Monthly Archives: June 2023

Summer #Sun

Summer Sun

We are into summer weather and sunburn is a real risk. Sunburn dramatically increases the risk of skin cancer, and the UV rays can cause premature aging of the skin.

Prevention is the best approach. Wear sunscreen on both sunny and cloudy days. UV rays get through the clouds. Put on sunscreen 15-30 minutes before going outside. Reapply it every 2 hours and after getting out of the water.

It is best to use a broad-spectrum sunscreen with sun protective factor (SPF) 30 or higher. It takes about 1 ounce to cover an average adult’s body.

It is helpful to wear clothes with a UV protective factor listed on the label. Wear a wide brimmed hat. Avoid midday sun exposure.

Children less than 6 months old should be kept out of direct sunlight. People with light skin, blue eyes, and blond or red hair are at the highest risk of sunburn, but all skin colors are at risk.

Also, remember that sun rays can bounce off of sand, water, and concrete. Sunglasses should be worn, even by kids. Stay safe!

This blog was based largely on an article by Wood and colleagues in JAMA Pediatrics on March 27, 2023.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

# Self-care

How do you practice self-care?

Proper Diet

I practice what I preach (imperfectly): proper diet, adequate sleep, regular exercise (aerobic & anaerobic), alcohol in moderation, no smoking or illicit drugs, see family doctor regularly for preventive health services, practice mindfulness, pay attention to relationships, five hugs per day (or more), have hobbies, attend to spirituality including regular church attendance, be charitable, and marry the right person.

Seems like a lot, but it keeps me healthy and happy.

Be well.

Peter M. Hartmann, MD

A Favorite Person in History

Jefferson Memorial in D.C.

Who is your favorite historical figure? Thomas Jefferson came to mind. While imperfect, he helped engineer an amazing democratic experiment that has led the U.S. to where it is.
I admire his mind. President Kennedy spoke to a group of Nobel prize winners in the Jefferson room in the White House. He told them that there had never been such a collection of genius in that room, “except when Thomas Jefferson dined alone.”

#Probiotics for #Depression

Struggling with Depression

Depression does not always respond completely to antidepressants. Often, the response is only partial. What can be done for depressed people in that case?

Usually, adding another medication can solve the problem. However, that can be costly, adds to the side-effect risks, and does not always work.

Finding alternative “add-ons” is an ongoing effort. One intriguing possibility is the use of a probiotic as adjunctive treatment. A study has been done in the United Kingdom by Nikolova and colleagues; the results were were published in JAMA Psychiatry in June 2023.

This was a randomized, double-blind, placebo-controlled trial (high quality research approach). Adults ages 18 to 55 who had a Major Depressive Disorder being treated with an antidepressant with only an “incomplete” response were given a probiotic or a placebo.

The probiotic was a multi-strain version (multiple species of bacteria often found in the normal GI tract). It contained 8 billion colony-forming units per daily dose.

Half of the research subjects took the probiotic daily for 8 weeks; the other half took a placebo (inactive ingredients only).

At the end of the 8 weeks the researchers found that the group taking the probiotic had “… greater improvement in depressive and anxiety symptoms compared with placebo.”

The researchers had anticipated that probiotics were a reasonable option to try because of the known microbiota-gut-brain connection. Microbiota refers to the bacteria normally found in the large intestine, which work synergistically to aid digestion, help regulate the immune system, and provide two-way feedback between the gut and the brain.

This is an exciting research finding. It needs to be replicated with even more research subjects before it is ready for a formal recommendation by the medical community.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Obesity and # Willpower

Food choice as a “medication.”

Many people believe that obesity is due to a lack of willpower. However, the Obesity Medicine Association says that is a myth.

The Association points out that “obesity is a chronic, progressive, relapsing, and treatable disease.” The Association consists of healthcare professionals with expertise in treating people with obesity.

It is devoted to finding effective management. They have found that understanding the underlying physiology has led to effective treatments. Unfortunately, their findings and recommendations have not yet spread sufficiently throughout the medical community.

Obesity is a neuroendocrine disorder involved with energy balance in the body. A center deep in the brain (not the conscious thinking part) acts as a “conductor” for this complex process.

Energy balance relies in part on a group of enzymes and proteins that regulate hunger, feeling full, the need to move more, and the like. Thus, most of our eating behavior is driven by internal signals.

The Association notes that there are effective treatments for this chronic disorder. These include using food as a “medicine” such that education and careful planning results in eating foods that promote health and avoiding ones that do not.

Other elements of treatment include both aerobic and anaerobic exercise, personal support, and, potentially, medications and or surgery.

There are known health risks from obesity. There are 14 cancers that occur more often in obese people. In addition, there are more than 360 obesity-associated conditions such as diabetes, hip and knee arthritis, and others.

Experts in the Association recommend setting a series of small goals rather than one large one. Once a small goal has been met, you move on to the next small goal.

