood sugar is to track your carbohydrates since they are what raise blood sugar. foods rich in carbohydrates include bread/grains beans fruit milk and yogurt and added sugars such as those in sweet foods and beverages. foods rich in protein and fat do not raise blood sugar like carbohydrates do. protein foods include lean meats poultry fish eggs and tofu. fats are items like butter vegetable oil nuts and seeds and avocado. vegetables are typically recommended because they are low in carbohydrates but high in nutrients. so they can be consumed in large amounts. the key is to include healthy carbohydrates in controlled amounts while including protein vegetables and healthy fats with meals. if you consume sweetened beverages switch to water. i highly recommend seeing a diabetes educator to help you put it all together. below are some articles that might help: healthy diabetes diet 6 foods that may help control your blood sugar how does my diet affect diabetes? cinnamon fenugreek garlic avocados and nuts blueberries which are also a great source of soluble fiber and a number of other important nutrients red cherry vinegar can help you in lowering the blood sugar. <link> top essay writing service

### Human:\nwhat does it mean when your blood sugar drops to 57? . my grandmother has type 2 diabetes and she was wondering what a reading of 57 is.\n\n### Assistant: that is a low blood sugar reading. the american diabetes association recommends 70-180mg/dl for most nonpregnant adults with diabetes. before meals it's 70-130mg/dl and 180mg/dl or less after meals. more or less blood sugar levels may be recommended based on individual circumstances. if your grandmother continues to experience low blood sugars she should see her healthcare provider. she may need changes in the medications she is taking. for more on managing blood sugars see this webmd article.

### Human:\ni've been on mirena for a year. my period has suddenly stopped after several months of lighter flow. is this normal?\n\n### Assistant: given that [the pregnancy test] was negative and you mentioned increasingly light flows over time my best guess is that this is a "normal" mirena side effect. simply stated if the uterine lining is like grass or lawn estrogen is like the fertilizer (causes a thickening of the lining) and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). this is why depoprovera (high dose synthetic progesterone) brings about a thin lining and why birth control pills (relatively progesterone dominant) bring about shorter lighter periods. the mirena distributes significant amounts of synthetic progesterone right at the level of the lining of the uterus. that is why a large percent of mirena users lose their periods after 12 months of use. as mentioned this can also happen with birth control pills and the depo provera shot. a thin lining is a healthy lining when it is caused by hormones in birth control methods. your lining will regrow after the mirena is removed---or even toward the end of the five years as the level of hormone in the iud is tapering down. .

### Human:\nwhy do new dads get depressed?\n\n### Assistant: you’d think any new parent would be elated to hold a precious newborn in their arms. although guys can’t blame it on their hormones sleep deprivation has a major impact on someone’s view of life. spend two (or more) months with three-hour stretches of sleep and see how you feel! some dads also get stressed about 50/50 shared parenting responsibilities. (although they are happy to help many of them don’t have their own dads as role models. ) dads’ depression symptoms often go unnoticed. that’s because men don’t cry. depressed men may act angry withdrawn or even abusive. it’s important for friends family and health care providers to identify dads with postpartum depression and encourage them to seek help.

### Human:\nwhat is tsh?\n\n### Assistant: tsh is thyroid-stimulating hormone produced by the pituitary gland in the brain. tsh stimulates the thyroid gland to produce and release thyroid hormone into the blood. thyroid hormone maintains normal metabolism growth body temperature and many other essential bodily functions. blood levels of tsh and thyroid hormone are maintained in a tight balance. high levels of thyroid hormone cause the pituitary to reduce the release of tsh. low levels of tsh lead the pituitary to release more tsh. this in turn stimulates the thyroid gland which produces more thyroid hormone which reduces the tsh level. this relationship is called a negative feedback loop. doctors use the blood tsh level as a screening blood test for thyroid function: high tsh usually means an underactive thyroid (hypothyroidism). low tsh is usually due to an overactive thyroid (hyperthyroidism). in people being treated for hypothyroidism or hyperthyroidism tsh also provides information on the success of treatment.

### Human:\nwhat are bioidentical hormones for menopause?\n\n### Assistant: bioidentical hormone replacement therapy (bhrt) is a more individualized method of hormone replacement. saliva testing is required to examine whether or not a patient has reach the targeted level of hormones in the body after receiving the therapy. the types of hormones used in this therapy include estrone estradiol progesterone testosterone and dehydroepiandrosterone. usually the cream is compounded by a specialty pharmacy. some insurance companies do not cover these products.

### Human:\nmy husband has been taking janumet for over a year. our insurance wants him to take cheaper medicine. any suggestions?\n\n### Assistant: janumet is a combination product containing januvia and metformin. both medications are used to help decrease sugar levels found in blood circulation after eating a meal but by different mechanisms of actions. metformin is a generic medication that can be found at several pharmacies on their special pricing lists for one month and three month supplies. however januvia is still a brand medication as well as janumet. there are plenty of different combinations of diabetes medications that can be used to lower sugar levels. however if sugar levels are being maintained with this combination product i would not switch. check with your insurance company to see if there is a lower co-pay for using januvia versus janumet. if so you still can get the same coverage as janumet by taking the two ingredients januvia and metformin. there aren’t medications in the same drug class but there are medications available to help lower sugar levels by a different means of action within the body. start by contacting your insurance to see what they cover and at what co-pay costs. work with your pharmacist and physician to see what will work best for diabetes coverage specific to your husband’s needs. check around with pharmacies to see if they have different generic lists of medications they cover at a lower cost that may be lower than your insurance. lastly talk to your doctor to see if he/she has any co-pay assistance cards. many brand medications do have an assistance program to aid with co-pays. .

### Human:\ni have type 2 diabetes and i am confused why 1 to 2 hrs after eating a full meal i feel hungrier than before i ate.\n\n### Assistant: it really depends on what and how much you are eating at mealtimes. if you are eating very little fat and protein which are filling you could be hungrier faster. here are some tips on how to stay full longer: include a protein source at meals and snacks. that could be an egg with your oatmeal lean meat with lunch and fish/beans at dinner. include a healthy fat source at main meals. that could be nuts/seeds topped on cereal or yogurt avocado on a salad or sandwich and veggies roasted with olive oil increase fiber intake by including beans fruits vegetables and whole grains which add to fullness. include salads at lunch and plenty of veggies with dinner. include 3-5 food groups (lean protein fruit vegetable whole grain healthy fat and dairy) at main meals 2-3 at snack time. keep your carbs consistent as directed by your healthcare provider. keep a journal and note which foods do a better job of filling you up because at least part of this is subjective. if you have recently changed your eating habits it may take a while to get used to eating different foods and more frequently. most people with diabetes eat at least 3 meals and one snack. good luck!

### Human:\ntested first time bs fast 135 pp 180 and s. chol 255. is choles due to diabetes or otherwise or both are independant?\n\n### Assistant: actually the answer is a bit complicated. high cholesterol and diabetes are independent risk factors for heart disease. some people may have one or the other. but many people have both and they do appear to be related. scientists are studying the effects that high blood sugars and insulin resistance have on the different types of fats in the blood. insulin is a hormone made by the pancreas. it helps the cells in the body take up and use glucose for energy. in diabetes the cells become resistant to the effects of insulin. glucose then builds up in the blood. the more resistant the cells are to insulin the higher the triglycerides and ldl (or bad cholesterol) levels become. at the same time the hdl (or good cholesterol) levels fall. but the good news is that both diabetes and high cholesterol can respond to the same healthy lifestyle changes. talk to your doctor about positive changes that you can make in your diet and exercise habits that can put you back on the road to good health. webmd is a great source of information about diabetes and about high cholesterol. here are two links to get you started. <link> <link> you may also want to talk to a diabetes educator or nutritionist. they can help create a diet plan that is right for you.

### Human:\ndoes stomach fat decrease insulin effectiveness\n\n### Assistant: fat around the belly is associated with insulin resistance and increased risk of diabetes. this may not happen for every person especially if they engage in healthy habits but this type of fat is considered a risk factor for certain health conditions like diabetes. for more on the subject see the truth about fat.

### Human:\nif i have alot of anger stress and emotional baggage what is the best sport i could exercise or learn to help me vent?\n\n### Assistant: exercise can help you manage stress by releasing endorphins which are neurotransmitters in your brain that help you to feel good. another benefit of exercise for stress management is that it can also be used as a break or as personal time away from your stressors to clear your head if necessary. exercise can also help with depression and anxiety and can help improve your sleep help you to feel better or boost your energy levels. there is no one type of exercise that will help you manage stress better than any other. the main thing that you need to find is a type of exercise that you enjoy doing. exercise should come naturally and should be something that you look forward to doing not something that you feel forced to do and don’t get enjoyment out of. remember this is about making yourself happy so you may have to experiment with different activities until you find something that really works well for you. set realistic goals that are achievable and dedicate an amount of time that you find manageable so that you’re not adding more stress or creating another burden. besides exercise there are many other stress-reduction techniques like journaling meditating using breathing exercises or mental/guided imagery. you could also meet with a psychologist psychiatrist or your doctor to discuss other treatment/management options. hi a big sorry that should read rugby otherwise we don't wont you running around looking for ruby to get rid of your anger she would not like it? then again? good luck hi first your stress google natural ways out of stress lots of ideas for you to look at even meditation may help you. \as for your emotional baggage possible therapy could be a lot of help if you go to the right person who can talk over your problems with they say a problem shared is a problem halved. but if you need to get rid of anger try some english ruby may be just what you want get with the right team its ruff and tough. hope this helps. good luck hi yes back again i was doing some searching this afternoon and found this its packed with info for ways out of stress the link <link> good luck i too have a great deal of almost constant seething anger. i used to do competitive sports but found that ultimately they made me even angrier. i discovered peace wonder a sense of personal power the release of anger and adventure in hiking and walking. suggestion: get an ipod or similar device if you can with some of your favorite music on it. find a nice park and look for good hiking trails. wear rugged clothes and good shoes. don't push too hard just hard enough to release tensions burn up the excess stress hormones such as adrenaline and cortisol and bring forth your body's natural endorphins and serotonin which will make you feel good and appreciate the beauty around you. after you hike stretch to cool down to prevent muscle cramps and be sure to rest well; allow more than enough time to sleep and clear your mind of worries as you rest. i live in a noisy place without as much privacy as i'd like and i use my ipod when i rest too with soft soothing music that helps me fall asleep. some people use a fan or other "white noise". when you are actively angry you cannot digest food but once you've calmed down eat food that will replenish the resources you've burned up because anger uses up a lot of the body's natural fuel. be sure to stay hydrated throughout. it may take some time but gradually this just might help. good luck.

### Human:\nwhat is the adrenal gland?\n\n### Assistant: the adrenal glands are a pair of organs that sit on top of each kidney. the adrenal glands produce numerous hormones responsible for our response to stress and the balance of salt and water in our bodies. cortisol aldosterone epinephrine (adrenaline) norepinephrine and certain sex hormones are released by the adrenal glands. tumors in the adrenal glands can secrete excess hormones causing cushing’s syndrome (too much cortisol) conn’s syndrome (too much aldosterone) or extremely high blood pressure (pheochromocytomas). abnormally low function of the adrenal glands is called adrenal insufficiency which can have many different causes. incidental harmless adrenal gland tumors are frequently discovered in healthy people on imaging tests obtained for other reasons.

