Wednesday, December 29, 2010

MORE Losing Holiday Weight

Tip number two for losing that holiday weight is another common sense solution- GET SOME REST! A study published in the Annals of Internal Medicine this year compared weight loss between a group that followed a low calorie diet and had only an average of 5.5 hours of sleep per night versus a group that followed the same diet and averaged 8.5 hours of nightly sleep.
It may surprise you that not only did the people with more sleep had more weight loss, but they also had greater reduction in body fat and in HUNGER.

Scientists are not sure of exactly how more sleep resets your hunger thermostat or changes your metabolism, but we certainly know that less sleep stresses your body, which is not conducive to better health. If you struggle with INSOMNIA as the reason for your lack of sleep, make sure you are having good sleep hygiene (keeping a regular bed time, not watching tv or doing computer right before bed, etc.) and limiting or avoiding caffeine and alcohol. Check out my blog on covering the clock, and make an appointment with your doctor if you cannot restore good sleep on your own.

BOTTOM LINE: Make sure you are getting at least 8 hours of sleep to maximize your success with losing those extra holiday pounds!

Calcium: Adequate serum calcium is needed for fecal fat excretion. Observational data has shown that those who supplement their diet with calcium have lower levels of body fat. This systematic review found supplementation of about 1,200 mg of calcium per day leads to an increase in fecal fat excretion. Obes Rev 2009; 10(4): 475-86

Sleep: A very small pilot study compared a low calorie diet and either 5.5 hours of sleep vs 8.5 hours over 14 days. Those who slept more had greater loss of weight and body fat, and, among other things, less hunger. The authors postulate it was due to the neuroendocrine changes decreased sleep induces. Ann Intern Med 2010; 153: 435-441

Chronic PPIs: When used chronically, PPIs are associated with pneumonia, C. diff infection and other problems. This case control study found obesity developed in patients with GERD who were treated chronically with PPIs vs other treatments World J Gastro 2009; 15(38): 4794-4798.

Tuesday, December 28, 2010

Losing that Holiday Weight

Borrowing from my editor-in-chief's blog (Dr. Frank Domino) at the 5-Minute Consult, I'd like to share some tips this week to help you lose that extra weight you picked up over the holidays. Remember, the average American unfortunately gains close to 10 pounds between Thanksgiving and New Year's, so if your pants are fitting a bit tootight, you are not alone!

First of all, a simple trick models have known for years: DRINK WATER!! A trial of obese adults (published in the journal Obesity this year) showed that people who drank 16 oz of water before each meal along with following a low calorie diet lost >4 pounds MORE than the group that simply followed the same low calorie diet.

Often, we think we are hungry when we are really thirsty, so focusing on this simple tip of drinking a couple glasses of water with each meal will help you recognize what your body is really craving.

BOTTOM LINE: Add TWO 8 oz glasses of water to breakfast, lunch and dinner to help lose some of that holiday waistline!

Monday, December 27, 2010

Skier's Toe

Ever been skiing and noticed your toenail had turned black and incredibly painful at the end of the day? Was it black in part or all of the nail? This is a very common injury from skiing, and in fact, is often referred to as a "skier's toe".

The medical term is a subungual hematoma, which simply means bleeding under the nail. This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big (so your foot slams back and forth) ski boot.

The good news is that this can be quickly remedied in a clinic if you head in within hours or a day of noticing the black nail. If you wait several days trying to tough it out, we have less success treating the nail. The doctor typically burns a tiny hole in the nail, which allows the drop or two of blood to come out. (Sorry for the yucky description, but that's what we do.)

The BETTER news is that again, PREVENTION is key! Make sure your ski boots fit properly- don't cram your foot into a friend's boots- and be sure your socks are not bunched up. This painful injury does NOT occur if your shoes/boots fit correctly!

BOTTOM LINE: Make sure your ski boots and socks fit properly, and avoid getting skier's toe!

Thursday, December 23, 2010

Going Skiing?

Are you headed to the mountains for some skiing this winter? The powder is definitely calling, especially after the huge storms we've had this week! One unexpected and unhappy surprise of a mountain vacation can be the development of symptoms of altitude sickness.

When does it start?
-usually within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?
-MIld to moderate:Headache, decreased appetite or nausea, insomnia, and lightheadedness
-Severe: All of the above plus vomiting and shortness of breath

Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications.

