Does my frequent yawning mean my brain isn’t getting enough oxygen?

Posted May 13, 2013, 2:00 am

DEAR DOCTOR K: I yawn a lot. My friend said this is a sign my brain isn’t getting enough oxygen. Is that true?

DEAR READER: Most of us yawn more often in the early morning and late evening. Does it mean you’re tired? Bored? Not getting enough oxygen? It turns out that we actually know very little about why we yawn.

When I was in medical school, one of my teachers speculated that yawning was a response to low oxygen or high carbon-dioxide levels. That theory was fairly common. It was also plausible: When we open our mouths and take in a deep breath, we take oxygen into the body and expel carbon dioxide. Carbon dioxide is waste produced by the body’s cells and needs to be eliminated.

Unfortunately, the theory that yawning reflects low oxygen or high carbon dioxide levels isn’t true. Yawning occurs even when oxygen and carbon dioxide levels are normal. And research has shown that volunteers do not yawn less after being exposed to high oxygen levels, and do not yawn more after being exposed to high levels of carbon dioxide.

Another myth is that yawning always indicates a need for sleep. It is true that people often yawn as they are ready to retire for the night. But we also yawn when we get up in the morning and at other times during the day. Yawning appears to depend on a variety of factors such as arousal level, distraction, and even seeing someone else yawn.

Here are some reasonable explanations I’ve heard for yawning (though none has been proven):

The lungs are full of tiny little air sacs. Not all of them are filled with air. If an air sac remains without air, it can collapse. When you yawn, you take in more air than with a normal breath. That opens up tiny airways and prevents them from collapsing. This could explain why yawning seems to occur when your breathing is shallow, such as when you’re tired or bored.Yawning is associated with stretching of the muscles and joints and an increased heart rate. So it may serve as a preparation for an increased level of alertness, especially after a period of relaxation.Yawning could provide nonverbal communication to others that it is time to relax.

Finally, yawning may be a sign of disease. Although rarely the first sign, excessive yawning has been observed among people with multiple sclerosis, ALS (Lou Gehrig’s disease) and Parkinson’s disease. I say this with trepidation. Please don’t misunderstand: Yawning is not a sign that you have one of these terrible diseases. It is just a sign that you’re human.

In fact, we humans are in good company. All mammals and many other animals yawn. Why does a lion yawn? A penguin? We can’t answer that question any better for them than for us.

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Announcing the “4 Fundamentals”, Merrell Partnership/Giveaway, and Live Q&A

I’ve worn Merrell shoes for ages, even back in 2007 for Japanese horseback archery training.

It’s a long story, but I still have those bad boys.

In 2012, Merrell themselves noticed that I wore Merrell. DMs were sent, and the seeds of a partnership were born. Today, I’m thrilled to formally announce that I’m collaborating with Merrell in 2013 to get more people outdoors. Of course, they want to move product, but I’m happy to help. Why? Because I already love their stuff, and the new minimal shoes are precisely what I wanted and wrote about in The 4-Hour Body. The soles of the M Connect line are designed by Vibram but less socially awkward than their Gecko-feet variety, which I’d stopped wearing.

I’ll be doing a lot with Merrell using their Twitter and Facebook accounts (keep reading), so you might want to follow them here:
Merrell Twitter
Merrell Facebook

I’d also like to give away some shoes! Just answer both of these questions in the comments below:
- What does “connection” mean to you?
- What are your favorite bodyweight-only exercises?

The best 10 responses will get 10 pairs (one pair each) of Merrell shoes: 8 domestic US winners and 2 international winners. All answers are due no later than 5pm PST on Tuesday, March 12.

I will be doing a few live events today, Saturday:

- Live SXSW keynote in Austin, TX — 11AM-12PM Tomorrow, Saturday, March 12. It’s called “Acquiring the Skill of Meta-Learning” and is about how to become world-class in nearly any skill in 6 months or less.

- Book Signing at SXSW following above presentation, from 12:30pm to however long it takes

Then, next Monday (March 11), a free 2-hour Q&A on Twitter:

Here’s how it works:
- Go to @merrelloutside and follow them.
- Starting 9pm EST, ask any questions you like in the following format “@tferriss @merrelloutside [Insert question]?” Anything is fair game, and I’ll do my best to answer as many as possible.

Have a great weekend… and get outside!