### Human:\nwhy am i always hungry and tired? . i am a 19 year old male 6'0" tall 150 pounds. i work out at least 4 times a week including cardio and weight training. i eat healthy and balanced with the occasional junk food. i don't drink caffeine or soda. i always eat breakfast lunch and dinner and snack throughout the whole day. some days i eat over 3500 calories. i don't gain or lose weight easily. i sleep between 8-10 hours every night including the weekends. however i am constantly hungry even after a meal and i am always tired.\n\n### Assistant: there could be a few things going on. even though you eat healthy you could be low in nutrients causing you to feel tired. the only way to know for sure is to go for a physical and get labs run including vitamin d glucose and iron. also less likely increased hunger accompanied with thirst and weight loss could be sign of diabetes. also look closely at the quality of your diet. are you eating filling foods with meals including healthy fats (nuts and seeds/avocado/veg oils) whole grains lean proteins dairy beans/legumes and fruits and veggies? the fiber found in plant foods such as fruits vegetables whole grains and beans help fill you up. fat provides adequate calories and is satisfying and protein is also filling. make sure your meals contain 4-5 food groups and snacks 2-3. you want to avoid grazing on less filling snacks high in refined grains and low in nutrients (crackers pretzels chips). if you need help see a registered dietitian. you can find one in your area at eatright. org. read more. filling foods do you feel hungry and tired on days when you eat more than 3500 calories? probably there is mismatch between calorie intake and expenditure. feeling hungry is ok with your workout schedule but feeling tired is worrisome. any family history of diabetes please check. there are a few reasons you are feeling tired without any reason. one of them is anemia which is a lack of red blood cells and conversely oxygen from the lungs is not properly brought to the tissues and cells. anemia may be caused by deficiency of vitamins or minerals internal bleeding or chronic diseases. women who are at “that time” of the month are susceptible to anemia as blood is lost during menstruation. still iron deficiency due to menstruation is less than in pregnant women or lactating mothers as their body needs extra iron to maintain healthy blood levels. things may also go wrong when your thyroid glands refuse to cooperate with you. thyroid hormones thyroxine (t4) and triiodothyronine (t3) are responsible for metabolic processes in the body. too much thyroid hormone causes hyperthyroidism which speeds up metabolism while too little thyroid hormone slows down metabolism. hyperthyroidism causes fatigue and muscle weakness and starts in the thighs. doing energy demanding activities become difficult and other symptoms include weight loss feeling warm shorter menstruations increased heart rate and thirst. hypothyroidism also causes fatigue and muscle weakness. the symptoms are reversed to hyperthyroidism such as weight gain feeling cold and longer menstruations. diabetes notorious for causing a range of problems in the body is also related to fatigue. as glucose is the staple fuel of the body it is not utilized properly in patients with type 2 diabetes as the absence of insulin causes the glucose to build up in the body. without its staple fuel the tissues of the body are not nourished properly and causes fatigue. sadly being sad can also be the reason you feel tired. depression induces negative feelings and also has negative effects on the body as it causes a reduction in energy levels changes in sleep and eating patterns decreased concentration and overall laziness and worthlessness which keeps you in bed all day. reference: <link>

### Human:\nwhat could be causing my irregular periods and spotting?\n\n### Assistant: if you are using some type of hormonal birth control this might represent prolonged break through bleeding. erratic bleeding on birth control can be started if one gets an infection such as chlamydia (e. g. from new sexual partner or a partner with other partners). if you are not using hormonal birth control then the most common reason for erratic and prolonged bleeding (once an accidental pregnancy has be ruled out) is a hormonal change. usually this change is linked to a missed ovulation in the month or months before the abnormal bleed. causes for not ovulating are multifold: thyroid problems pituitary problems ovarian cysts physical stressors (e. g. sudden increases in exercise crash dieting) emotional stressors (problems with parents or boyfriends/girlfriends exams) increased body weight anorexia rotating shifts at work etc.

### Human:\nare there foods and/or drinks that may cause acne breakouts? . my eight year old daughter is presently having bouts with acne breakouts. we've been advised about using different hair products that won't clog her pores with heavy oil ingredients. what other products may be causing her acne issues? her grandmother (we've recently found out) has allowed her to drink sodas and fruit drink beverages on daily visits. could this contribute to some of the skin problems she's having?\n\n### Assistant: there is some evidence that a diet limited in dairy products and low in sugar and processed carbohydrates can help decrease the risk of acne breakouts. that would mean not overdoing milk cheese and yogurt while maintaining a diet rich in whole foods including fruits vegetables whole grains lean meats beans and healthy fats (vegetable oils/avocado/nuts and seeds) that is also low in sugar and processed foods. so too many sugary drinks may have an adverse affect on acne. but diet is only part of the story and a healthcare provider can help you figure out all the contributing factors. for more on diet's effect on acne see these articles: <link> <link> no acne is not caused or worsened by certain food or drinks. this is a common misconception. acne is caused primarily by hormones that cause an over excetion of oil often made worse by certain bacteria found in acne lesions. if your eight year old is having acne she may be starting to puberty which can occasionally happen this early. she should see her medical provider. sugary drinks and sodas can make her fat but they will not cause zits. yes i have red bumps on my eyelid and down the left side of my nose and for the past three days i have been drinking apple juice and when i woke up this morning there were red bumps (kind of like acne. i don't really know). but as i was saying they were all down the left side of my nose and on my eyelid and right below my eyebrow!

### Human:\ni have bad breath. how do i cure it? will a tongue scraper work?\n\n### Assistant: bad breath or halitosis can have many causes including poor oral hygiene smoking alcohol stomach problems dry mouth sinusitis diabetes tooth abscess gum infections etc. with so many potential causes it is hard to say that a tongue scraper will help. the bottom line is that you need a diagnosis for the cause of the halitosis before deciding on a treatment.

### Human:\nwhy am i always thirsty?\n\n### Assistant: excessive thirst is hard to define. people normally drink varying amounts of liquid depending on their activity level and the temperature indoors and out. there are two main medical conditions that should be considered if you feel constantly thirsty: diabetes mellitus: the common form of diabetes in which high blood sugar levels spill into the urine increasing urine flow. the excessive urination leads to dehydration causing the person to become thirsty and drink more fluid. diabetes insipidus: an uncommon problem in which a hormone called anti-diuretic hormone (adh) is either low absent or not functioning properly. adh normally acts on the kidneys to cause them to retain water. in diabetes insipidus the lack of normal adh function results in high urine flow a constant feeling of thirst and high fluid intake. your doctor can test you for these conditions over one or two office visits.

### Human:\nafter every meal i get a really uncomfortable bloated feeling gasy and feeling extremely tired. what may cause this? . i took a pregnancy test and am not pregnant. . i thought it was a lactose intolerance but have found that isn't it after doing a lactose free diet.\n\n### Assistant: when you look at your dietary intake be conscious of both quantity and quality of the foods that you eat. my initial thoughts are that your feelings of being uncomfortable and bloated might be because you’re eating too fast or too much at one time. the first thing i would suggest that you try is to cut back on how much you eat in one sitting making sure that you eat your food slowly and chew thoroughly. try eating a small portion of a meal waiting 15 minutes and then consuming more of your meal if you’re still hungry. you could also try to eat 5-6 smaller more frequent meals throughout the entire day as well. also important to consider is the type of foods that you’re eating. you may notice some of these symptoms if you’re not eating healthy in general. i would recommend food journaling your dietary intake so that you can begin to notice trends between what you’re eating and when you feel this way. some foods may cause you to feel more bloated and to have more gas naturally but you may also have a food intolerance sensitivity or allergy. you can meet with your doctor to have an allergy test but those aren’t always 100% accurate. registered dietitians will often recommend an elimination diet to help determine if there are certain foods that your body will not tolerate. an elimination diet begins by being very restrictive with your food intake followed by gradually reintroducing more food into your diet. once you notice symptoms returning you can begin to better identify which foods are causing the problems you are experiencing. please meet with your doctor or a registered dietitian for more guidance. i feel full and bloated all the time now for the past two months. i eat very healthy and am not on any medications. my sister now has the same symptoms. i am 30 and she is 40. we are not pregnant but as you did we also took tests because it felt similar to when we were pregnant. did you go to the doctor? are you still bloated? i cannot believe how long it is lasting. i was checking my hormone levels too. i fill up with gas for no reason - like it is in the air or something. please answer back if you had any resolutions to your problem.

### Human:\nwhat is arthropathy?\n\n### Assistant: arthropathy just means “joint problem. ” doctors often use arthropathy interchangeably with arthritis which means "joint inflammation. " there are some forms of arthropathy that are distinct from arthritis: neuropathic arthropathy: nerve damage from diabetes or another nerve condition results in slow damage to joints. in diabetic people arthropathy usually affects the foot and ankle. (arthritis may also be present. ) hypertrophic pulmonary osteoarthropathy: the ends of bones in the ankles knees wrists and elbows start to grow abnormally and painfully in an adult. the tips of the fingers become rounded called clubbing. this form of arthropathy occurs more often in people with lung cancer. hemarthrosis: bleeding into a joint like the knee can occur after injuries or medical procedures and is a common problem in people with hemophilia. arthritis is common and other arthropathies are uncommon so in most cases when a doctor says arthropathy it means arthritis.

### Human:\nmy stomach always growls turns and feels bloated after i eat. i also have a lot of flatulence. what could be wrong? . i am not sure what is wrong with me. my stomach growls loudly and obnoxiously after i eat and it is very embarrassing not to mention the fact its very uncomfortable almost painful. i also have excessive flatulence in addition to this. i want to know what is wrong and i am tired of sitting in class with this issue it has been going on for at least 6 months now. i don't eat fast and i am definently not hungry and i have tried eating more frequent it doesn't help.\n\n### Assistant: there are a number of things that could be contributing to your gas symptoms. the growling stomach you mention is actually your intestines contracting from the movement of air through the intestines. here are some potential causes of your gas: taking in air through drinking with straws carbonated beverages chewing gum smoking and eating hard candies. eating too many gas-producing vegetables such as cauliflower broccoli cabbage brussels sprouts onions artichokes beans and asparagus. certain fruits like apples pears and peaches may cause problems. the inability to digest certain foods like lactose in milk. not enough beneficial bacteria in your gastro-intestinal system. this webmd article provides more details on potential causes of gas. you may want to see a registered dietitian and/or write down what you eat to spot problem foods. and if you continue to have pain or discomfort a doctor visit makes sense. i agree with all the information provided by maryann. other than that eating spicy and dry foods may cause bloating and flatulence. sip some hot water after your eating is over. add some curds/yogurt with sugar to your diet. this will help you a lot. i have a similar issue and it has lasted about two months. i feel full/bloated and really have not been eating much. i have been burping a ton. i thought i might be pregnant becuase i am a little nauseous too. my sister thought my burping was funny until it happened to her. she has been reading about hormone levels and found that melatonin is a hormone in your body and changes all the time like insulin levels. in the winter with lack of sunlight melatonin levels can be high and stay in the gut. her book said this creates high acid levels in the stomach and thus you will have more gas. we are trying full spectrum light therpy to get our circdian rhythm back to normal and maybe surpress day time melatonin from producing. do you still have symptoms?

### Human:\nhow much should i weigh?\n\n### Assistant: doctors nutritionists and public health authorities most often use the body mass index to define a healthy weight. body mass index (bmi) is your weight in kilograms divided by the square of your height in meters (kg/m2). according to the cdc a bmi of less than 18. 5 is considered underweight. a normal bmi falls within the range of 18. 5 to 24. 9. the bmi range of 25. 0 to 29. 9 is considered overweight and a bmi of 30. 0 or higher is considered obese. . obesity increases the risk for diabetes high blood pressure heart attack stroke certain cancers. losing weight reduces your risk. waist size matters too. even in people who are only slightly overweight a waist circumference greater than 40 inches in men and 35 inches in women increases health risks. don’t believe your pant size; it often underestimates waist circumference. measure your waist yourself with a tape measure just below the belly button.

### Human:\ni'm 34 have hot flashes night sweats high fsh levels and no period for two months. do i have ovarian failure? . after a progesterone withdrawal test my period started in two days.\n\n### Assistant: what the progesterone withdrawal tells you is that there is definitely some stimulation of the lining of the uterus by estrogen -- estrogen can come from the ovary and it also can be made in other parts of the body too. if the fsh is high it does mean that most likely you are heading toward menopause. the major question i would ask you is "are you hoping to have children beyond this point? " if you are i would encourage you to consult with a gynecologist who specializes in what is called reproductive endocrinology as soon as you can. (the american society of reproductive medicine or asrm could help you find someone near you if you don't know of anyone locally). if you are not planning for children at this point there is no race toward intervention. if you are indeed heading toward menopause and are having symptoms you would be a good candidate for a low-dose birth control pill that would take care of your symptoms well. as i have mentioned before for women who do experience premature ovarian failure taking hormones is usually a good idea -- so do not be afraid of hormonal intervention.

### Human:\nhelp! . i am having difficulty locating recipes and ideas for my type of diet; i need a gluten free low cholesterol vegetarian diet. i love to cook and experiement so fear of trying new things is not an issue.\n\n### Assistant: it sounds like you have your work cut out for you! but the good news is that there are many good-tasting healthy foods that will fit the bill. you should start with some good basic gluten free recipes-like the ones found in our gluten-free recipes directory. look them over and pick the ones that do not contain meat. and start cooking! there are many types of vegetarian diets—ones that include eggs and dairy –or vegan options that do not include any animal products at all. if you choose ovo-lacto (eggs and dairy) vegetarianism just be sure to use only low-fat dairy in your cooking. eggs can be part of a healthy low fat diet—just don’t go overboard. it is the yolk that has the cholesterol. so switch to the egg whites whenever you can. and you can use olive oil as a healthier alternative to the animal fats. if you are changing your diet because of health issues such as heart disease diabetes celiac disease or high cholesterol talk to a dietitian. they are a wealth of information. many insurance companies will even help cover the visit. detailed information about a gluten-free diet is also available at the celiac disease foundation website <link> also make sure you talk to your doctor before starting any new diet. there are several recipes that can be found on the webmd website. i have included links to gluten free recipes and vegetarian recipes. when looking at the ingredients of a recipe feel free to alter to fit within your diet regimen. i have also included a link about the tlc diet (therapeutic lifestyle changes) to help you choose foods that are lower in cholesterol.