Hydration and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
If you have had altitude sickness previously, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains take your breath away- plan ahead to prevent altitude sickness!

Wednesday, December 22, 2010

Mixing Drinks & Medications?

People have become increasingly cavalier about mixing medications. In our age of polypharmacy, we think nothing of taking this pill for our heartburn, plus this one for ADD, and that one for anxiety and depression. In fact, our doctors prescribe these combinations all the time, usually with good reasons and positive effects.

Why am I writing about this? Because there are (at least) two major problems that result from this mindset.

1. People like to SHARE. We want to help our friends, and often people share their PRESCRIPTION medications-from saved up antibiotics, to cough suppressants, pain pills and anxiety medications. When you remove the medical professionals (both providers and the pharmacy team) from the equation, there are no checks and balances to watch out for drug interactions.

2. People forget ALCOHOL is a drug. Especially this time of year, alcohol is offered and consumed without a second thought to whether or not it might interact with prescription medications. The most DANGEROUS combinations are ALCOHOL, NARCOTICS (pain pills and cough suppressants) and ANXIETY MEDICATIONS (like Xanax/Valium, etc.) Please note- your SLEEPING PILL falls into this category as well!
In this case, 1 +1= 3 or more, as the additive effects are much greater than the individual effects simply combined. In particular, you can STOP BREATHING when you combine these drugs. And BREATHING is good, right?

PLEASE, before you toast the season, picture your prescription bottles sitting in your drink. Is this MIXED DRINK safe?

BOTTOM LINE: PLEASE, do NOT share prescription medications, and do not COMBINE alcohol, narcotics, and/or other sedatives!

Tuesday, December 21, 2010

Gluten-Free Christmas Wish

WOW! My Christmas came early this year, when Disneyland (gotta love the Mouse!) actually replaced a fast food restaurant (Mc D) with-get this- a DELICIOUS BAKERY called Babycakes NYC that is completely GLUTEN-FREE and vegan, to boot! While perhaps this bakery belongs in the Magic Kingdom's Fantasy Land, it is actually located in Downtown Disney. What a wonderful addition for all the patrons who have celiac disease (remember, it's 1 in 100 Americans!) or are gluten-intolerant, as well as those who have opted for a vegan diet.

Looking at the Babycakes NYC website will definitely stir up your appetite, as you drool over delicious appearing donuts, cupcakes and assorted pastries. This is an ideal time to remind everyone, though, that "vegan, gluten-free, and organic" do not equate with LOW CALORIE! Babycakes offers TREATS AND SWEETS, which are DESSERTS and should be enjoyed in appropriate portions.

BOTTOM LINE: Cheers to Disney for welcoming a delicious bakery for their health-conscious (and/or special health needs) Disneyphiles!

Monday, December 20, 2010

Caffeine, Alcohol and Peppermints, Oh My!

As if the cough last week weren't enough, are you now plagued with with heartburn? Yes, in our commercial-literate world, we may call it GERD (Gastro-Esophageal-Reflux Disease), but heartburn is still a great descriptor. December is often a very tough month for health! We are fully into cough and cold season, and at the same time, we are frantically running around in crowded public areas...touching the same escalator handrail, doors, etc. as the sneezing, coughing folks ahead of us. In addition, we are meeting old friends for our annual "catch up" coffee, drinks or meals, and burning the candle at both ends.

Caffeine, alcohol, and peppermints (did someone say candy canes?) abound, and ALL THREE of these have one common side effect in the body- they loosen the sphincter between the esophagus (food tube) and stomach that is supposed to function to keep acid down south in the stomach. Instead, these substances allow it to relax, and acid can slosh back up into the esophagus, and voila- HEARTBURN FOR THE HOLIDAYS!

What to do? Okay, first things first, stop the burn by popping a few antacid tablets. Not enough relief? Add in an OTC acid relief product like cimetidine (Tagamet) or ranitidine (Zantac) or even the next level up of acid blockers such as omeprazole (Prilosec). Still no relief? Time to see your doctor! Of course, it SHOULD go without saying that you need to STOP THE OFFENDING CAUSE (yes, the coffee, drinks and mints) if your symptoms are persisting beyond the occasional event!

I'd be remiss if I didn't add NICOTINE to the the list of irritants for GERD, by the way, so here is my chance to beg you to make QUITTING SMOKING your number one New Year's Resolution!

BOTTOM LINE: Caffeine, alcohol, peppermints and nicotine all cause HEARTBURN- watch out for the symptoms and recognize the cause!

