Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

NPs and PAs Make a Difference in Rural Communities

Hello, dear readers, and (yes, it’s mid-February) happy 2020. We hope the new year is treating you well. You’ve filled our mailbox with some very interesting questions and quandaries, including how to follow through on New Year’s resolutions. We look forward to tackling that topic -- and many more of your questions -- in the coming months. Meanwhile, onward to your most recent thoughts, tips and suggestions.

-- A reader from central Florida, who just recently caught up with a column about the growing role of nurse practitioners (also referred to as NPs) and physician assistants (also known as PAs) in primary care, wanted to add to that conversation. “Where we live it’s pretty rural, and if we didn’t have nurse practitioners at our local clinic, we wouldn’t have health care,” she wrote. “They make a difference to my family and all the people in our community.”

-- A column about hemorrhoids continues to get a lot of response, both from older adults and new moms. A reader from Ohio says when her hemorrhoids flare up, she knows she’s been slacking off on getting enough salad and fruit into her diet. “I use a drugstore cream, and that helps, but I also start eating a lot more from the produce section,” she wrote. “It takes a couple of weeks, but the episodes always end.”

Another reader, writing from Indiana, had this succinct advice: “Blackstrap molasses, taken orally.” While this approach to hemorrhoid relief isn’t supported by scientific research, there’s no downside to trying it. Blackstrap molasses is rich in minerals such as iron, potassium and magnesium, as well as B vitamins. It’s a byproduct of sugar production, though, so take it in moderation. (And it has a powerful and slightly bitter flavor.) About a tablespoon or so can be mixed into hot water as a drink once or twice a day, and it can be used in cooking as a flavoring or a glaze.

-- A column about a study that linked depression to certain missing microbes in the gut continues to generate a lot of interest. Researchers found that people living with chronic depression lacked two types of microbes, known as Coprococcus and Dialister. Many of you have written to ask how to bolster these populations in the gut. Although increasing the numbers of specific bacteria in the gut is beyond our abilities at this time, you can boost the general health of your gut microbiome with a few simple habits. Eat plenty of fiber from a variety of sources, add fermented foods to your diet, cut back on sugar, cut out processed foods, avoid unnecessary antibiotics and get enough sleep and exercise. These steps may represent a significant dietary shift for some of you, but it’s worth it. We now know without a doubt that a diverse and robust gut microbiome is tied to overall good health and immune function.

Thank you to everyone who took the time to write. We love hearing from you and look forward to continuing this conversation with you next month.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)