### Human:\ni’m newly diagnosed with cancer. what are some important things for me to know?\n\n### Assistant: hearing the diagnosis of “cancer” is quite simply a shock to the system. the first reaction is often panic followed by a tidal wave of emotions: “how can this be? ” “why me? ” “i’m scared and not able to handle this. ” but handle it you must. the following is a list of essential things that anyone newly diagnosed with cancer should know. 1. understand the diagnosis. there are many different types of cancer even within the same broad category. for example breast cancer has three general categories: hormone receptor positive (for the estrogen and/or progesterone receptors) her2 positive and triple negative (hormone receptors and her2 are negative or not present); the three types are often treated very differently. nearly every type of cancer has different sub-types and it is important to know which one you have. 2. do not jump the gun and think the worst. not all cancers of the same type act the same. some “bad” cancers may be curable. get all the facts straight and get them only from the experts who treat the disease not from physicians who are not cancer experts and not from well-meaning friends and family who “know someone with…” 3. meet first with local specialists. what other tests are needed to fully determine the stage or extent of the cancer in the body? do you need surgery chemotherapy and/or radiation? have these questions answered first in your community near where you live or work. physicians that specialize in treating cancer have been highly trained whether they practice in a community setting or at a large medical center. since cancer treatment may not be a one shot deal but can involve six months or more of therapy it is important to make these treatments as convenient and safe as possible. having a good cancer center close to home can make a world of difference. 4. consider a second opinion. the need for a second opinion depends on the quality of the first opinions you receive and on your preferences as a patient. do not think that the grass is greener elsewhere and that an incurable cancer is curable at a more heavily advertised center. if the cancer specialists in your area have an excellent reputation and you like their approach to you and your cancer then you may not feel that another opinion is necessary. on the other hand if you feel that surgery is better performed at a high volume center for example or you just want the peace of mind that comes with confirmation of treatment recommendations then a second opinion is right for you. the best doctors do not dissuade patients from seeking other opinions nor from receiving cancer care close to home when that is more convenient.

### Human:\nwhat can i eat for a week while i am waiting to take a thyriod scan. i have to avoid foods for 2 weeks before treatment 0n 19&20. what can i eat in time frame while i wait t o take this treatment\n\n### Assistant: sometimes but not always people getting a thyroid scan are asked to eat a diet low in iodine for about two weeks beforehand. please check with your healthcare provider. if that is the case here are tips on how to eat a low iodine diet: starchy foods like pasta and potatoes are okay but avoid rice. avoid bread that contains calcium iodate or potassium iodate. most fruit is fine except for fruit cocktail with maraschino cherries all vegetables except for dark green leafy (spinach/kale) nori (black pepper in sushi rolls) seaweed and sea vegetables raw and unsalted nuts are okay but stay away from roasted/salted nuts and trail mixes that contain chocolate pieces. most meat sources are fine except for processed meats such as bologna ham deli meats hot dogs salami pepperoni and sausage. no fish allowed no milk cream or cheese (unless in very small amounts) egg whites or egg substitutes but no whole eggs avoid muffins cornbread and other quick breads pastries and cookies unless homemade with allowed ingredients unsalted snack foods like crackers pretzels popcorn sugary candies and fruit juice are okay but avoid chocolate or chocolate containing products like candy bars puddings custards chocolate milk beans are fine but soy products are allowed and others not. if you are not a vegetarian avoid until after your scan. avoid lasagna burritos macaroni and cheese and other items made with cheese and eggs such as meat loaf meatballs and other patties.

### Human:\nwhat are hormonal causes for heavy periods?\n\n### Assistant: in the developed world girls now get their periods earlier and women spend less time being pregnant and breast feeding on demand. this means that the average women can now expect to have more than 400 menstrual cycles in her lifetime (eshre 2007). even the use of most hormonal contraceptives (pill/patch/ring) will yield a monthly bleed. so it’s no wonder that women are so concerned when their cycles seem to be longer and heavier than usual. to address the most-pressing question “when should i be concerned? what is the medical definition of too much bleeding? ” there is a medical definition of “too-heavy periods. ” if a woman is bleeding 80cc (2. 7 ounces — about 1/3 of a cup) or more that is excessive bleeding. trying to measure exactly the amount of bleeding is difficult even in a research setting much less in a home bathroom! some general indications of excessive bleeding can include: * saturating a maxipad or super tampon every 60-90 minutes for several hours. * passage of large clots (quarter-sized or larger). * significant bleeding for more than seven days. probably the most important factor would be if your bleeding is heavy enough to interfere with your normal activities. so if your bleeds are too heavy read on for some possible explanations. hormonal causes hormonal causes are usually linked to missed or erratic ovulation. as you may know in a normal cycle estrogen is produced all month. estrogen is responsible for building up the lining of your uterus so you have something to shed each month. in a normal cycle progesterone production increases following ovulation. progesterone “stabilizes” the uterine lining in preparation for a possible implantation of a new pregnancy. if you are not pregnant that month the levels of estrogen and progesterone fall triggering the release of the uterine lining — your period. so if you do not ovulate the estrogen build up of the lining continues but without the usual ovulation-associated progesterone. thus the hormone levels don’t decline and the lining stays up inside the uterus as a missed/late period. alternatively the lining can begin to shed under its own weight producing prolonged bleeding. after several months of missed periods the lining of the uterus can become very thickened. prolonged and heavy flows are not uncommon after months of missed flows. there are many causes for not ovulating including low thyroid a benign pituitary growth (“adenoma”) or a problem with the hypothalamus. all of the stress-related causes of not ovulating (e. g. sudden increases in exercise crash dieting problems with relationships financial worries etc. ) can be linked to the effects of stress hormones from the brain on the hypothalamus. increased body weight may trigger hormone changes leading to polycystic ovarian syndrome (pcos). a transient ovarian cyst can halt ovulation for a time. there are treatments for each of the causes of heavy bleeding we have discussed. so if you or someone you know have episodes of heavy blood loss rather than a normal period talk to your doctor because there are ways to stop going with the flow.

### Human:\nshould a diabetic avoid watermelon pineapple and raisins or is this sugar different because it's "natural" sugar?\n\n### Assistant: the key is not to avoid certain foods when you have diabetes but to be aware of the total carbohydrate in foods and keep intake consistent throughout the day. a small piece of fresh fruit 1/2 cup canned and 1/4 cup dried fruit contains about one carb serving (15g total carbohydrates). most people with diabetes can have between 3 and 5 carbohydrate servings at each meal and 1 to 2 at snack time. foods with added sugars are less nutritious than foods with natural sources of sugar but what counts for blood glucose control is watching total carbs. for good health healthier sources of carbohydrates are recommended including whole grains fruits and low fat dairy. make sure to work with your healthcare provider on the appropriate of carbohydrates for you. for more on carb counting see this article.

### Human:\ni have been on ortho tri-cyclen lo for nearly a year. my period started a week early this month. what could this mean?\n\n### Assistant: ortho tri-cyclen lo contains a low amount of estrogen. sometimes your own hormones can rule over the pill form that you are taking. other factors can also throw off your cycle like stress. sometimes women’s’ hormones can also "talk" to each other causing women in the same vicinity to become regulated to the same cycle. if you have just started a new job or school where you are hanging out with other women every day your cycles can become synced with theirs. before you start a new pill pack you may want to take an at-home pregnancy test. keep an eye on your cycles and if they are continually irregular you may need a different type of birth control.

### Human:\ncould diabetes be playing a role in my hair loss?\n\n### Assistant: diabetes is rarely responsible for hair loss unless your blood sugars are poorly controlled. the most common cause of hair loss in both men and women is androgenetic alopecia also called male or female pattern hair loss. see your local dermatologist to obtain a diagnosis and treatment plan.

### Human:\nif i'm using the correct acne treatment (for me) should i still be having breakouts about every other week? . i'm wondering if i should go to a dermatologist or if something over the counter will work for my breakouts. my products i've been using for several months seem to clear my skin up for about a week then i'll be all broken out and covered in pimples the following week. i'm really just wondering if i need a different product or if this every other week breakout is normal and expected. thanks\n\n### Assistant: if you are still breaking out every other week then your current acne treatment is not working well enough. it is time to see your doctor or a dermatologist. there are a lot of products that are available by prescription that can help get your acne under better control. options may include topical creams and/or oral antibiotics. for women with hormonal acne oral contraceptives or a diuretic called spironolactone may be prescribed. for severe or cystic acne your doctor may suggest a powerful acne medication called accutane. laser or light therapy is another option for treating severe acne. tell your doctor about any other products you are using on your face such as cleansers or cover-up. some of these can cause acne flare-ups. hormone cycles can also cause pimples to keep coming back. check out help for teen acne on webmd for more helpful tips.

### Human:\ndiagnosed with gestational diabetes. my post prandial blood sugar is often 125 not 120. is that ok? . diagnosed with gestational diabetes. my post prandial blood sugar is often 125 not 120. is that ok?\n\n### Assistant: that seems within the normal range. but what really matters is not one blood sugar level but the overall pattern. that's why its recommended you write down what you eat along with your blood sugar levels and show them to a diabetes educator. they work with you on modifying your diet to help manage blood sugars during pregnancy. for more on recommended blood sugar targets see this article.

### Human:\nurinary tract infection. prescribed by physician estrace. have used it for a week but the itching is unbearable. have tried cortisone 10. what next?\n\n### Assistant: estrace is a hormone. cortisone 10 is an over-the-counter cortisone cream. neither one would treat a urinary tract infection. many women who have symptoms of a urinary infection can have a vaginal infection often yeast. vaginal yeast infections are very itchy and cortisone 10 may actually make the yeast worse. talk to your medical provider about the possibility of your symptoms being caused by a yeast vaginitis and not a uti. ask for patient-specific recommendations.

### Human:\nare there lifestyle and dietary factors that can decrease the risk of breast cancer?\n\n### Assistant: weight is a really important factor to the postmenopausal woman. higher body mass index and postmenopausal weight gain increase a woman’s risk for breast cancer. a woman who has a bmi of more than 33 is 27% more likely to get breast cancer than a woman with a bmi of less than 21. losing about 22 pounds will lower your risk regular physical activity can help women protect themselves from breast cancer. engaging in say fast walking for 10 hours or more per week can benefit women immensely. drinking alcohol has definitely been shown to be a risk factor and the more one drinks the higher the risk. i always say “one drink is good for the heart but two drinks are bad for your breasts”. other factors that seem to help decrease the risk: eating olive oil sticking to a low-fat diet that includes monounsaturated and polyunsaturated fats complex carbohydrates and minimal red meat. taking vitamin d and coq10 may also help lower your risk. soy is still controversial so i advise eating no more than what is in a standard asian diet — 20 grams per day. breastfeeding for a least six months may decrease breast cancer risk. with every 12 months of breastfeeding a reduction of 4. 3% was seen for breast cancer risk. finally if a woman can control for this she should try to have a baby at a younger age. having a first baby before age 25 will decrease a woman’s risk by 10% and having a baby before 35 decreases her risk by 5%. unfortunately having a first baby later in life puts a woman at greater risk for breast cancer because of perimenopausal breast changes from hormones of pregnancy. yes

### Human:\nwhat is more important for a newly diagnosed diabetics? change diet or stop smoking?\n\n### Assistant: i would say whichever you feel you can do most successfully. smoking is a huge health risk factor and can affect blood sugar levels. if you choose to do that first which makes a lot of sense you can still make small changes to your diet while taking medication. for example eating at the right times to coincide with medication and checking blood sugar can be a good first step while you kick the smoking habit. once your smoking habit is under control you can dive deeper into diet and exercise. but the key is starting somewhere and taking it one small step at a time. good luck! see more. smoking cessation health center a healthy type 2 diabetes diet

### Human:\nam blood sugar 86 - ate water 4 hamburger patties 1/4 c almonds 1/4 c cashews 1/4 cup plain yogurt next am 99 how? . i have candida and have been monitoring my blood sugar to ensure it doesn't go too high and further my problems. i don't understand how i can go from blood sugar of 86 one morning to 99 the next when i had no more than 31 carbs all day. please help me understand where i'm making my mistake. . water = carb free. 4 hamburger patties = (<1 each). 1/4 cup cashews = 8 carbs. 1/4 cup almonds = 8 carbs. 2 tblsp plain yogurt = 11 carbs in a cup\n\n### Assistant: diet is not the only factor that increases blood sugar. if you don't have diabetes your blood sugar will be tightly controlled either by increasing insulin to combat high carb intake or utilizing stored forms from the liver and muscles to be put back into the blood stream. so even though you take in little carbohydrates your body will aim to keep levels within a normal range. when the diet remains low in carbohydrates and the stored sources run low the body then turns fat into glucose but this also produces ketones which can have unpleasant side effects. don't forget your brain needs glucose! according to the institute of medicine individuals need 130g of carbohydrate for the brain to run efficiently. i would check with your healthcare provider or registered dietitian for the appropriate diet for your condition. if you have diabetes it's best to see a diabetes educator to help with any changes in diet as medication is also likely to change.

### Human:\ni read that pregnant women are at greater risk for food-borne illness. what can i do to protect myself and my baby?\n\n### Assistant: everyone's at risk but those at greater risk are infants young children pregnant women and their unborn babies older adults and people with weakened immune systems (for example those with hiv/aids cancer diabetes kidney disease and transplant patients). some people may become ill after ingesting only a few harmful bacteria. others may remain symptom-free after ingesting thousands. to prevent food-borne illness keep these key actions in mind: wash your hands. keep raw meats and ready-to-eat foods -- like salads -- separated during preparation. cook foods to the proper temperature by using a food thermometer. refrigerate foods promptly and reheat leftovers to 165 degrees fahrenheit.