Friday, December 17, 2010

Hospice at the Holidays?

Okay, I know what you're thinking...why talk about HOSPICE at the holidays? Isn't that kind of depressing? While Hospice care can be a tough subject, I actually ALWAYS think of Hospice at the holidays, for several reasons.

1. I believe everyone who works at Hospice is an ANGEL. Period.

2. Hospice provides a tremendous service that is a beautiful gift not only for the patients themselves, but for the families, too. Their job every day is to help with the physical and emotional needs of people passing from this life on to the next, and they are comfortable with this transition in a way most of us are not. Their confidence and capabilities are amazing.

3. Holidays are especially tough for families who have lost someone in the past year, so remember to reach out in a special way to your family and friends in this situation.

4. One of my favorite gifts is our local Hospice's ANGEL. Each year, a local artist designs a new angel ornament, and these can be purchased on line and sent directly to your loved ones. Hospice benefits from the profits, your recipient gets a lovely angel, and everyone benefits!

BOTTOM LINE: Thinking of Hospice at the Holidays is fully in keeping with the peace and goodwill of the season. Please reach out to anyone you know who has lost a loved one in 2010.

Thursday, December 16, 2010

Christmas Gift of HEALTH!

'Tis the season of giving, and many of us are trying to find the perfect gifts for our friends and families. Before you choose gift baskets loaded with wine, chocolate, and other delicious goodies, though, stop and think. Is this the right gift for your friend who is struggling with her weight? What about your mother-in-law who has high cholesterol and "borderline" diabetes? Well, maybe not, but hey, it's the holidays, right? Doesn't everyone deserve a little treat? And they LOVE chocolate...

Well, yes, I agree that everyone deserves a treat, but is it really a treat if we're giving them something that works against their health goals? If your friend is fit and healthy, knock yourself out with edible treats with a clear conscience. BUT... if they are NOT, why not focus on gifts that encourage health? Mind you, I'm not suggesting sticking a bow on a bag of carrots, either. How about fun workout socks or a new top? Buy matching pedometers for you and a buddy or two for some friendly competition or at least mutual encouragement. How about a gift certificate for a massage or manicure or pedicure? Or a new healthy cookbook? Or-gasp- a plain old BOOK book-by your favorite author? Need a suggestion? Try ANY of Jeff Abbott's thrillers! Out of money (and who isn't?) Make a gift certificate for a outing to a park or walk around the lake or a bike ride. Be creative!

BOTTOM LINE: Think twice before sending out edible treats to ALL your friends and family this year, and show you really care by giving gifts that promote physical, mental or spiritual health! Happy Holidays!

Wednesday, December 15, 2010

FDA Warning: Cough Medication DANGER!

Yesterday the FDA issued a warning regarding a medication that has frankly NEVER been on my radar as a dangerous drug- Tessalon (benzonatate). Sadly, there have been five deaths reported in children under the age of 2 after accidental ingestion of this medication, which is a gel capsule and looks like candy or a bath bead.

Is the medication safe for adults? Yes. Tessalon perles are indicated for cough suppression in patients over the age of 10. In my practice, I have found that the drug has a high variability in effectiveness, but rarely has any side effects. Many patients love this drug because it works well to suppress their cough without making them feel goofy or sedated, like the stronger narcotic cough syrups tend to do.

I think the real take home message here is that ALL medications, ESPECIALLY those that "look pretty", need to be in CHILD-PROOF containers AND put away out of reach from little hands. There are far more accidental poisonings from common over the counter medications and vitamins, and ALL PILLS should be stored behind locked cabinets when you've got children in your home (living there or visiting!)

BOTTOM LINE: Please have a special, truly CHILD-PROOF medicine storage area in your home, and realize kids always have and always will stick things in their mouths without thinking!

Tuesday, December 14, 2010

Too Scared to FLY?

Do you have travel plans for the holidays? Any fear of flying? If you do, you are not alone. Many people, especially since 9/11, are very nervous flyers. I know that I never had any issues about flying until I became a mother, at which point suddenly I was emotionally convinced I would die in a plane crash and orphan my child (despite my brain telling me the statistics say otherwise.)

So, what can you do? Well, there are many choices, but suffering in silence should not be one of them. First off, arm yourself with the facts that you are over thirty times more likely to have a fatal car accident than die in a plane crash. Most of the fear is not rational, however, so if the facts don't calm you, keep looking.