Posted on March 8th, 2013

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Antipsychotic Meds Not That Helpful for Depression: Study

These drugs, meant for other conditions, come with side effects including weight gain

By Steven Reinberg

HealthDay Reporter

TUESDAY, March 12 (HealthDay News) -- For people who don't fully respond to antidepressants, adding commonly prescribed antipsychotic drugs appears to be only slightly effective and is linked to unwelcome side effects, a new study finds.

Drugs added to antidepressants (like Prozac, Paxil and Celexa) include the antipsychotic medications aripiprazole (Abilify), quetiapine (Seroquel), risperidone (Risperdal) and olanzapine/fluoxetine (Symbyax).

Antipsychotic drugs are traditionally used to treat conditions such as schizophrenia, bipolar disorder and obsessive-compulsive disorder -- not depression.

"The evidence supporting the use of antipsychotics in depression is marginal," said lead researcher Glen Spielmans, an associate professor in the department of psychology at Metropolitan State University in St. Paul, Minn.

Antipsychotic treatment of depression has become increasingly widespread but the underlying evidence base puts this practice into question, he said.

"Other options may be as effective, or more effective, and carry a lesser side-effect burden," Spielmans said. For instance, cognitive behavioral therapy has been shown to be effective for treatment-resistant depression, he said. Cognitive behavioral therapy is a treatment that helps patients try to change their thoughts, feelings and behaviors.

For one expert, these drugs also aren't a first choice for patients who don't respond fully to antidepressants.

"I have mixed results in terms of how effective they are," said Dr. Bryan Bruno, acting chair of psychiatry at Lenox Hill Hospital, in New York City.

"I treat a lot of patients who are on antidepressants and not responding well. Prescribing these drugs is not something I do often because of the costs and because of the side effects," said Bruno, who was not involved with the study.

Some of these drugs are pricey. For example, Abilify can cost more than $200 a month without insurance, according to the Everyday Health website. With insurance the cost varies by plan.

"I prefer using other strategies like adding other antidepressants, or using brain stimulation treatments, and psychotherapy," Bruno said.

For some patients, however, these antipsychotics can be helpful, including those with insomnia and those whose depression is coupled with a psychosis, he noted.

The report was published in the March issue of the online journal PLoS Medicine.

To gauge the effectiveness of these drugs, Spielmans' team pooled data from 14 studies that compared antipsychotic medications to an inactive placebo in patients for whom antidepressants weren't enough to relieve depression.

This process, called a meta-analysis, attempts to find common threads from different studies that reveal a pattern, which adds information beyond what one study finds.

The new analysis found these drugs offered only a small benefit in relieving symptoms of depression and little or no benefit in improving patients' quality of life or ability to function.

The drugs did, however, have some unwelcome side effects such as restlessness, sleepiness, weight gain and some abnormal lab test results such as increased cholesterol levels, the researchers reported.

Spielmans suggested that some of the trials they looked at may have tried to boost the perception of the effectiveness of the drug and downplay its side effects.

"Studies were sometimes designed in a biased manner that may have slanted the results," Spielmans said. "Data were sometimes reported in a way that likely made the drugs appear more effective than they actually were."

In addition, he said, the researchers found that some side effects were tucked away on the U.S. Food and Drug Administration's website and in clinical trial registries rather than being reported in the published medical journal reports of the studies.

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My doctor thinks I have hypothyroidism — how will he diagnose it?

Posted May 09, 2013, 2:00 am

My doctor thinks I may have hypothyroidism. How will he make the diagnosis?

Hypothyroidism is the medical term for an underactive thyroid. Some conditions are hard to diagnose, but fortunately hypothyroidism is not one of them.

Your thyroid is a small gland in your neck that makes the thyroid hormones, called T3 and T4. These hormones leave the gland and travel in the blood to every cell in your body. Thyroid hormones influence the rate at which every cell, tissue and organ in your body functions.

Hypothyroidism occurs when your thyroid gland doesn’t produce enough thyroid hormones. Your body slows down, creating symptoms such as fatigue, depression, weight gain, feeling cold for no good reason, constipation and dry skin.

Your thyroid gland is controlled by another gland: the pituitary gland, which is in the brain. It sends a chemical message to your thyroid, telling it how much hormone to make. The chemical message is called thyroid-stimulating hormone (TSH).

Your brain is constantly sensing whether there is an adequate level of thyroid hormones circulating in your blood. If not, the pituitary makes more TSH. Higher levels of TSH prompt the thyroid to produce more thyroid hormones. Low TSH levels signal the thyroid to slow down production.