### Human:\non nurtisystem for 35 days lost 20 pounds a1c from 6. 0 to 8. 1. . after being on the nutrisystem diabetic program for men for 35 days and losing a total of 20 pounds my a1c went from 6. 0 to 8. 1. i am 5' 7" and a current weight of 177. 2 pounds? why would my a1c increase? was it due to the previous 3 months?\n\n### Assistant: there could be a few things going on. did you change or alter your medication (if you are on medication)? also as you say a1c is an average over 3 months so how you were eating the two months prior makes a difference it's also possible your carbohydrate intake was lower before starting the diet and the increases changed your blood sugar. i would see a diabetes educator while you work at getting to the right weight for you. they can help guide you in the process. good luck!

### Human:\nis there any diet that can help improve or reverse hypothyroidism?\n\n### Assistant: the main treatment for hypothyroid is thyroid hormone pills. excessive intake of certain foods may decrease thyroid function including cruciferous vegetables (broccoli cauliflower kale) asparagus peaches peanuts peas soybeans spinach strawberries and radishes. being consistent with fiber intake instead of consuming a lot at one sitting can help as too much can reduce the absorption of thyroid medication. lastly it is recommended not to take thyroid medication on an empty stomach and not the same time as other supplements especially calcium and iron. i take synthroid and it specifically states to take on an empty stomach at lease 1 hour before breakfast. i am confused with your response about taking with food. the instructions for taking synthroid specifically state to take on an empty stomach and to take at the same time each day. i have been doing research myself concerning this matter since i am hypo and frustrated with the excessive lbs. whole wheat bread fish and eggs are helpful with this condition. i find that eating more vegetables helps to give me energy. parfaits seem to give me a boost. let me mention that these are things i am training my body to adapt to help the metabolism with this condition. exercising is a great option but let's be realistic some of us work crazy hours come home to children pets significant others school so that can be a bit complicated. my ideas aren't much but i hope you find what works best for you. corazondel anything with whole wheat in it is the worse thing you can eat because of the gluten it kills the thyroid. the best is completely gluten free. there are so many websites about this.

### Human:\nwhat are the risks of long term use of hormone replacement therapy?\n\n### Assistant: the main concern with prolonged ht is an increased risk of breast cancer. the risk seems to be greater in women taking combined therapy (estrogen plus a progestogen) than in women taking estrogen alone. and it may be that starting ht right away after menopause is also associated with greater risk. the good news is that the risk returns to baseline within several years after stopping ht. you should also be aware that combined ht can make it more difficult to read your mammogram (both while you're taking hormones and in the first years after stopping). as a result you might be called back for additional views or biopsy of suspicious areas. right now most experts recommend limiting ht to several years. the nams 2010 ht position statement ( www. menopause. org/psht10. pdf ) suggests that longer use is acceptable for a woman if she believes that the benefits outweigh the risks (especially if she's had trouble stopping therapy). the other condition includes women with low bone mass or osteoporosis who cannot tolerate osteoporosis drugs. the one exception to limiting ht to a few years is the woman who has had premature menopause either because of natural failure of her ovaries or surgical removal. in that case most experts are comfortable advising you to continue ht at least until the age of natural menopause about age 50 at which time you can reassess. if you've been taking hormones for a very long time you might want to start by discussing a lower dose. many clinicians now prescribe half the dose we used to use.

### Human:\nmy periods have always been weird – never normal. my latest period lasted three days and is very light. what is wrong? . i took a home pregnancy test and it was negative. i also had my tubes tied. could i possibly be pregnant despite the test?\n\n### Assistant: while it is uncommon to conceive after having had a tubal ligation it can happen. moreover there is an increased risk of it being a tubal or ectopic pregnancy. thus you were wise to do a reliable pregnancy test given your prior history of super light flows while actually pregnant. if you develop any pregnancy symptoms your should have the test repeated by a gyn or local family planning clinic as an ectopic pregnancy can delay the production of normal amounts of hcg (pregnancy hormone). a more likely explanation for the "too light flow" would be a missed ovulation. if the pregnancy test is negative then the next most common cause of a missed period is not having ovulated that cycle. in a normal cycle estrogen is produced all month. estrogen is responsible for building up the lining of your uterus so you have something to shed each month. in a normal cycle progesterone production increases following ovulation. progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. if you are not pregnant that month the levels of estrogen and progesterone fall triggering the release of the uterine lining—your period. so if you do not ovulate the estrogen build up of the lining continues but without the usual ovulation associated progesterone. thus the hormone levels don't decline and the lining stays up inside the uterus—as a missed/late period. alternatively just a small amount of the top of the lining can be shed which appears as a very scant flow. causes for not ovulating are many: thyroid problems pituitary problems ovarian cysts physical stressors (e. g. sudden increases in exercise crash dieting) emotional stressors (problems with partners children finances) increased body weight anorexia rotating shifts at work etc. you mentioned a prior history of "weird periods" that were "never normal. " that might also suggest alterations in your ovulations. there is a second less common cause for not having a period--or a too light flow. in some women the estrogen levels become very low. the levels are so low that no uterine lining is available to be shed. bottom line repeat the pregnancy test if you have pregnancy signs. if it is negative then you may want to keep a menstrual calendar. if your cycles become absent for three months (or are just minimal spotting) see your gyn or clinic for follow up. certainly if you develop other symptoms such as pelvic pain (e. g. ovarian cyst) get seen promptly. if your tubes are tied its almost if not completely impossible to get pregant. periods are wierd and not really predictable. just dont assume its over yet. wear something for the next few days just to make sure its completely over.

### Human:\nare there any drug interactions between pristiq levothyroxine and acai berries?\n\n### Assistant: the acai berry is a fruit that has more recently been marketed to have antioxidant properties. it has also been credited with other health benefits that have not yet been scientifically proven. false claims include the reversal of diabetes and other chronic illnesses enlarging the size of your genitals increasing men's sexual virility and increasing sexual desire in women. in addition there are no current studies supporting the berry’s supposed promotion of aiding in weight loss. i cannot tell you if there are any interactions with levothyroxine or pristiq. i can tell you that the two medications you are taking are safe to take together. pristiq does not have any food considerations when taken orally. it is recommended that levothyroxine be taken on an empty stomach 30 minutes to 1 hour prior to breakfast.

### Human:\nwhat causes dry mouth?\n\n### Assistant: there are several causes of dry mouth also called xerostomia. these include: side effect of certain medications. dry mouth is a common side effect of many prescription and nonprescription drugs including drugs used to treat depression anxiety pain allergies and colds (antihistamines and decongestants) obesity acne epilepsy hypertension (diuretics) diarrhea nausea psychotic disorders urinary incontinence asthma (certain bronchodilators) and parkinson's disease. dry mouth can also a side effect of muscle relaxants and sedatives. side effect of certain diseases and infections. dry mouth can be a side effect of medical conditions including sjögren's syndrome hiv/aids alzheimer's disease diabetes anemia cystic fibrosis rheumatoid arthritis hypertension parkinson's disease stroke and mumps. side effect of certain medical treatments. damage to the salivary glands the glands that produce saliva for example from radiation to the head and neck and chemotherapy treatments for cancer can reduce the amount of saliva produced. nerve damage. dry mouth can be a result of nerve damage to the head and neck area from an injury or surgery. dehydration. conditions that lead to dehydration such as fever excessive sweating vomiting diarrhea blood loss and burns can cause dry mouth. surgical removal of the salivary glands. lifestyle. smoking or chewing tobacco can affect saliva production and aggravate dry mouth. continuously breathing with your mouth open can also contribute to the problem.

### Human:\ncan diabetes or my metformin cause high cholesterol? i was taking prevastatin but my cholesterol is very high. i also had a big steak dinner the night before the test could that make a difference? it confuses me because i eat oatmeal once or twice a day which is supposed to help lower cholesterol plus i am on pravastatin. my doctor just switched me back to simvastatin but i am very concerned. i have a peanut butter sandwich and a half with my breakfast each morning would that make my cholesterol skyrocket?\n\n### Assistant: it is possible that what you ate the night before your blood test could influence your test somewhat (probably not significantly). if you think this is the case you can repeat your test eating like you normally would. but another factor is your blood sugar control. if you blood sugars have been higher lately that could also cause your cholesterol to increase. you can tell this by checking your hemoglobin a1c. a registered dietitian can help sort this all out. you find one in your area at eatright. org or going through your doctor. see also foods that help lower cholesterol. good luck!

### Human:\nwhat is indicated when you have a high systolic number but a normal distolic number?\n\n### Assistant: this is a very good question! your blood pressure reading consists of two numbers. the number on the top is called the systolic number. the number on the bottom is the diastolic. the systolic number is the pressure in your arteries when your heart is beating. the diastolic number is the pressure when your heart is relaxed between beats. blood pressure is considered normal when it is below 120/80 mm/hg. if the systolic number is 140 or higher or the diastolic number is 90 or above this may mean you have high blood pressure or hypertension. but your doctor will not usually diagnose you after just one high reading. he or she may have you come back again or may have you take your blood pressure at home. as we get older several things happen inside our blood vessels. our arteries get more stiff and plaque builds up. this makes the pressure of the blood inside the arteries increase when the heart is pumping. thus the systolic number goes up as we age. other things that can also cause the systolic number to go up include heart disease anemia thyroid disease and heart valve problems. doctors pay very close attention to the systolic number because it is linked more closely with heart attack and stroke risk. the good news is that there are many things you can do to bring down your systolic blood pressure. if you have been diagnosed with high blood pressure your doctor can help you get back on track. he or she will likely suggest lifestyle changes including healthy eating options and regular physical activity. if you smoke you can get help quitting. if stress is a problem for you ask for help in reducing it. you may need to take medication to keep your blood pressure in a healthy range.

### Human:\nare regular menstrual periods triggered by regular ovulation?\n\n### Assistant: a woman can have apparently regular flows and yet still not be having regular ovulation. how can this happen? in a cycle without an ovulation estrogen stimulation (assisted by the hormone fsh) will continue to make the lining of the uterus grow thicker and thicker. in the absence of an lh (luteinizing hormone) surge no ovulation will occur. the progesterone level will not rise. when the follicle that contains the un-ovulated egg involutes (shrinks) the woman’s blood estrogen level will drop. this triggers much of the lining to be shed. thus if it takes two to three weeks for the follicle and un-ovulated egg to regress the woman may have somewhat regular bleeds. how often does this happen? in the first year after menstrual periods begin up to 55% of the cycles may occur without ovulation (mansfield & emans 1984). in a study of 20- to 35-year-old women who had regular cycles but were infertile an average of 30% of women were not ovulating. among these 123 women with regular cycles the highest incidence of not ovulating was 41%. this highest incidence occurred among women who had never had a conception. women who had at least one documented pregnancy had a lower incidence of non-ovulation despite regular periods (hegab 1987). finally the presence of very regular periods accompanied by common premenstrual symptoms (“molimena”) suggests an ovulatory cycle — especially when there are menstrual cramps. yet this may not always be the case. in as many as 5% of these “classic for ovulation” cycles ovulation may not have occurred (speroff 1999).

### Human:\nbmi of 35. i am 29 a woman who is 4'11 weigh 178 lbs. my breasts are over dd. i am not fat. how can my range be obese? . i have large hips but they are mostly muscle. my breasts are the only other large fat content place on my body. are there better ways of determining a healthy weight?\n\n### Assistant: bmi is just a classification of weight and not a determinant of health. that being said carrying extra weight can increase health risk. first i would consider your size over time. have you always been this size or have their been increases lately? if this seems to be your normal weight than it may just be where your body wants to be. if it has increased lately you may want to take note of what has changed to see if it has affected your weight. next would be to look at your other health-related numbers. if you cholesterol blood pressure and blood glucose are all normal than those are positive indicators of health. regular exercise and a health diet matter too! lastly where you carry excess weight makes a difference. those who carry fat in the abdomen tend to be at higher risk for chronic disease like diabetes and heart disease. in particular figuring out your waist-hip ratio can help you determine if this is a concern for you (see this article for more information). weight is just one piece of the health puzzle. finding out about all the other pieces can help a great deal!