Plan ahead- create a diversion packet for yourself with an engaging book, music, or DVD. Get noise-canceling headphones (or at least good earplugs). It's amazing how when you can close your eyes and not hear the plane noises, you can relax much more easily.

Avoid stimulants like caffeine and decongestants
- no need to ramp up your heart rate before you even get on the plane!

If you have the luxury of time before you travel, consider biofeedback, hypnosis, or meditation training.

I mentioned yesterday that you might want to talk with your doctor. What can she offer? We have several choices, actually. For long flights, I will frequently prescribe a "sleeping pill" such as Ambien or Lunesta. Some patients do very well with medicines that simply control your heart rate, such as metoprolol (a beta-blocker). Others with more intense anxiety respond well to a rapid and short acting sedative such as Xanax.

Bottom Line: Fear of flying is common- plan ahead and talk to your doctor if you would like to consider a medication to lesson your stress.

Monday, December 13, 2010

Flying Somewhere this Holiday?

As the holidays are upon us and travel plans are ramping up, I thought I’d share some health-related flying tips. With all the emphasis on flu these days, I’d be remiss not to start with the basic advice that you should NOT fly if you have a fever or a productive cough (or other flu symptoms such as headache, sore throat, and body aches.) That being said, there are many times that you may need to fly when you have mild cold or allergy symptoms, and there are a few tricks that may be helpful.

The one time that I actually recommend OTC products such as nose sprays like Afrin is if you have a stuffy head/nose/ears and need to fly. Make sure to put it in ziplock bag for security, but then use it when you are seated on the plane to reduce ear discomfort upon takeoff. Gum, mints or any beverage will help clear your ears as well.

I also suggest sucking on the zinc lozenges- any variety- I happen to like the ones combined with vitamin C. Zinc oral dissolvable products have been shown to reduce acquisition of respiratory viruses. Unfortunately, simply taking a zinc supplement that you swallow has not been shown to provide equal benefit.

If you have no contraindication to taking aspirin, a baby aspirin taken the day of your flight will reduce your risk for blood clots that can occur with prolonged sitting. Try to get up every hour or two and walk to the bathroom- that will help, too.
Nervous about flying? Talk to your doctor about a short-acting mild sedative or sleep aid (if the flight is long enough.) No need for embarrassment, as fear of flying is very common. I’d estimate I get this request close to once per week (and more often this time of year!)

Should you wear a mask? I suppose if either YOU have a cough or your seatmate does, that is reasonable.

BOTTOM LINE: If your travel plans include flying, create your own "flying first aid" kit to take with you!

Friday, December 10, 2010

Colorful Diet does NOT mean M&Ms!

In the rush of the holidays, are you grabbing handfuls of red and green M&Ms more than handfuls of strawberries and grapes? How can you keep up your 5-10 servings of fruits and veggies per day during the holidays?

Not surprisingly, the answer is the same as the rest of the year- PLAN AHEAD. Start your morning with a smoothie (the picture above was from our breakfast)- frozen fruits like strawberries stay the same price year-round, even though they are out of season. Do you notice the banana is over-ripe? No worries- in a smoothie, it doesn't matter!

BEFORE YOU HEAD OUT TO A PARTY, have a large healthy snack and a big glass of water. If you're not starving when you enter the party, you will be way less likely to overload on high calories offerings.

TAKE SNACKS TO WORK. Apples are still cheap and plentiful, so I take a couple to work each day, along with a small container of my nuts of choice (cashews or almonds, usually.) If I don't eat these, I will be way to tempted by chocolate-covered everything at the office!

BOTTOM LINE: This time of year more than any other challenges our time and waistlines; PLAN AHEAD and PUSH UP the vegetables, fruit and water in your day!

Thursday, December 9, 2010

Can't stop coughing?

Cough, cough, cough...argh! Is there any point in seeing your doctor when all you have is a left-over cough after an upper respiratory infection? YES! While it is rare that you will need antibiotics, there are other medications that your doctor may recommend to help you quiet that cough.

Often, after a viral infection, we are left with a cough. Untreated, that cough might last up to six weeks. Frequently, it is worse at night and may keep you (or your spouse) from sleeping- which adds fatigue and grumpiness to the picture. At a minimum, your doctor may choose to prescribe a narcotic cough syrup (assuming the OTC dextromethorphan-containing products are not working) so that you and your loved ones can get some rest.

