dventist wellness and lifestyle professionals Neil Nedley, M.D.; Hans Diehl, Dr.H.Sc., M.P.H.; and John Kelly, M.D., M.P.H., tackle lifestyle issues and struggles common to many adults living in North America and other world regions by responding to two health-based situations. The suggestions for lifestyle changes may not necessarily be appropriate and beneficial for everyone dealing with concerns similar to those presented here, but the information provided should be helpful to many. We do, however, encourage readers to discuss these wellness principles with their doctors before incorporating them into their own healthful living practices.—The Editors.


The issue: I am a 59-year-old woman to whom life has become rather grim. I had a difficult time with menopause, and to make matters worse, my husband left me for a woman 15 years his junior.

I work to support myself, but my work has become less meaningful to me. I come home every day to an empty house feeling depressed and wasted. I attend church, participate in prayer meetings, and assist in community service activities—but in my personal life I feel depressed, lonely, and, frankly, useless.

I have considered suicide, but not really seriously, because I feel my children (ages 28 and 30) would be traumatized were I to do such a thing.

What approaches do you recommend? Do you think I need Prozac?



Your situation does sound challenging indeed, and my heart goes out to you and many others who are struggling with depression. You are wise to seek advice. When you recognize that life is losing its meaning and you are feeling depressed or even suicidal, get help fast. The good news is that people who take the appropriate steps in such situations have been able to recover and come out well.

There are two main types of 
depression—endogenous and reactive. Endogenous, or mainly genetically 
predisposed depression, is usually the more severe of the two and subsequently more difficult to treat. A number of interventions and treatments, however, are available and helpful. Your situation fits more into the 
category of reactive depression, and although it is very real, it’s easier to treat and also to prevent and control 
in the long term. Intentional lifestyle changes are foundational in being happy and healthy.

Although medication is recommended in some situations, antidepressant medications do not come “one-size-fits-all,” and you need to consult a physician before making 
any decisions concerning treatment. Numerous nonmedical interventions that have proven effective for many who suffer from depression are also available. Here are some ways to jump-
start your recovery process, especially in situations of reactive depression:

Establish an exercise routine. Start by walking vigorously for 15 minutes in one direction, then turn around 
and walk back. As physical strength improves, you should work up to about five or six miles every day. Remember to breathe deeply and fill your lungs with fresh air. Walking supplies the brain with oxygen and raises serotonin levels.

Drink plenty of fresh, pure water between meals each day. When you are dehydrated your body feels more fatigued and your brain has trouble staying alert. Even simple facts can become harder to recall when you are dehydrated.

Eat healthfully. What and how much you eat also can influence how effectively your brain operates. Make sure to consume foods high in omega-3, tryptophan, folic acid, and calcium, such as flaxseed, spinach, green soybeans, almonds, lentils, collard greens, sesame seeds, and carob. Be careful not to overeat. Getting sufficient vitamin D via direct sunlight or supplementation is also important.

Experiencing bright light or sunshine first thing in the morning is very helpful in the battle against depression. Your body clock will reset and will improve your sleep, mood, and energy cycles so you can sleep better and feel good during waking hours. 
I suggest 30 minutes to one hour 
per day of sunlight or bright-light exposure.

Get enough sleep. Sleep deprivation alone can be a major contributing factor to depression. Get seven to eight hours of nightly sleep, with at least two hours before midnight if possible. Go to sleep in a cool, dark room and arise at approximately the same time each day.

Focus on positive, cheerful thoughts. Spend time with God in His Word each day. Experience the power of forgiveness, and choose your thoughts carefully. To lift your spirits sing a hymn whenever you can and spend time with uplifting, encouraging people. A challenge I often give to patients is to go several consecutive days without saying anything negative. If they mess up, they start again.

More than 100 factors—including menopause—can contribute to depression. But here’s good news: people recover from depression. As Christians, there is additional hope in the precious love and grace of Jesus and the caring support of fellow believers. There may be a time to take Prozac, and then a time to give it up—but there is never a time to give up hope. Complete recovery is within your grasp.