### Human:\nmy 11 year old recently started her period. she has a period every 14 days and it lasts for six days. is this normal?\n\n### Assistant: yes this can be common as it can take up to two years after the first period for the ovaries to completely mature and produce regular ovulations every month. in the early years of menstruation estrogen production is more than adequate to build up a thickened lining in the uterus. but without regular ovulations not enough progesterone is made. as you may know in a normal cycle estrogen is produced all month. estrogen is responsible for building up the lining of your uterus so you have something to shed each month. in a normal cycle progesterone production increases following ovulation. progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. if you are not pregnant that month the levels of estrogen and progesterone fall triggering the release of the uterine lining—your period. so if you do not ovulate the estrogen build up of the lining continues but without the usual ovulation associated progesterone. thus the hormone levels don't decline and the lining stays up inside the uterus as a missed/late period. alternatively the lining can begin to shed under its own weight producing prolonged and erratic bleeding--this is likely what has happened to her. another way inadequate progesterone production from missed ovulations can create too heavy a flow is as follows. simply stated if the uterine lining is like grass or lawn estrogen is like the fertilizer (causes proliferation and a thickening of the lining ) and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). this is why depoprovera (high dose synthetic progesterone) brings about a thin lining and why birth control pills (relatively progesterone dominant) bring about shorter lighter periods. it is also why women who miss ovulations (no progesterone produced) are at a greater risk for too thick lining. lastly less than 10% of adolescent women with heavy menstrual bleeding have an undiagnosed blood clotting disorder. this would be more likely if she had a family history of von willebrand's syndrome. given the duration of her bleeding i would urge you to have her see either your gyn a pediatrician or your family md. a short course of hormones may be helpful in stopping this distressing bleeding pattern yes it is nothing to worry about. this could mean instead of one egg a month she produces 2. i get mine every 14 das alsoand always have and i am 22. my mom had the same thing.

### Human:\ni am a woman in my 60s who is experiencing balding like men do. can rogaine work for older women?\n\n### Assistant: premature balding in women can be attributed to several factors including stress medication and heredity. your first step should be to exclude any medical causes such as hormonal imbalances polycystic ovarian syndrome adrenal disease or thyroid disease. for hereditary hair loss topical rogaine is currently one of a few compounds that are fda approved for regrowing hair.

### Human:\nis it possible to be fat and fit?\n\n### Assistant: yes you can be overweight and in good shape at the same time. in fact physiologists now believe that being overweight and fit is far healthier than being skinny and out of shape. how much healthier? one recent study of 2 600 people shows that subjects who were unfit were four times more likely to die than those who were very fit —whether those fit people were normal weight overweight or obese. that’s because exercise — no matter how much you weigh — reduces your risk of a broad range of ailments including cardiovascular disease cancer and diabetes.

### Human:\ncan you tell me what causes hair loss on lower legs and calves in men?\n\n### Assistant: there are several reasons for hair loss on the legs. poor circulation may be a factor which can be caused or aggravated by diabetes thyroid disorders peripheral artery disease medications poor diet lack of exercise smoking being overweight and other health issues. to properly diagnose your condition and to rule out a serious condition you need to be evaluated and tested by a physician. it might be worth checking on your 5-alpha reductase level. this is an enzyme that regulates the conversion of testosterone into dihydrotestosterone (dht). reduced 5-alpha reductase levels can lead to an overabundance of dht which in turn can adversely affect the health of hair follicles and reduce hair reproduction on your legs. pad can cause hairless legs. lack of proper blood circulation is the root of this phenomenon. crossing your legs and/or ankles. it's rubbing the hair off. crossing your ankles.

### Human:\nwhy i am craving only for sweet food? . since i stopped contraception pills i couldn't stop eating sweet food. i gained 6kg within 2 weeks. and then i decided to stop. so for 2months now i haven't touched any sweet chocolate fizzy drink or bakery. instead i eat dried fruits peanuts yogurts fruits porridge. i cant eat salty. even though i eat only healthy im always eating! i feel this constant sweet food craving! (i haven't lost weight even though im doing sports everyday not eating in the evenings. i've been taking chromme for 1month).\n\n### Assistant: there may be a few reasons why you are cravings sweet foods. one thought is that your blood sugar may be low and your body is trying to tell you that you need to eat something in order to bring your blood sugar levels back to normal. low blood sugar could come about by not eating enough food throughout the day or by not making appropriate food choices. it could also be from a lack of energy or exhaustion especially from lack of sleep where your body will begin to look for other sources of energy. sugar can be metabolized and converted to energy very quickly so it’s an obvious choice. the cravings may come as a response from being very restrictive with your diet. it can be hard to sustain an eating plan where you are constantly depriving yourself of things that you want to indulge in. instead consider moderation and portion control as healthy alternatives. lastly there are also psychological reasons for craving sweets as well. for example when you are stressed you may sometimes seek comfort in food wanting something that tastes really good. eating sweets can trigger a reward mechanism in your brain by releasing serotonin which helps to boost your mood and help you to feel better. there are a variety of reasons for sweet cravings both physical and psychological. it could be that now that you are off the pill your cycles are back to normal and you are experiencing more cravings related to fluctuations in hormones. it also could be your restriction of sweet items is causing you to be even more drawn to them. you first want to look at your diet. is it balanced with all the food groups? are you getting enough dietary fat for satisfaction? what are your absolute favorite sweets? have you tried incorporating items like dark chocolate or smaller portions of other sweet foods you like? there is emerging research that mindful eating can decrease food cravings in people with eating problems. that means eating meals at the table eating slowly enjoying food and leaving judgment out of your thoughts about food. that means no more "i was bad so i might as well throw caution to the wind" or "i shouldn't eat that because it is bad for me. " it's all about listening to your body and trusting yourself around food. a registered dietitian can help you find out why you are craving sweets (go to eatright. org to find one in your area). for more on mindful eating see this post on webmd's real life nutrition. <link> good luck! hi and thanks so much for your question. there's a good chance that you have an issue with being hooked on or addicted to sugar. take a moment and complete this easy 2 min quiz devised by experts from yale university <link> in your situation what you're doing is actually something we call "eating around the addiction". you did well to eliminate refined and processed sugar from your dietary intake. however you didn't replace it with rewarding and tasty enough sweetness from natural sources and thus you're still in crave mode. you want the sweet but can't eat it so you eat around it by continuously munching on other foods. one problem with that in addition to packing on pounds is that you may start getting hooked on the dried fruits and nuts as well. the foods people become most hooked on are called the hyperpalatables--- sugary/fatty/salty food combos. it's never tuna on a bed of greens that we get hooked on. it's the super rewarding hyperpalatables most of which are refined and processed foods. in my book the hunger fix i note that you need a strategy of detox and recovery in which you substitute the refined sweets with natural sweets as well as add other foods that naturally boost the brain's dopamine the reward brain chemical that gives you pleasure and satisfaction. in addition log onto the webmd food and fitness planner and you'll also see a wealth of naturally sweet and tasty foods you can now incorporate into your dietary regimen to stop the cravings. another thing i note is that you're not taking in much protein. a secret way to stop cravings is to combine lean protein with fiber--- carrots and hummus peanut butter with apple slices yogurt with blueberries low fat cheese with an apple. works like a charm. good luck and let us know how you're doing dr. peeke i was struggling with sugar for quite a while. i did a little research for my personal dietary needs. i am basically a carbo addict. if you want to call it that. what i did find was really helpful. south beach diet book really helped me understand about what foods can do to your body chemistry. the processed foods manufactured these days are even more highly processed than in the recent past. these higher processed foods make you crave more and more of them. there are lots of hidden sugars in foods which also make you crave more of them. the trick i found was to 1. eat the type of foods that help you prevent the cravings like protein and foods on the low glyciemic index. foods that have lots of nutrition give your body what it needs and you begin to crave less of the junk. 2. take a look at your eating habits and modify them. me for example love to eat at night. it may not be the best thing but i seem to sleep better with some food in my stomach. that said i have switched out the junk or carbs. replace ice cream with greek yogurt. relpace high fat chips with cruncy celery and peanut butter or cream cheese. instead of a sandwich with bread make a turkey roll up. 3. exercise helps to regulate your sugar levels so i work at getting some exercise which also helps my mood levels in case the mood ties into eating for more comfort. 4. and lastly when the sugar craving gets the best of you have something like chocolate chips. put 10 or so into a tiny prep bowl. i bring them in my office for that afternoon pick me up. i am always suprised when i don't even eat them all. hope that helps a little! just a thought. i was craving sweets too for a long while. i also felt very tired most of the time. when i went to my doctor i found out i was diabetic. my body craved sweets because it thought it was needed in my diet. am only saying this because no one else mentioned it here and it would be smart to go get tests. you probably are not diabetic but why not get tests to find out if you have deficiencies etc? couldn't hurt to check.

### Human:\nwhy am i always hungry?\n\n### Assistant: most people are not always hungry. just after eating the body releases chemicals into the bloodstream and directly onto nerves that create the sensation of satiety or feeling full. there are many causes for an increased appetite: increased activity (exercising) boredom feeling sad or blue high life stress mood disturbance (depression or bipolar disorder) oral corticosteroids an eating disorder (anorexia or bulimia) an overactive thyroid gland (hyperthyroidism). eating low-calorie foods sugary junk foods or low-fat foods can make you feel hunger that’s more intense and comes on sooner after eating. foods with whole grains healthy fats and proteins are more satisfying take longer to digest and stave off hunger pangs longer.

### Human:\nhow can proteinuria be treated? . i have been suffering from ckd-3 since 2004. by maintaining my blood pressure at normal level (110+/70+) adhering to a strict low-protein and low-sodium diet i have managed to delay the progression of the disease to a more severe stage. since early october i started a treatment plan for my ckd using herbal nutrients and medicines prescribed by a naturopath. for eight years i had never had protein in my urine. but since about two weeks ago my urine became foamy an indication of proteinuria\n\n### Assistant: it sounds like you've been doing the right thing by keeping your sodium and protein intake low as recommended by the national kidney foundation. several health organizations recommend regular checks of proteinuria so don't rely on symptoms and get yourself checked. i also recommend checking in with your nephrologist about the herbal treatments you are trying to see if they are contraindicated. if you have diabetes blood sugar control is very important as well as keeping your blood pressure down. there are other factors that can increase the progression of renal disease including anemia abnormal blood lipids such as cholesterol and problems with mineral metabolism. a registered dietitian can help you troubleshoot your diet as a whole. you can find a dietitian at eatright. org.

### Human:\ni am getting dizzy when i eat sugar and my legs also feel numb. . i am just under 5'7 and weigh 130 lbs. i am 18 and just came to college and i have had really bad allergies. i go to washington state university in pullman wa. i have also been sick the majority of the time i've been here. i have had multiple colds and had the flu once. i have been here since august and my eating habits have gotten worse but i haven't gained weight. i am starting to feel dizzy when i eat sugary foods and my legs sometimes feel numb. i also have to urinate frequently.\n\n### Assistant: i am not a doctor but wanted to respond to the nutritional aspects. some of the symptoms you list such as frequent urination are symtpoms of type 1 diabetes. i'm not saying you have it but it is worth being checked out. as for the dizzy feelings after sugar it's hard to say. i would aim to eat balanced meals with a protein healthy fat whole grains and fruits and vegetables. if you eat sugar do so after a balanced meal or snack. eating sugary foods on an empty stomach may contribute to the dizzy feelings. the best possible thing to do is get a physical that includes lab work to make sure everything is okay. in the meantime focus on taking care of yourself by eating well and getting sleep.

### Human:\ni am on birth control. i experienced light bleeding for a couple of days after my cycle ended. what could be happening?\n\n### Assistant: there are a couple of possible explanations for this light spotting. the most common one would be light breakthrough bleeding due to the hormones in your birth control pill (bcp). with prolonged bcp use the lining of the uterus can become thinner. this can make it easier for spotting to occur. often such spotting will present after intercourse or even heavy exercise. typically it does not develop into a full on "period-like" bleed. other reasons for spotting after sex can include problems with the face of your cervix. for example if you have a new infection with chlamydia that can make the cervix friable (easier to bleed when touched by fingers penis etc). if you had a polyp in the cervical canal the polyp tissue is very fragile and bleeds easily. . my best guess is bcp caused spotting. if the spotting persists or you have risks for chlamydia (e. g. new partner or multiple partners) you should see your gyn of clinic for follow up. if the bcp is the culprit for the poor cycle control a change in bcp formula or brand can be helpful.

### Human:\ni lost my brother to breast cancer. since having children i still get some milk out of the nipple. is this normal?\n\n### Assistant: it is important for women to know that breast cancer can be a man's disease as well. this also means that a genetic link can come from a male relative. fortunately the symptom you describe is not likely to be linked to breast cancer risk. it is not uncommon for women to be able to get small amounts of nipple discharge after having breastfed. the usual triggers for this to occurs are: nipple stimulation a a part of sexual foreplay hot showers birth control pills or "checking for discharge" by repeated squeezing. sometimes women will notice discharge from one or both nipples. this prompts concern especially if she has not recently breast fed. generally we tell women that bilateral white or clear discharge which is only present with nipple stimulation is likely to be "normal. " as mentioned above being on birth control pills can sometimes enhance breast discharge. certain psychiatric medications—especially the antipsychotics —can initiate nipple discharge. bilateral spontaneous secretions can be prompted by a pituitary problem or hypothyroidism. both low thyroid and elevated prolactin (from the pituitary gland) can be checked for using simple blood tests. the most concerning nipple discharges are those which are red/bloody unilateral and coming from just one or two ducts. if you were my patient i would check a sample of the discharges for undiscernable blood (using the fecal blood card). i would do a careful breast exam and might send you for a mammogram or ultrasound—depending upon your age. i prefer to be safe rather than sorry--even when the discharge sounds non-pathologic. so get it checked out even though it is likely that you will be told it is ok.