Additionally, it is very common to develop a transient asthma-type of reaction in your lungs after a cold. We call this reactive airways, and the extra mucus production as well as spasm can lead to some wheezing and/or cough. The good news is that this is not a permanent change, AND we can use a couple different types of inhalers to improve your cough and shortness of breath.

Traditional home remedies such as cool mist humidifiers and topical menthol products can also provide good symptomatic relief.

If you have a cold, then seem to recover, and then get broad-sided with an intense cough and fever a week later, you may indeed need an antibiotic because you have become secondarily infected. In this case, an antibiotic may be recommended, but the mainstay of treatment will still include rest, fluids, and over the counter cough suppressants such as dextromethorphan, which is designated "DM" in most combination cold products.

BOTTOM LINE: Got a tickling cough? Use OTC meds and hydration. Stuck with a nagging, lingering cough? Go see your doctor for some extra help, but don't expect antibiotics.

Wednesday, December 8, 2010

Beyond Chicken Soup- What Helps the Common Cold?

This week I've been talking about colds and the role of vitamins can play in treating them. We know that the common cold is caused by a virus, so therefore antibiotics (which kill bacteria, not viruses) do NOT help. What DO I recommend for my patients?
Much of what your parents may have offered you works well, by the way...

1. Oral decongestants- phenylephrine or pseudoephedrine- work well to relieve nasal stuffiness, but can have significant side effects of raising blood pressure, causing palpitations/jitteriness or insomnia
2. SHORT TERM (3 days) use of nasal decongestant sprays; also relieve nasal congestion with less side effects
3. Nasal saline sprays and washes often relieve congestion as well as the medicated versions
4. Aromatic oils (menthol, camphor, and eucalyptus) used topically provide subjective improvement in nasal congestion- don't forget about the topical "vaporub" or the forms of these oils that you add to a warm bath!
5. Analgesics: acetaminophen (tylenol) or ibuprofen (Advil/Motrin) help with headache and body aches
6. HYDRATE! Remember chicken soup? ANY liquid helps, but drinking warm broth often has the double benefit of sore throat relief along with hydration. The more you hydrate, the less headaches and looser mucus (so it will de-congest) you will have.
7. Salt water gargles ease sore throats as well; repeat several times a day for the first day or two, and don't be shy with the salt: use 2 tablespoons per 8 oz of water- it wont even all dissolve, but that's how much you really want to increase effectiveness.
8. Cough suppressant: try OTC products with "DM"- dextromethorphan. More on this tomorrow...

BOTTOM LINE: Symptomatic relief of the COMMON COLD is important, but antibiotics are NOT part of the equation.

Tuesday, December 7, 2010

Zinc for Colds?

If Vitamin C is not the answer to prevention or treatment of colds, what about zinc? Around 25 years ago, studies showed that zinc lozenges could significantly reduce the duration of the common cold. Since that time, the medical literature has been conflicting, with roughly half of the studies showing benefit, and half appearing equal to placebo.

Zinc nasal preparations were then released, but in 2009, the FDA issued a warning that these intranasal zinc preparations had the potential to cause permanent loss of smell, so they are no longer recommended.

It turns out that you need to have ionic zinc in the lozenges to be effective, and the vast majority of products out there do not have this type of zinc. Taking zinc supplements in pill form doesn't work either, so don't be fooled into swallowing yet another pill.

What DOES work? Well, the best prevention is what your mom most likely taught you growing up: WASH YOUR HANDS! It doesn't matter if you use the hand sanitizer or old-fashioned soap and water, but whatever you use, scrub for 20 to 30 seconds, and try not to touch your face or eyes.

BOTTOM LINE: If you are going to use zinc to try to shorten the duration of your cold, get an ionic zinc lozenge preparation. More importantly, however, WASH YOUR HANDS!

Sunday, December 5, 2010

Vitamin C for Colds?

Okay, since I talked again about vitamin D last week, why not talk about a few more vitamins? What about Vitamin C for colds? Should it be taken as prevention, or as a cure? Can you get too much?

Honestly, the medical literature has gone back and forth on vitamin C and colds. Large studies have shown little benefit in prevention, unless you are an extreme athlete or living in very cold temperatures. For people in those categories, it appears Vitamin C in doses greater than 200mg per day can indeed decrease the frequency of upper respiratory infections. Skiers, perhaps you should start your morning with a big glass of juice instead of hot chocolate or coffee!