Having support from a professional, improves the ability to reach health and quality of life goals that an obese person may have. Seeking the services of a member of the Obesity Medicine Association can prove to be helpful.

What I have written is based in part on a podcast by Drs. Pennington and Golden from the Association that was published on an AMA site for physicians. It was recorded on March 7, 2023. If there are any errors, they are mine and should not be attributed to the Association.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Teaching People About Health

What are you passionate about?

I was a practicing physician for 50 years. Seeing people of all ages struggle with various illnesses has given me a mission during retirement.

I have a WordPress blog, and I try to publish something every week. My hope is that interested people will read the blogs and have a deeper understanding of what is needed for good health.

Be well.

Peter M. Hartmann, Md

Family Medicine & Psychiatry

#Depression Due To #Medication

Many medications can cause depressive side-effects.

An article in the Journal of Clinical Psychiatry in May 2023 noted that about 2/3 of people with #treatment-resistant depression are on a non-psychiatric medication that can cause depressive symptoms.

Treatment-resistant depression means that the depressed person has received at least two different trials of at least two different antidepressants at adequate doses for an adequate length of time.

If you have depression that is not responding to usual treatment, you may want to review all of the medications you take to find out if any of them can cause depressive symptoms.

Thirty percent (30%) of the people with resistant depression in the study were on 2 or more medications and 20% were on 3 or more medications that have depression as a side-effect.

Here is a list of 9 common medications that have depression as a known side-effect:

1. Estrogen hormones (e.g., many birth control pills) 2. Opiates 3. Some antacids (e.g., omeprazole) 4. Anti-seizure medications 5. Medication for Parkinson’s Disease (e.g., Sinemet) 6. Stimulants (eg. Adderall) 7. Beta-blockers for high blood pressure and other diseases (eg., Inderol) 8. Benzodiazepines (e.g., Xanax) 9. Some allergy medication (e.g., cetirizine).

You can review the list of your medications with your doctor or a pharmacist. If you are on one or more that can cause depressive symptoms, your physician may be able to change you to different medications.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Acne in Adult Women

Acne

Research on the use of a specific diuretic to treat acne in women was reported in the British Medical Journal 2023;381; e074349.

Women age 18 or older with acne on their face that was bad enough to consider using an oral antibiotic were studied. Half of the women were given a diuretic (spironolactone) and the others were given a placebo (an inactive substance).

The group taking spironolactone had noticeably better control of acne than the group on placebo. This was not apparent after 12 weeks of treatment but was significant by week 24.

During the study, the women were allowed to continue any topical treatments for acne that their doctor recommended.

Spironolactone has been around for many years. It is approved for treating acne. Doses range from 25 mg to 200 mg. It is also used for a number of different medical conditions, including the treatment of swelling, excessive body hair, high blood pressure, and others.

The most common side effects include elevation of blood potassium, nausea, vomiting, abdominal cramps, and other less common ones. The majority of people tolerate it very well.

It should not be taken by pregnant women but is safe if breastfeeding.

The bottom line is that spironolactone is a reasonable alternative to oral antibiotics for the treatment of facial acne in women.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Is Online #Semaglutide Safe?

The FDA has released a statement concerning online purchasing of semaglutide. This medicine is used to treat type 2 diabetes and obesity or overweight individuals with health problems related to their weight.

Semaglutide works by mimicking a hormone released by the gut when we eat. It stimulates insulin production and, at high enough doses, has an effect on brain centers resulting in decreased appetite and feeling full.

There are 2 forms of semaglutide for treating type 2 diabetes: Ozempic (injectable) and Rybelsus (oral). In addition to helping control diabetes they reduce the risk of heart attack, stroke, or death in people with known heart disease.

There is only one FDA-approved version for weight loss, Wegovy (injection). It can be used in appropriate patients ages 12 and older. It should be used along with diet and exercise.

Because Ozempic and Wegovy are in short supply, some companies are making a form of semaglutide by a process called compounding. They are not tested and approved by the FDA.

It is not illegal to compound medications, but they are not subject to FDA oversight. The FDA has become aware of adverse events after using compounded semaglutide.

On their website, the FDA notes that “… in some cases, compounders may be using salt forms of semaglutide, including semaglutide sodium and semaglutide acetate.” These forms of semaglutide are different from the FDA-approved one.

The salt forms “have not been shown to be safe and effective.” The FDA is concerned about purchasing medications online “from unregulated, unlicensed sources” because of the risk of “potentially unsafe products …”.

The FDA recommends that you use their “BeSafeRx campaign resources and tools…” Doing so enables you to make “safer, more informed decisions …”

They also encourage anyone who experiences an adverse event or quality problem to report the concern about “any medications to the FDA’s MedWatch Adverse Event Reporting program.”

The information for this blog was taken from the site http://www.fda.gov on June 2,2023.

Peter M. Hartmann, MD

Family Medicine & Psychiatry