### Human:\nhow long does it take to bake 11ibs of chicken? . i am currently having to go gluten wheat and dairy free again and my cooking skills never strong to begin with are in even worse shape after eating a million salads finger foods and sliding down the hill to **** on a pile of pizza hamburgers and those $2 for 6 burritos that are the gluten equivalent of an insulin overdose. help!\n\n### Assistant: if you are referring to cooking a whole chicken (thawed) it is generally 20 minutes per pound at 350 f plus an additional 15 minutes. but cooking times will vary so make sure you cook the chicken until it reaches an internal temperature of 165 degrees measuring at the thickest part. you can search chicken recipes online to get ideas. as for going gluten free the good news is there are a lot of gluten-free products on the market. this article will give you some ideas to get started. give yourself some time and you'll slowly add some healthy meals to your repertoire. if you have trouble a registered dietitian can help you. you can find one in your area at eatright. org.

### Human:\ni use the two hour after meal method to check my sugar. sunday's reading was 246 monday's was 116. is this swing a sign?\n\n### Assistant: i'm not sure if the change in blood sugar you experienced is a sign but it might simply be a result of what you ate. did you eat the same amount of carbohydrates at both meals? if you had more carbohydrates on sunday that would explain the higher levels. recommended blood glucose levels 2 hours after eating is less than 140 mg/dl for people 50 or younger; less than 150 mg/dl for people ages 50-60 and less than 160 mg/dl for people over 60. for more on measuring blood glucose levels with diabetes see this webmd article.

### Human:\nshould i get my blood level of vitamin d checked?\n\n### Assistant: as with many blood tests (such as hormone levels) there can be considerable variation in results from lab to lab time of day or season since vitamin d levels tend to be best at the end of summer. perhaps the best indicator of general vitamin d levels is [the] 25(oh)d blood test for it measures vitamin d from both sun and dietary sources. this form of vitamin d also lasts in the body for around 30 days. . so who should push for blood testing? bearing in mind that the 25(oh)d blood test can cost upwards of $200 many primary care providers have chosen to just recommend an increased intake of vitamin d. the dose is based upon the person's specific health history. until there are studies set specifically to establish optimal dosage and blood levels the primary care model makes sense. among healthy adult women without excessive sun contact consuming 800 iu per day of vitamin d is a reasonable choice. for your specific vitamin d recommendation check with your gynecologist or primary care provider.

### Human:\nwill baby have type i diabetes if i have gestational diabetes. i have just been diagnosed with gestational diabetes. the doctor said i will need to take insulin. i am worried my baby will be born with type i diabetes. what are the risks to my baby? i am 43 weeks along.\n\n### Assistant: children born to mothers with gestational diabetes mellitus (gdm) are at a higher risk for obesity type 2 diabetes and metabolic syndrome; but your child will not be at a higher risk for type 1 diabetes. it’s important to follow your doctor’s recommended course of action for managing gestational diabetes to help minimize the potential risks which may include: • maintaining appropriate weight gain • following specific dietary guidelines • following your doctor’s recommendations for an appropriate exercise routine • monitoring your blood sugar levels frequently • taking insulin as directed blood sugar levels will typically return to normal for you after 6 to 8 weeks after delivery but you will be more likely to develop gestational diabetes again during subsequent pregnancies. please refer to the following for more information: <link> <link> no

### Human:\nwhat blood sugar levels are considered normal and what levels are diabetic?\n\n### Assistant: at present the diagnosis of diabetes or prediabetes is based in an arbitrary cut-off point for a normal blood sugar level. a normal sugar level is currently considered to be less than 100 mg/dl when fasting and less than 140 mg/dl two hours after eating. but in most healthy people sugar levels are even lower. during the day blood glucose levels tend to be at their lowest just before meals. for most people without diabetes blood sugar levels before meals hover around 70 to 80 mg/dl. in some 60 is normal; in others 90. again anything less than 100 mg/dl while fasting is considered normal by today's standards. what's a low sugar level? it varies widely too. many people's sugar levels won't ever fall below 60 mg/dl even with prolonged fasting. when you diet or fast the liver keeps sugar levels normal by turning fat and muscle into sugar. a few people's sugar levels may fall somewhat lower. without taking diabetes medicine though or having uncommon medical problems it's difficult to drop sugar levels to an unsafe point. to diagnose diabetes your doctor may do a fasting blood glucose test. fasting blood glucose values: low – less than 70mg/dl normal - between 70 to 99mg/dl pre-diabetic – between 100 – 125mg/dl diabetic – greater than 126mg/dl non-fasting blood glucose values: low – less than 70mg/dl normal - between 70 to 139mg/dl pre-diabetic – between 140 – 199mg/dl diabetic – greater than 200mg/dl the standard diagnosis of diabetes is made when at least two separate blood tests show that your blood sugar is elevated. 80 to 120 normal. fasting : under 120 is normal over 120 is high two hrs after food testing: under 150 is normal over 150 is high. 80 to 100

### Human:\nmy weight has hit a plateau. what do i do?\n\n### Assistant: there are several reasons why your weight can hit a plateau including: losing weight too quickly. when this happens your metabolism (the rate at which your body burns calories) can slow down because your body senses it is starving. rapid or large amounts of weight loss can slow your metabolism by as much as 40% in six months. losing muscle. when you lose weight up to 25% can come from muscle tissue. and since muscle is the engine in your body that burns calories and helps maintain your metabolism losing it can hinder weight loss. weightlifting can help preserve and build muscle. reaching your body's particular set point -- the weight and metabolic rate your body is genetically programmed to be. once you reach that point it's much harder to lose weight and even if you do you're likely to regain it. if you're at a weight at which you've hit a plateau in the past if your body generally seems to gravitate toward that weight and you're within a bmi (body-mass index) range of 20 to 25 then you may be at your set point. decreasing your physical activity and/or increasing your caloric intake. people lose weight all the time by reducing their caloric intake without doing any exercise but it's almost impossible to keep weight off without exercising. many scientists agree that physical activity is the single best predictor of whether a person will maintain a weight loss. other health factors including thyroid or adrenal gland problems; medications like antidepressants; quitting smoking; menopause; and pregnancy. even with any of the above factors the bottom line to losing weight is eating fewer calories than you burn. studies show that people almost always underestimate how many calories they're eating. so if you're struggling with weight loss you're still exercising and you've ruled out any of the above reasons for weight plateaus look at your calorie intake. as for exercise and weight plateaus sometimes a change in routine can help. instead of the treadmill try the bike or the stepper. instead of a dance class try a stretch and tone class. if you're not weight lifting this would be a good time to start. if you already do aerobic exercise try adding intervals (short bursts of higher-intensity exercise) to your aerobic workouts. and keep reminding yourself that if you maintain an active lifestyle and continue with healthy eating you will reach your goals. it can be frustrating when you’re putting so much hard work into losing weight only to hit a plateau. don’t be discouraged; a few simple changes may be all that you need. for exercise consider the f. i. t. t. principle: f – frequency – how often or how many days you exercise i – intensity – how hard you work during your exercise t – time – how long or how many minutes you spend per session. t – type – the type of activity that you are doing making adjustments in one of these areas could help you break through your plateau. of course the more that you do with your exercise the greater the benefits you should see from it. for example let’s say that your current exercise routine is walking three times per week for thirty minutes at a moderate intensity. you could add more days per week or spend more time per session to expend more calories and hopefully further boost your metabolism to promote weight loss. try increasing the intensity by walking at a quicker pace or incorporating intermittent bouts of jogging. you could also try carrying arm weights having a weighted backpack or incorporating more hills or inclines to challenge yourself further. your body may have just become accustomed to your exercise routine so sometimes it can also be helpful to change the type of activity as well. try different forms of cardiovascular exercise or try doing strength-building exercise if you’re not already. with nutrition try reassessing your dietary intake. in what ways can you eat healthier? can you eat out less often or drink less soda? what about having less chips pastries or candy? can you increase your fruit or vegetable intake? try food journaling to track and monitor your dietary intake so that you can better recognize areas for improvement. don’t forget to reevaluate your calorie needs as you continue to lose weight. keep working at it! often times the best way to break through a plateau is simply persistence! stay calm and don't worry about it the more you worry the worst its going to get how low do my carbs need to be to lose weight

### Human:\ncan a low ferritin level cause hair loss and heart palpitations in women? my ferritin level is at 12. every time i shower or blow dry my hair i am losing tons of hair! i can barely cover my scalp at crown of my head. after researching i found that ferritin levels in women should be around 70. i have also been experiencing an increased heart rate since august. i went to cardiologist and he said my heart was healthy. my thyroid is fine. started taking iron supplements (45 mg) 3000 mbg biotin pills and using shampoo that removes dht from hair within the last week but have seen no difference.\n\n### Assistant: there is some research to show that anemia is associated with hair loss but not all studies agree. in fact a 2010 study in the journal of the american academy of dermatology showed no difference. it's best to work with your healthcare provider on optimal ferritin levels and supplementation. you also want to rule out other potential issues related to hormonal or skin changes. changes such as pregnancy childbirth and menopause can increase hair loss. when it comes to nutrition protein and adequate calories play an important role in hair growth so including good protein sources at most meals may help (lean meats eggs fish beans and dairy) as does eating balanced meals throughout the day. this webmd article provides more information on eating right to keep hair healthy.

### Human:\nhow can a man orgasm more quickly?\n\n### Assistant: when a man is often able to orgasm but takes a very long time (typically 45 mins or longer) this may be called "delayed ejaculation". this is different than "inhibited ejaculation" which can result in a man often not having an orgasm at all. there are a wide range of causes and often this is helped by meeting with a sex therapist. meeting with a doctor to rule out medical conditions that may be getting in the way of penile sensation is also often helpful (conditions such as diabetes). in the mean time some men find it helpful to use a vibrator together with their partner. increasingly there are more couples vibrators available on the market including the we-vibe which is worn partially inside a woman's body during intercourse. less expensive but also somewhat less intense are vibrating condom rings available in many drug stores. some men orgasm more easily with intense vibration such as the accuvibe or hitachi magic wand. couples may hold this between partners' bodies which can feel pleasurable for both partners. some men alternatively find pleasure from holding the vibrator to their penis while their partner kisses them. this can help to ease orgasm for the man while making it easier for his partner to assist as well.

### Human:\ni have type ii diabetes. what is the best form of exercise for my condition? . i take metformin twice a day and insulin in the evening. i would like a recommendation on a good exercise program especially since i have a busy and sometimes inconsistant schedule.\n\n### Assistant: most helpful answer the easy answer would be any exercise. find an activity that you like. it can be as simple as walking (aerobic) or even taking up a sport like tennis. the best exercise program is really one that you will do on a regular consistent basis at least three or more times per week. find a partner - it is easier to exercise with a friend. having type 2 diabetes means you need to make the time. having a busy schedule is the norm for everyone. the insulin you take daily makes up for the little insulin that you produce. metformin helps sensitizes your body and muscles to insulin. in people with diabetes the only way to break and improve insulin resistance and reduce your risk of heart disease and other complications is by using muscles. most any type of regularly performed physical activity will do. find something you like it helps increase the chance that you will stick to it. a buddy system for exercise also helps make you more accountable and less likely to miss out on the social mental and physical benefits of exercise. a combination of aerobic type exercise and weights targeting core muscles is something to aim for. find an endocrinologist that is passionate about working with people that have type 2 diabetes. the surgeon general recommends 30 minutes of moderate intensity physical activity most days per week. for individuals with diabetes it’s recommended that there should not be more than two consecutive days without aerobic physical activity because the benefit of increased insulin sensitivity gained from exercise generally doesn’t last longer than 48-72 hours. moreover high-intensity physical activity will tend to enhance insulin sensitivity more than low-intensity physical activity. also a greater duration spent on exercise appears to more effective than a lesser duration. with both intensity and duration however the benefits appear to be a result of more energy being expended. exercise can significantly lower a1c levels and can even help glycemic control during times when not exercising. both resistance training and aerobic exercise have helpful effects on insulin and can help with diabetes management. do not exercise if your blood sugar is too low and stop exercise if you feel faint have chest tightness or are extremely short of breath. i generally recommend a combination of both aerobic exercise and some resistance exercise in most of my patients. and the good news is that most people can do low-impact exercise (like walking) and still see a benefit. you should talk to your doctor about your own specific exercise prescription. and while you're asking see if your doctor is exercising too! walking is the best exercise for everything! if you don't seem to have time to go and walk park as far from the door at work grocery store drug store anywhere you go as possible. then walk briskly while going in and out and if possible while you are shopping. this will help some and hopefully make you want to walk more and get into a routine! you can always find 30 min 3 times a week to walk!