To diagnose hypothyroidism, your doctor will perform a physical examination and some blood tests:

Physical exam. Your doctor will assess the size of your thyroid by feeling around your neck. He or she will check for physical signs of hypothyroidism, such as coarse hair or hair loss, dry or yellowish skin, and pale or puffy appearance. Your weight, cholesterol levels and blood pressure will also be checked.TSH test. This test is the best way to determine if you have thyroid disease. (I’ve put a table showing the normal, low and high values for the TSH and other thyroid blood tests below.) If your TSH level is high, you are hypothyroid. If TSH levels are below normal, you are hyperthyroid: Your thyroid gland is making too much thyroid hormone. (There are exceptions to this, but they are infrequent.)T4 and T3 tests. Once secreted by the thyroid, only a small amount of T4 is “free” and available for immediate use. In hypothyroidism, there’s not enough free T4 in the blood. There’s also not enough T3 in the blood.

Together, the TSH, free T4 and T3 tests can establish a diagnosis. They can also indicate how severe your problem is.

The ranges below apply to people who are not yet taking thyroid medications.

Within normal range of 0.45–4.12 mIU/LWithin normal range of 0.8–2.0 ng/dLCentral (also known as secondary) hypothyroidism, indicating a pituitary disorderCentral (also known as secondary) hyperthyroidism, indicating a rare pituitary abnormality producing TSHSubclinical (mild) hypothyroidismSubclinical (mild) hyperthyroidism*An abnormal TSH level can indicate a range of problems depending on whether the pituitary gland is functioning normally.**The normal ranges in the bloodstream vary from lab to lab.Sources: Third U.S. National Health and Nutrition Survey; Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management, 2004 (Consensus Panel Recommendation).

Fortunately, treating hypothyroidism is easy. You take thyroid hormone in pill form, to replace the hormone your thyroid gland is not making enough of. The same thyroid blood tests used to diagnose hypothyroidism also are used to determine if you’re taking the right dose of thyroid medicines. These tests are repeated regularly, since a person’s dose can change over time.

Diagnosing hypothyroidism has become much simpler and more precise since I went to medical school.

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Benedict Cumberbatch at the South Bank Awards

Benedict Cumberbatch flashed a smile at the cameras at the South Bank Awards last night - Celebrity news & gossip as and when it happens - online at Glamour.com. Keep up to date with all your favourite celebrities.

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When Disability Strikes Unexpectedly

Becoming disabled even for a short time can turn your life upside down. Extended disability can sometimes create financial problems and emotional stress.

Knowing what to do if you become disabled can help lessen the stress and financial burden of disability.

How to Negotiate Your Medical Bill

You haggle at the car dealership, at the farmers market, and at flea markets. But your doctor's office? That doesn't occur to most people. Yet there's a lot of room for negotiation over medical care costs, says John Santa, MD, a medical expert with Consumer Reports. Simply speaking up about money can make a difference in what you'll ultimately pay, Santa says. "When people are stressed financially, that's helpful information [for a doctor] in terms of taking care of them medically," he says. "That...

Read the How to Negotiate Your Medical Bill article > >

If you've become disabled and can't work, financial assistance may be available from a variety of sources. Each program has its own eligibility requirements, so you'll need to do some investigating.

Here are key ways to get help when you are disabled:

Group disability insurance. Some employers offer group disability insurance. If you're disabled and can't work, most plans pay between 40% and 65% of your income before you became disabled.

Sometimes there are "waiting periods" before the policies begin paying benefits. These can range from 30 days to six months.

If you're healthy now but want to be prepared in case you become disabled, check out disability policies with your employer or your insurance agent.  

Private disability insurance. Some people buy private disability insurance policies. You must do this before you're disabled.

Short-term disability insurance usually replaces part of your income for just three to six months. Long-term disability insurance may last until you're 65, depending on the terms of your policy.

Private disability insurance can cost between 1% and 3% of your annual salary, so a group policy through your employer may be more affordable.

Workers' compensation. If you are disabled while on the job, you may qualify for workers' compensation. This program typically pays up to two-thirds of your income before you became disabled. It also covers medical expenses to treat the work injury.

Regulations vary from state to state. Check with your state's employment department for information.

State disability programs. A handful of states offer their own disability insurance plans. To qualify, you need to have been paying into the program through payroll deductions. Your state's department of employment can provide more information.  

Social Security. The Social Security program offers disability payments after you've been disabled for five months.

Benefits are based on money that was withheld from your earnings and paid to Social Security by your employer. If you haven't worked or paid into the Social Security fund, you will not be eligible for benefits. In that case, you may qualify for Social Security supplemental insurance.

