health

Nutritional Factors to Consider When Trying to Gain Weight

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | June 10th, 2017

Dear Doctor: So many articles seem to be about weight loss, but I'm actually underweight. I eat enough, live a healthy lifestyle and exercise. But I'm 5 feet 1 inch tall and weigh 100 pounds. The charts say I need to gain about 12 pounds to be normal. How can I gain weight?

Dear Reader: The first thing we would suggest is that despite the various charts, you may already be at the appropriate weight for your metabolism. No two people are exactly alike, and the fact that your body weight doesn't conform to a calculated average doesn't automatically mean you are underweight.

A useful tool for gauging healthful weight is the body mass index, or BMI, and it's going to hold a happy surprise for you.

BMI is a simple calculation that indicates the likely proportion of lean muscle to body fat based on a person's weight and height. It doesn't directly measure the percentage of body fat -- that requires a skin caliper test, hydrostatic weighing or a bioelectrical impedance test, to name a few. But research suggests that BMI correlates as strongly to various metabolic and disease outcomes as does the measure of body fat.

A BMI that ranges from 18.5 to 24.9 is considered to indicate a normal or healthy weight. The good news is that at 5 feet 1 inch and 100 pounds, your BMI is 18.9, which puts you into the healthy range. However, if you would feel more comfortable with a few more pounds on your frame, we have some suggestions.

Because a high proportion of body fat puts you at greater risk of heart disease, Type 2 diabetes, hypertension and certain cancers, you want to be careful that the weight you gain is a healthful proportion of muscle and fat. That means splurging on high-calorie/low-value foods like processed snacks, sugary sodas, candy, pastries, fried foods -- you know the drill -- is not the way to go. Instead, approach your weight gain with the same focus, research and precision of a successful weight loss plan.

-- Keep a food diary and figure out how much you eat per week. Then, pick a reasonable amount by which to increase your food consumption.

-- Instead of eating three big meals per day, aim for four to six small ones. This gives you additional opportunities to eat more without getting too full.

-- Skip the low-calorie and fat-free versions of the foods you typically eat. Whole-milk yogurt, 2-percent milk, butter rather than margarine, salad dressings made with healthful oils -- these are your allies.

-- Add calories to the foods you already enjoy. Try mixing nuts into your yogurt, spreading nut butters on your toast, sprinkling cheese into your scrambled eggs and jazzing up your salad with avocado.

-- Stick with healthy proteins, but choose those that are more nutrient-rich. Salmon, for instance, is higher in calories, and delivers healthy omega-3 fatty acids.

Ease into your new eating regimen gradually. You want it to be sustainable and enjoyable. And we recommend that you make your family doctor a partner in your new endeavor. Good luck!

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Doctor's Insensitivity Causes Patient Distress

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | June 9th, 2017

Dear Doctor: My doctor recently made such an insensitive remark to me about my dog's death that I still haven't gotten over it. This is the clinic most accessible to me, and it won't let me change doctors. Do I even bother to bring this up at my next appointment, or just try to forget about it?

Dear Reader: I can understand why you would be upset. The relationship humans have with dogs is one of simple love, without the degree of complexity that isolates humans from one another. Because I have experienced the death of a dog, I know that it can be like losing a family member.

Your doctor, however, may not have had that experience, may never even have had a dog, may be indifferent to dogs or may just plain dislike them. We don't know. Nor do we know exactly what he or she was thinking at the time of the appointment. Clearly, however, your doctor could have done a better job of acknowledging your suffering.

But keep in mind, if you can, that your doctor has many patients and must give attention to each one of them. This includes not just listening, but getting a thorough history of the current problem, making an accurate diagnosis and providing an appropriate treatment. Then there are the other duties: taking phone calls from patients, refilling medications and ensuring documentation on electronic medical records.

Also, like everyone, doctors' personal lives can intrude on their professional lives. Like their patients, doctors suffer from the maladies of life, including coping with the illnesses of loved ones and maybe even their own health problems.

What I know from working with doctors over the last 20 years is that most are good-intentioned -- but not perfect. We try to be. But we do make mistakes sometimes in dealing with people. Although it's difficult to admit that we could have done better, we nonetheless want to know how to do so next time.

In my own practice on occasion, a patient has confronted me when they thought that I hadn't listened to their problems appropriately. I've had to swallow my pride at these times, stay calm and realize that I could have done better. This isn't easy in any profession, but it's critical in the doctor-patient relationship: We have to keep the lines of communication open.

My recommendation is to talk to your doctor about how much your dog meant to you. I would stress how long you had your dog, how it was a source of comfort and how in many ways your dog made your house feel much more like a home.

We can only hope that your doctor will understand and sympathize with your loss. If he or she doesn't, take a step back and look at the relationship overall. If this is an isolated event, try not to focus on the reaction to your dog's death.

If this isn't an isolated event, and you feel that the relationship between you and your doctor is strained, you should consider finding a new primary doctor. You may need to travel farther, but it may be worth the trouble. After all, a good doctor-patient relationship starts with good communication.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Osteoporosis Diagnosis Not Uncommon in Older Men

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | June 8th, 2017

Dear Doctor: I am a 74-year-old man and have been diagnosed with osteoporosis. Is this common in men? I thought this was a disease that women get. What will the treatment be? Will it help?

Dear Reader: Your diagnosis puts you among the estimated 2 to 5 million men in the United States who have osteoporosis. Another 12 million men are at risk of developing it. A progressive disease in which bone mass is lost more quickly than it is replaced, osteoporosis results in porous, brittle and weakened bones that are at greater risk of breaking.

While it's true that osteoporosis is more common in women than in men, the reason for that turns out to be as much about timing as about gender. Both women and men go through the same cycles of bone growth and bone loss. However, the period of bone loss begins earlier in life for women than it does for men. Add in the fact that women tend to live longer than men, which means more years of bone loss, and they are more likely to develop the disease.

When we reach our 30s, the time at which bone growth generally peaks, men have accumulated more bone mass than women. This is believed to be due to the presence of androgens, which are hormones like testosterone, and which have a role in building the skeleton in young adults. Men produce significantly more androgens than women, and thus accumulate bone mass at a higher rate.

After bone production peaks, men and women begin to gradually lose bone mass at similar rates. However, when women enter menopause, typically sometime during their 50s, the various protections offered by the so-called female hormones estrogen and progesterone begin to fade. One of the results of menopause is accelerated bone loss. At this point in life, women are losing bone at a faster rate than men are.

A decade or so later, though, men experience a drop in testosterone production. When that happens, men and women are once again losing bone mass at roughly the same rate. At the same time, calcium absorption for both women and men also slows. Some research has suggested that estrogen deficiency may play a role in osteoporosis in men as well.

In addition to the natural hormonal cycles, certain behaviors and conditions can accelerate bone loss. Alcohol abuse, smoking, gastrointestinal disorders, poor diet, lack of exercise or being immobile due to injury are risk factors for the disease. Caucasian men are at higher risk than men of other races.

In both women and men, fractures due to osteoporosis tend to occur in the hip, wrist and spine. Although osteoporosis is four times more common in women than in men, men with hip fractures have a higher mortality rate.

Treatment is often a regimen of FDA-approved medications, proper nutrition, weight-bearing exercise and any needed lifestyle changes. If testosterone deficiency is detected, your doctor may craft a treatment plan to address the cause.

We'll leave you with some good news -- when detected before significant bone mass is lost, osteoporosis can be effectively treated.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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