### Human:\nam diabitic and told i also have narapathy how any types of narapathy are there and is any types of treatments\n\n### Assistant: diabetic neuropathy is nerve damage that can happen as a result of having diabetes. there are four types of diabetic neuropathy: peripheral autonomic proximal and focal. the most common location for neuropathy to occur is your legs and feet and some common symptoms are numbness and loss of sensation pain tingling or burning. treatment and management for diabetic neuropathy entirely depends on which type that you have and the specific symptoms you’re encountering. maintaining healthy blood sugar levels will certainly be an integral component of any treatment plan. i really encourage you to meet with your doctor to better understand which type that you have and how you can properly manage it. you can also visit the following websites for an overview on diabetic neuropathy and some treatment options: diabetic neuropathy – topic overview diabetic neuropathy – treatment overview

### Human:\nwhy is yogurt so good for me?\n\n### Assistant: for anyone who's trying to get in shape and stay that way yogurt packs a terrific weight maintenance punch. here are some rules of the road when considering integrating yogurt into your nutrition plan. 1) what to look for on the label: in a 6 ounce serving make certain you're getting 100-150 calories; 3. 5 grams or less of fat; saturated fat 2. 5 grams or less; protein at least 8-10 grams; sugar 20 grams or less; calcium at least 20% rda; vitamin d at least 20% of rda. 2) high protein yogurts are great: the greek and icelandic yogurts are concentrated nonfat or low fat and have a whopping 16 grams protein per container. if you get them non-flavored they have less than 10 grams of sugar. i like to add a teaspoon or two of chopped walnuts or sliced almonds flax seed and blueberries. that makes for a great meal or mid-afternoon snack. 3) yogurt's loaded with vitamins: a single serving provides potassium phosphorous riboflavin iodine zinc vitamin b5 (pantothenic acid) and vitamin b12. vegetarian women are short on b12 which is found mostly in animal products. one eight ounce serving contains 1. 4 micrograms of b12 60% of what adult women need. 4) yogurt may help you shed pounds: researchers at the university of tennessee found that women who ate yogurt a couple of times a day (up to 18 ounces) dropped 22% more weight and 81% more belly fat than women who didn't. calcium in yogurt helps cells shed the belly weight by preventing stress hormone from packing on the ab fat. well yogurt and especially greek yogurt is a very good source of nutrients and especially protein! it is good for your health and skin! you can also check this blog for more tips about greek yogurt in particular: www. igreekyogurt. com

### Human:\nwhat are carbohydrates?\n\n### Assistant: a carbohydrate is the chemical name for sugars and grains. carbohydrates always contain the elements carbon hydrogen and oxygen. fruits breads pasta potatoes beans cereal and rice are high in carbohydrates or “carbs. ” many vegetables are also rich in carbohydrates. soft drinks candy and most other sweet junk foods also contain highly processed carbohydrates. natural carbohydrates are an important part of a healthy diet. the healthiest carbs are in whole grains vegetables fruits and beans. these foods are filled with other nutrients along with carbohydrates. our bodies have to work a bit to digest these carbs. processed carbohydrates such as high-fructose corn syrup are unhealthy when consumed regularly in large amounts. experts believe they are too-easily digested causing blood sugar spikes that might contribute to developing diabetes and other health problems.

### Human:\ni love oatmeal and i am a diabetic. is it good to eat in a regular basis? . the issue is that i read that some doctors say that oatmeal is alright but you must be careful with it as a major part of your diet but others say it is fine as long as it is not loaded up with all the "nice" things that make oatmeal so good like brown sugar and raisans which makes sense because of the high carbo content.\n\n### Assistant: most helpful answer the key for diabetes is keeping carbohydrate intake consistent throughout the day. oatmeal is a healthy carbohydrate-rich food that is beneficial for heart health and can fit in a healthy diet. you want to work with your healthcare provider on how many carbohydrates you need in a day. the american diabetes association recommends 45-60 grams of carbohydrate at a meal (3-4 carbohydrate servings). one half cup of oatmeal without added sugars contains about one carbohydrate serving (15 grams). if you add to tablespoons raisins that is another carbohydrate serving. the benefit of carbohydrate counting is you have flexibility about what you eat as long as you stay within your recommended carbohydrate intake. but choosing carbohydrates that are nutritous like oatmeal (and other whole grains) fruits and dairy is important for a healthy diet. if you need help see a diabetes educator for more assistance. for more information on carb counting see this article <link> i am a type 2diabetic and eat oats every morning. one of the first things i was taught was to add a good fat or protein to a carb breakfast. i eat 1/3rd cup of steel cut organic oats cooked in water 6 oz. of almond milk 1tsp cinnimon and 1 tbs. of almond butter. i also eat one cup of fruit but eat the fruit 1hr prior to the oats. this wait time allows the fruit to digest before the oats start to digest. i have been taught also to not eat a startch or grain carb together with a fruit as the stomach treats this combination by frementation during digestion. my blood sugars are norml eating this way. total carbs for this meal is around 66grams which is high but eating this way negates the high blood sugars!

### Human:\ncan i alter my diet prior to and/or while pregnant to decrease my risk of gestational diabetes?\n\n### Assistant: most health care providers test for gestational diabetes mellitus (gdm) between 24 and 28 weeks of pregnancy. gdm is diabetes that occurs in pregnant women who have not had diabetes before becoming pregnant. with gdm your body has a hard time using the insulin it needs to get energy from food you eat. the american diabetes association estimates that 18% of pregnancies are affected by gestational diabetes. you can lower your risk of gestational diabetes by losing excess weight getting 30 minutes of physical activity on most days and by following a balanced eating plan with a variety of foods. choose foods high in fiber and low in fat and calories. and be sure to focus on fruits vegetables and whole grains.

### Human:\ni’m on birth control but have some brown spotting before my period. now my period is a week early. is this normal?\n\n### Assistant: spotting before your flow begins is not uncommon. as soon as you take your last active pill the hormone levels begin to drop. generally it takes about 72 hours for the levels to drop sufficiently to produce a "menstrual-like" flow but some spotting can begin as the the levels are dropping. the dark brown color simply reflects the scant amount of flow. a slow scant flow has a longer exposure to oxygen creating the darkened color. now the birth control pill (bcp) period which starts a week early is a different issue. that would be considered bcp breakthrough bleeding--also known as poor cycle control. this is all too common among hormonal birth control users. fortunately it does not impact your contraceptive protection but it is a hassle. if you have several months of poor cycle control you can see your gyn or clinic for follow up. sometimes a switch of bcp brand or formulation can be helpful. if it stays stable (e. g. bleed always arrives a week early) that would be ok but if it is moving around all over the pill pack that would be inconvenient.

### Human:\ncan the tongue become larger as we age?\n\n### Assistant: yes. tongue enlargement is usually harmless unless it is secondary to a systemic disease like hypothyroidism. medical and/or surgical management may be necessary. see your doctor to rule out any specific medical problems.

### Human:\nwhat does it mean if your thyroglobin ab are very high but all the others are normal? and how does that affect the body? . i am wondering if the thyroglobin ab being high could correlate to the weight gain(15+ lbs a month and can't lose it) breast enlargement(2 cup sizes) fatigue and lack of menstration. i have been tested for cancer(negative) and i have no family history of these issues. from the research i have done i cannot find an answer so i am hoping that someone could enlighten me so i would have a stepping stone the next time i went to the doctor about this.\n\n### Assistant: a high thyroglobin antibody level in and of itself does not mean you have thyroid disease. they are found in nearly 20% of all women. however high levels of thyroglobulin antibodies associated with other thyroid antibodies are found in 80 to 90% of people with immune mediated inflammation of the thyroid (hashimoto’s thyroiditis). this is the most common type of thyroid hormone deficiency in the u. s. thyroglobulin antibodies are also found in pregnant women relatives of patients with hashimoto’s thyroiditis and in people with other immune mediated diseases such as type 1 diabetes. the usual course of hashimoto's thyroiditis is gradual loss of thyroid function. antibodies to thyroglobulin are considered to occur as a result of damage to the thyroid from special white blood cells (t cells). common symptoms of thyroid hormone deficiency include fatigue being cold all the time weight gain constipation dry skin and menstrual irregularities. since these symptoms occur in other diseases it is important not to always blame thyroid deficiency as the cause. fortunately laboratory tests for thyroid function make this diagnosis relatively easy. however because loss of thyroid hormone develops over time and antibodies can herald problems you will want to follow-up with your doctor about your thyroid tests and your symptoms.

### Human:\nwill vitamin k cream erase spider veins?\n\n### Assistant: spider veins are usually the result of weakened vein valves that trap blood that used to flow freely. genetics hormone levels and sun exposure can also play into the development of spider veins. unfortunately the topical application of anything will not eliminate spider veins.

### Human:\nmy hgba1c is 9. 1 and my fasting blood sugar is 92. is this idicative of diabetes? . my vitamin d is also low. my doctor has prescribed a prescription for that and he wants to repeat the hgba1c. i'm not sure if that can alter the test or not.\n\n### Assistant: although studies show low vitamin d is linked to poor diabetes control it wouldn't necessarily give you a false reading. a hemoglobin a1c higher than 6. 5% indicates diabetes. the fact that your fasting blood glucose was normal is probably why your doctor is having you re-take your hemoglobin a1c. hopefully the second test will give you some clarity. the a1c is the average of your readings for 6 months. a 9. 1 reading puts your average reading at around 170. average not exact. that is diabetic. mornings without eating should average 80 - 130. two hours after eating should be under 180. if the 170 is a fasting reading you have diabetes. my opinion and what i was told in classes. not all methods for measuring hba1c are totally specific -one of the usual substances incriminated is hb f or foetal haemoglobin which only should usually be present in small amounts in adult blood however some people do carry larger amounts which can interfere with the assay.

### Human:\nis coffee good for your heart and how much coffee? . i heard it was good for the heart one cup a day is it true?\n\n### Assistant: there is emerging evidence that moderate coffee consumption is linked to decreased risk in type 2 diabetes parkinson's and liver cancer. a recent study published in circulation heart failure discussed in detail here on webmd showed moderate coffee intake was associated with lower risk of heart failure. the researchers recommended 2 average american cups of coffee as moderate which was actually 4 smaller cups in europe. it's important to remember that these studies only show associations and do not prove cause and effect. but if you love coffee you can feel good about making it a part of your healthy diet. i know i do!

### Human:\nhow much of an impact does vitamin d have on cardiovascular disease?\n\n### Assistant: in finland a 25- to 30-year study of over 6 000 persons found an increased risk of fatal vascular disease in those who had the lowest blood levels of 25(oh)d. interestingly this relationship was apparent for the incidence of strokes but not heart attacks. proposed mechanisms for improved blood vessel health include vitamin d's beneficial impact on high blood pressure via kidney hormones decreased inflammation inside the arteries and improved insulin resistance via changes in parathyroid hormone (lee 200<positive_smiley>.

### Human:\ni have been on depoprovera for 4 months. for the last month i have been spotting often. what could be happening?\n\n### Assistant: there are a variety of possible explanations for sudden onset spotting on depoprovera: 1. new infection with chlamydia--this is less likely unless you have a new sexual partner or a partner with multiple other partners. 2. stress--many women using hormonal birth control (pills/patches/ring/shot) have had an apparent correlation between life stress and spotting on their birth control method. i have also seen this occur in a couple of my postmenopausal patients. yet there are no good studies in the medical literature on this phenomenon. if there is a connection between life stress and the adrenal gland hormones that can be converted to weak estrogens that might be a trigger for breakthrough bleeding. 3. "normal" effects of the depoprovera shot on the lining of the uterus--simply stated if the uterine lining is like grass or lawn estrogen is like the fertilizer (causes a thickening of the lining) and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). this is why depoprovera (high dose synthetic progesterone) brings about a thin lining and why birth control pills (relatively progesterone dominant) bring about shorter lighter periods. if the lining of the uterus gets very thin it can prompt more breakthrough bleeding. since it has been a month of constant spotting i would urge you to return to the gyn or clinic who administers your depoprovera. they can check for infections (if needed) and can give you a more "for sure" answer about the spotting. if someone is having very heavy breakthrough bleeding a short course of low dose estrogen pills can sometimes terminate the spotting. .

### Human:\ndoes janumet cause weight loss or the opposite?\n\n### Assistant: most helpful answer janumet a medication used in type 2 diabetes causes weight loss. janumet is a combination medication of metformin and sitagliptin. metformin (glucophage) and sitagliptin (januvia) can each be used alone for the treatment of diabetes. janumet is indicated when diet and exercise fail to adequately control diabetes and both metformin and sitagliptin are appropriate. metformin definitely causes weight loss and sitagliptin usually results in weight loss or is weight neutral. a 24-week study that looked at weight loss with janumet found that the amount of weight lost was about the same for patients on metformin alone. during this 24-week study patients lost between 1. 3 to 2. 9 lbs. since weight loss is an important part of the treatment plan for most type 2 diabetics it is very helpful to use a medication that helps you go in the right direction. don’t forget that diet and exercise are still the key ingredients to weight loss. talk with your provider about how you can achieve your weight loss goals and if a medication like janumet is right for you.