Where there does seem to be benefit across the board is when Vitamin C (again in doses greater than 200mg per day) is taken once you develop cold symptoms. At that point, Vitamin C seems to decrease the duration of symptoms.

How much is too much? The RDA is 75mg for women and 90mg for men. Supplements come in 100, 200 and 500mg tablets, plus I'm sure you've seen and maybe taken the mega-dose vitamin C packets that come in powder packets. These typically have 1000mg of Vitamin C (along with a handful of other vitamins). While C is water-soluble, which means that "extra" vitamin C not used by your body will simply exit in your urine, it is possible for megadoses (often exceding 2000mg per day) to cause kidney damage by precipitating a special type of stone formation in the kidneys.

What type of Vitamin C is best? As always, you are better off getting your vitamin C from whole foods-fruits like berries, red peppers, guavas, kiwis, and yes, oranges. You will NOT overdose from these natural sources!

BOTTOM LINE: Vitamin C may help shorten the duration of a cold, and could help with prevention for those in cold climates or if you will be doing "extreme" physical activity.

Thursday, December 2, 2010

Vitamin D: Front Page News!

This week Vitamin D (aka. the Sunshine Vitamin) made front page news this week when the Institute of Medicine tripled the recommended daily dose from 200IU (International Units) to 600 IU. Interestingly enough, there were polar opposite slants on the same story. The TIMES said that extra Vitamin D and calcium are not necessary, while the Wall Street Journal quoted experts saying that that this increase is not nearly enough.

What should we believe at this point? Well, like everything in medicine, it depends. Seriously. If you are elderly or otherwise decreased in mobility; if you have increased risk of cardiac disease or cancer; if you have dark skin or live in northern locations with limited sunlight; then I think the medical evidence is solid that you likely will need Vitamin D supplementation.

I practice medicine in Austin, Texas, which is clearly a sunny locale. Despite that, I have found in the last year or two that I have been more aggressively checking vitamin D levels that 90+% of my patients were deficient. Interestingly enough, a good chunk of these patients (I would estimate a third) have had clinical improvement in some fashion after a few months of vitamin D replacement. Often it is with mood and energy, and other times it is with very nonspecific "aches and pains" that the patient previously was attributing to "aging." Initially I gave simply over-the-counter doses, but within 6 months saw minimal improvements and switched to supplementing with prescription weekly Vitamin D (at 50,000IU per week doses.) This is the dose that has yielded results both in lab tests and far more importantly, in patient symptoms.

BOTTOM LINE: The jury may still be out on Vitamin D supplementation, but we do know that replacing Vitamin D in people who are proven to be deficient can potentially improve their health in multiple organ systems (bones, cardiac, neuro/psychological.)

Wednesday, December 1, 2010

Are you SAD?

While everyone around you is humming Christmas songs, pulling out their Hannukah decorations or making ski vacation plans , are you left feeling sad? Perhaps it's not the holiday blues, but SAD- Seasonal Affective Disorder. This depressive disorder was formally named only a few decades ago, in the 1980's. It affects over half a million people each winter, including some symtoms in up to a third of patients seeing their primary care physicians during this season.

Who gets seasonal affective disorder? It's most common in women (3:1 over males) and young adults 20-30 years old, but it is seen in across the board. January and February are the most common months that SAD is diagnosed.

What are the complaints? Often fatigue, weight gain and recurrent illness are the primary issues, rather than simply "sadness".The simples range from a mild case of "winter blues" to serious depression.

What is the cause? There are different theories, most of which are linked to hours of sunlight. There is disruption in our circadian rhythms as well as decreased seratonin secretion during winter months, and of course, less Sunshine vitamin (Vitamin D).

Prevention? Light therapy (using full spectrum light bulbs in your home and work) or consciously spending more time outside in the sunlight can help prevent S.A.D. Of course, moving to a more southern location can help, especially if you are far north, but that is not typically feasible for most people.

Treatment? Light therapy, anti-depressant medications (Buproprion is the only one FDA indicated, but SSRI's are also used), and Vitamin D replacement (if low) all have shown effectiveness in improving symptoms.

BOTTOM LINE: If you recognize a pattern of feeling sluggish every winter and perking up in the spring and summer, talk to your doctor and see if together you can change "S.A.D." to glad this year!

PS. Happy December 1st! Change those air filters!!