Medicare. If you've been disabled for more than two years, you qualify for Medicare coverage even if you haven't reached retirement age.

Medicare coverage is particularly useful if your disability involves ongoing medical care.

Most people submit their initial claims for disability assistance on their own, says Nancy G. Shor, executive director of the National Organization of Social Security Claimants' Representatives. "But if you are denied coverage, you may want to think about talking to an attorney or an independent claims representative."

Appealing a decision to Social Security or workers' compensation may require appearing before a judge. The appeals process can be complicated and time consuming.

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Gov. Christie’s weight-loss surgery: a good idea for health

Posted May 08, 2013, 4:49 pm

New Jersey Governor Chris Christie’s revelation yesterday that he had secretly undergone weight-loss surgery back in February shouldn’t come as a big surprise. He has been publicly (and privately) struggling with his weight for years and fits the profile of a good candidate for this kind of operation.

Although weight-loss surgery, also known as bariatric surgery, should be considered a last resort when diet and exercise don’t work, it can do some amazing things. Among people who are severely overweight, it can yield a 25% to 35% weight loss within two years. In many people who undergo the surgery, type 2 diabetes, high blood pressure, high cholesterol, and the disruptive and potentially harmful snoring pattern known as sleep apnea disappear. It can also improve a number of other health problems, ranging from arthritis and heartburn to infertility and incontinence.

In general, weight-loss surgery is appropriate for people with a body mass index (BMI) of 40 or higher, as well as for those with a BMI of 35 to 39.9 and a severe, treatment-resistant medical condition such as diabetes, heart disease, and sleep apnea.

Much of the speculation about Christie’s surgery was whether he did it for political reasons or concerns about his future health. But there shouldn’t be any speculation about whether he was a good candidate for it. While the Governor never made public his exact weight, the estimate is over 300 pounds. At just under 6 feet tall, that gives him a body mass index of at least 41. Christie also acknowledged trying to lose weight many times, using different weight loss programs. He had some initial success. But like most obese people, he regained all the lost pounds and more.

Even if Christie’s claims of otherwise being in good health are correct, he was at high risk of developing problems directly related to his weight. I believe his choice was a good one for his health.

Christie underwent laparoscopic gastric banding, also known as lap banding. There are also two other types of weight-loss surgery.

Gastric banding is done laparoscopically, meaning through small holes made in the abdomen. The surgeon wraps an adjustable silicone band about two inches in diameter around the upper part of the stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. The small size of the upper stomach make a person feel full much sooner than before. Depending on the person’s rate of desired weight loss and how he or she feels, the band can be easily tightened or loosened as needed by injecting or withdrawing sterile salt water saline through a port implanted just under the skin. Compared with gastric bypass, the surgery is simpler and has a lower risk of complications immediately following the operation.

Gastric bypass, also known as the Roux-en-Y procedure, shrinks the size of the stomach by more than 90%. This makes a person feel full after eating very small amounts of food. In addition, the body absorbs fewer calories because food bypasses most of the stomach and upper small intestine. The operation is done through an incision made in the abdomen or laparoscopically. The surgeon converts the upper part of the stomach into a small pouch about the size of an egg. The small intestine is then cut. One end is connected to the stomach pouch and the other is reattached to the small intestine, creating a Y shape. This allows food to bypass most of the stomach and the upper part of the small intestine, although both continue to produce the gastric juices, enzymes, and other secretions needed for digestion. These drain into the intestine and mix with food at the crook of the Y. Gastric bypass surgery is not reversible.

The gastric sleeve technique transforms the stomach into a small, narrow tube by removing the curved side of the organ creates a small pouch using the side of the stomach rather than the bottom. One advantage is that no rearrangement of the intestines is needed. The vertical pouch the sleeve procedure creates is less prone to stretching compared to the pouch left by a gastric bypass. Like gastric bypass, the gastric sleeve technique is not reversible.

For the first few months after surgery, appetite is usually turned down. Eating too quickly or too much overfills the stomach pouch. That can cause vomiting or pain in the chest and upper abdomen. After a high-carbohydrate meal, a person who has had gastric bypass surgery may suffer from “dumping syndrome,” a reaction that causes flushing, sweating, severe fatigue, nausea, vomiting, diarrhea, and intestinal gas. To prevent nutritional deficits, it’s also a good idea to take vitamins (especially vitamins B12 and D) and minerals (especially calcium and iron).

If you are considering weight loss surgery, realize that you must commit to a life-long change in the way you eat. Surgery without lifestyle change will either make you miserable or not result in successful weight reduction. Likely both.

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