_______________

Neil Nedley, M.D., is a full-time practicing physician in internal medicine with emphasis in preventive medicine, mental health, gastroenterology, and the difficul-to-diagnose patient.  For more information, go to www.drnedley.com.



The issue: I’m a 45-year-old male and worried about my coronary risk, especially because my father—now 70—had a heart attack at 50 and later bypass surgery and two subsequent stents.

I have the following lipid 
levels:
total cholesterol—250 mg.
LDL cholesterol—140 mg.
HDL cholesterol—35 mg.
triglycerides—375 mg.

I have not been able to improve the numbers on these coronary risk factors even though I exercise four days every week for 40 minutes at a time, I’m at my ideal weight, I don’t smoke or use alcohol, I eat little sugar or refined starchy foods, and I eat chicken (skinless) three times and fish twice a week.

What can I do to avoid the same health problems my father experienced? Will I have to take a lipid-lowering drug 
as well? What can I do to drive down my cholesterol and triglyceride numbers?




We can understand your concerns, especially after you witnessed your father’s deterioration of health and the pharmaceutical and surgical interventions for his coronary artery disease. We can also understand some of your frustration in that many of your laudable lifestyle improvements have not succeeded in creating a more optimal lipid profile and thus a lower coronary risk.

You seem to be particularly concerned about your high total cholesterol level. Here are some dietary suggestions that have been proven quite successful in lowering the total cholesterol in the bloodstream toward the more optimal level of 150 mg.

Lower the triglycerides, because they will reduce the total cholesterol number. Triglycerides (or blood fats) above 150 mg. are largely influenced by overweight, alcohol use, sugar, and refined starch intake. You already are avoiding all these things, but make sure that you also eliminate fruit juices and dehydrated fruits from your diet. 
If you are sugar-sensitive, then even natural sugar concentrated in fruit juice and dehydrated fruit could cause your triglyceride levels to spike. Also, cut back on refined flour products, which are usually devoid of sufficient fiber and can affect the triglycerides. Add one tablespoon of ground flax seeds (flax meal) to your daily breakfast. The addition of an ounce of walnuts and/or some avocado will also help assure a normal fatty acid profile.

Assuming your triglycerides respond as expected, a drop of 225 mg. (from 
375 to 150 mg.) would reduce your total cholesterol by one fifth of that amount, or by 45 mg. You’ll then be on your way to a lower total cholesterol!

Lower the LDL, because it will reduce the total cholesterol number. Optimize those LDL levels to at least less than 90 mg. You can best accomplish this with a more natural, very low-fat diet, devoid of cholesterol yet high in fiber.

LDL values are largely driven by:
1. the amount of saturated fat (meats, cheese, whole milk, and palm and coconut oils) and trans fats (hydrogenated fats commonly found in cakes, crackers, French fries, and many restaurant foods) in the diet. These fats cause the liver to go into overdrive in producing excessive amounts of cholesterol that enter the bloodstream.
2. the amount of dietary cholesterol. Cholesterol is found only in animal products. The amount of cholesterol in chicken (with or without the skin) is the same as that found in red meat.
3. the amount of soluble fiber in the diet. Soluble fiber found plentifully 
in fruits (pectin), grains (such as 
oats), and legumes (beans and lentils) reduces the circulating cholesterol in the bloodstream.
In addition, over-the-counter natural high-fiber products are available, which also can help reduce elevated LDL levels.
Follow these suggested dietary guidelines and then have your lipids checked again in four to six weeks. 
It would be rare for these lipid param-
eters not to become more optimal within that time frame. But if you are one of those rare cases, then some plant sterols and sometimes some prescription medication could be added.

 _______________
Hans Diehl, DR.H.SC., M.P.H., is director of the Lifestyle Medicine Institute in Loma Linda, California.  For more information, go to www.chiphealth.org.

John Kelly, M.D., M.P.H., is founder of the America College of Lifestyle Medicine in Woodburn, Oregon.  For more information, email jhkelly@llu.edu.







 
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