### Human:\nhow can i get rid of tummy cellulite?\n\n### Assistant: what i would do is: remove your excess fat gradually as rapid weight reduction makes your skin looser -- aiming for no more than 1/2-2 pounds of fat per week. weight lift 2-3 times a week incorporating core exercises along with the usual total body weight program. eat enough protein every day to build and maintain optimal muscle (60-80 grams per day). core work does not affect loose skin but you need to do it to strengthen and shape your ab and pilates is terrific. get your body fat % done and aim for 25% or so and then whatever the weight is commensurate with that go with that. once you have achieved the body composition that is optimal for you look at your abdomen. there is no magic pill or potion or exercise that will eliminate your loose skin. you will look and feel terrific at your goal body composition. you'll then have to ask yourself how much your ab really bothers you. . you might also meet with a plastic surgeon to discuss options. many people who have lots of skin sag do undergo a simple tummy tuck. some of my patients who've dropped 50 or more pounds live with their loose skin while others head for surgical correction. this is a personal decision. you can get rid of cellulite with the number of treatments like swimming walking weight training there are also number of spa treatments and laser treatments and endermologie treatment which can healp you to get rid of cellulite. but the question is that these method help you to get rid of cellulite permanently? because many people complain that after taking those costly treatments they are not able to vanish those cellulite completely. here i know and used a cream few months ago which helps me to recover the cellulite permanantly till now and is very reasonable which is within your budget you can use revitashape cream it is really very effective. source: <link> insulin proliferation in our bodies could lead to excessive fat. therefore discuss with your doctor for a 2-hour sugar challenge and measure the insulin spike. if allowed to continue excessive insulin could give rise to diabetes.

### Human:\ncould the acne on my back have anything to do with my diet?\n\n### Assistant: you have most likely genetically inherited your acne. however your breakouts may get worse when you eat more of certain foods. many studies have been conducted concerning the connection between diet and acne. and so far the most conclusive evidence is that a high glycemic index diet (a diet high in refined sugars) can worsen acne breakouts. some data also suggest that dairy foods can worsen acne due to presence of certain androgenic hormones in cow's milk. if you notice a link between when you consume dairy and the severity of your acne you may benefit from eating dairy substitutes and products that don't contain casein or whey.

### Human:\ncan anyone get dental implants?\n\n### Assistant: in most cases anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for a dental implant. patients should have healthy gums and enough bone to hold the implant. they also must be committed to good oral hygiene and regular dental visits. heavy smokers people suffering from uncontrolled chronic disorders - such as diabetes or heart disease - or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis. if you are considering implants talk to your dentist to see if they are right for you.

### Human:\nwhat should i do to prepare for a transesophageal echo?\n\n### Assistant: before a transesophageal echocardiogram tell your doctor if you have any problems with your esophagus such as hiatal hernia swallowing problems or cancer. on the day of a transesophageal echocardiogram do not eat or drink anything for six hours before the test. take all of your medications at the usual times as prescribed by your doctor. if you must take medication before the test take it with a small sip of water. if you have diabetes and take medication or insulin to manage your blood sugar please ask your doctor or the testing center for specific guidelines about taking your diabetes medications before the test. someone should come with you to your appointment to take you home as you should not drive until the day after the test. the sedation given during the test causes drowsiness dizziness and impairs your judgment making it unsafe for you to drive or operate machinery.

### Human:\ncan a type 1 diabetic use over the counter sinus and allergy medicine?\n\n### Assistant: before using any over the counter medication diabetics should first discuss with their doctor whether the medication is safe and appropriate. a common medication used for runny noses is a decongestant. decongestants are available either as a pill or as a nasal spray. common decongestants found in pill form include pseudoephedrine and phenylephrine. both of these ingredients may raise blood glucose and blood pressure levels. people with diabetes should only use decongestants cautiously and under the direction of a doctor. because of its misuse and side effects pseudoephedrine is found behind the pharmacy counter. this measure means that pharmacists can make sure that pseudoephedrine is being used appropriately. phenylephrine may be found on the store shelves. remember that many cold medications contain multiple ingredients. be sure to read carefully all the ingredients in a preparation. many cold preparations contain non-steroidal anti-inflammatory drugs (nsaids) such as ibuprofen (advil) or naproxen (aleve). these agents can be harmful to the kidneys of diabetics and if pain is not an issue may not be needed. therefore buying separate ingredients rather than a combination medication may be safer. a nasal decongestant works more quickly than a decongestant taken by mouth. this preparation is sprayed into each nostril. nasal decongestants usually do not have a significant effect on blood glucose or blood pressure levels because their effect is mainly local. however if used excessively they can have effects on glucose and blood pressure. the important downside to nasal decongestants is a possible rebound effect that makes your nose even more congested if you use them for more than 3 to 5 days. for that reason they are best for short-lived colds and not for persistent allergies. saline nasal sprays are safe for diabetics and do no affect blood glucose levels. nasal strips are another good option and are available over the counter. the strips work by mechanically opening the nostrils. antihistamines are a commonly used for a runny nose. antihistamines can help dry a runny nose due to an allergy but are not helpful for a runny nose due to the common cold. antihistamines do not raise blood glucose levels and are usually safe for diabetics. however some of the older over-the counter antihistamines cause sleepiness. this can be a real problem in diabetics especially when combined with sedatives or alcohol. diphenhydramine (benadryl) is an antihistamine that causes sleepiness but fexofenadine (allegra) loratadine (claritin) and cetirizine (zyrtec) are less sedating. the most important step though in treating your symptoms is to be sure you have the correct diagnosis. go over your symptoms and signs with your doctor. many times what seems to be an allergy may in fact be a bacterial sinus infection. bacterial sinus infections are common in diabetics and need to be treated with antibiotics which are only available by prescription. so don’t rush out and buy an over-the-counter preparation without first talking with your provider.

### Human:\ncure for gastroparesis. i was diagnosed with gastroparesis 4 years ago. i modified my diet to low fiber and took domperidone and nexium. for about 18 months after the diet change i still had occasional symptoms. however for the last 2 years i have not had symptoms and have reduced my rx intake by half. i have slowly introduced regular food back into my diet and still have not incurred any symptoms. is it possible to recover from this?\n\n### Assistant: i think it depends on the cause of gastroparesis. if it was due to uncontrolled diabetes and you are now have better control it can go into remission. so without knowing the cause i can't say for sure. i would work closely with your healthcare provider and a dietitian that specializes in gastrointestinal diseases. for more info see what is gastroparesis?

### Human:\ncan having a problem with your thyroid cause you to lose handfuls of hair at one time?\n\n### Assistant: certainly. either under or over-active thyroid can cause one to lose hair. check with your internist or endocrinologist to be sure your thyroid levels are where they need to be.

### Human:\ni am having trouble swallowing my food. it feels like i the food wont go down. i have very little teeth. i want to eat but every time i do the food won't go down and i end up having to throw it up.\n\n### Assistant: you need to see your doctor right away if you are having trouble swallowing your food. there can be many possible causes for trouble swallowing. some can be very serious. here are a few of the things that can cause difficulty swallowing: • the esophagus (the tube that runs from your mouth to your stomach) may be partially blocked by a tumor or web. it may also be narrow due to severe reflux. • a swelling in a surrounding area such as the thyroid or lymph node may be pressing in on the esophagus. • there could be a problem with the nerves or muscles that are involved in swallowing • poor teeth can be preventing food from being properly chewed • diseases such as diabetes or scleroderma may prevent the esophagus from moving the food along webmd has a very good article on difficulty swallowing that can give you some more information. but do call your doctor now and make an appointment to have this checked out.

### Human:\ni have been ill for a while and lost quite a bit of muscle and weight suggestions on getting it back and why i hurt? . so i have a thyroid disorder and i had it tested a month ago and still no answer back from anyone. i am feeling a bit better now but i can't seem to gain back the weight or the muscle. specifically on my legs and they hurt quite frequently. my legs were the strongest part before i got sick and they still are pretty strong but i've never had leg pain when i ran or carried things before. and it worries me how thin they are now along with the pain. should i be concerned? suggestions?\n\n### Assistant: be sure to get in touch with your doctor about your leg pain and thyroid -- only a healthcare provider can address your medical needs. once you get that worked out you can focus on gaining muscle. make sure you get protein at every meal along with a balanced diet adequate in calories. research shows 25 grams or more of protein at meals helps build muscle. to give you an idea 1 ounce of lean meat has 7 grams. also exercise that includes resistance training is beneficial as long as it's okay with your doctor. after working out consume a snack that contains protein and carbohydrates within a half hour of stopping exercise. more reading. healthy protein sources what to eat before during and after exercise

### Human:\nhow do i treat halitosis?\n\n### Assistant: bad breath or halitosis is an embarrassing condition with many possible causes. food tobacco alcohol prescription drugs and over-the-counter meds can all cause halitosis. in some instances diseases like diabetes or acid reflux can be the source. seventy percent of these cases are caused by tongue bacteria which can be treated by brushing or scraping the tongue. many times gum bacteria or tooth decay are the causes. the best place to start is at the dentist for an evaluation and hygiene visit.

### Human:\nmy appetite has increased suddenly. i have been eating more than i want to but cannot resist and i am gaining weight. i am a 64 year old male. my appetite has increased suddenly. i have been eating more than i want to but cannot resist and i am gaining weight as a result.\n\n### Assistant: a good appetite is a sign of good health but if your appetite has suddenly increased in might be a sign of disease. an important distinguishing point is if you are gaining weight. an increase in your weight suggests that your increased appetite might be a response to boredom stress or depression. certain drugs might also explain an increased appetite and weight gain. steroids such as prednisone and dexamethasone which are given for asthma joint and skin problems can cause an increased appetite. certain antidepressants cause an increased appetite and weight gain. increased appetite is a side effect of tricyclic antidepressants; amitriptyline (elavil) imipramine (tofranil) and doxepin (sinequan). increased appetite also occurs with medications used for schizophrenia or bipolar disorder; olanzapine (zyprexa) and clozapine (clozaril). some women experience appetite changes right before a period. this is especially true for women with pre-menstrual syndrome who can experience craving for carbohydrates and increased appetite around the time of menstruation. even changes in your diet can affect your appetite. eating a lot of carbohydrates and junk food increases insulin secretion from your pancreas to stabilize your body’s blood sugar and that can make you hungry. if on the other hand your appetite is increased but you are losing weight then diseases that affect your metabolism may be responsible. elevated thyroid levels (grave’s disease or hyperthyroidism) cause an increased appetite because thyroid hormone speeds up your metabolism. diabetes can present with an increased appetite and weight loss. increased exercise can cause your appetite to improve and depending on the calories burned from exercise and your intake your weight may vary. don’t ignore an increased appetite. keep a diary of the foods you are eating and note whether your behavior is affecting your appetite. check your weight and see if you are gaining or losing. see your doctor about a change in appetite to make sure that you do not have a medical condition that needs to be treated. there are many things that can increase appetite -- some beneficial and some not. for example an increase in physical activity may give you a more robust appetite which is fine if you feed your body well. but a lack of sleep or change in eating patterns can also increase appetite which is not so good. think about what has changed in your life both physically and emotionally that could be increasing your appetite. here are some other tips that can help: look not just what you are eating but how. try to sit for meals be mindful of the food enjoy eating an stop when you are comfortably full and satisfied. avoid eaitng on the go or grazng all day which may not satisfy your hunger. too many processed foods can also increase hunger because they aren't very filling or sustaining. eat filling foods including those high in fiber (whole grains fruits vegetables and beans) and protein (lean meats) along with healthy fats (nuts seeds healthy oils). get adequate sleep and physical activity.

### Human:\ni have high triglycerides and high ldl's and i'm in excellent physical shape. how do i lower these levels without meds? . high cholesterol htn etc. all run in my family. i cut out red meats and non-whole wheat breads and pastas for about 6 weeks without any change. i would like to find a way to drop my cholesterol w/o going on meds. my entire family is on various cholesterol and bp meds but they're all overweight and refuse to diet/exercise. is this something i can beat w/o meds? if i continue on with high levels throughout my life would i be able to mitigate the risks of heart disease diabetes and so on?\n\n### Assistant: you mention that you have a family history of high cholesterol so you may just have a genetic predisposition to having high triglycerides and high ldl cholesterol. that doesn’t mean however that you shouldn’t try to do everything that you can through modifiable lifestyle behaviors such as diet and exercise to manage your levels. some suggestions to lower your triglycerides and ldl cholesterol levels would be to: • do cardiovascular exercise five times per week for thirty minutes or greater • lose weight if you are overweight or obese according to bmi • change dietary habits like reducing saturated and trans fat from your diet cutting out sugar getting more fiber getting more omega-3 fatty acids and drinking less alcohol if you drink • quit smoking if you smoke i really applaud your efforts to avoid getting on cholesterol lowering medication. continue to do what you can with diet and exercise and continue to follow up with your doctor on a regular basis. it might sound strange but i had triglycerides over 1000 and got them to normal range with lots of black tea and 5000 mg of epa dha (omega-3) fish oil supplements daily. the fish oil was at my mds advice but didn't seem to work until i started drinking plain black tea in place of water - 5 tea bags in 64+ oz water daily.