Yesterday, in response to the “Ask This Doc” Q & A, I received many excellent questions, a lot of which are common concerns that I frequently encounter.

Therefore, I am posting some of those questions here today, along with my responses. I hope you will find them helpful as well.

If you would like to ask me a health-related question, I am always glad to answer them. Just click below to go to the original post.

Soft Drinks and Liver Health

“Can drinking a lot of carbonated sodas affect my liver?”

The short answer: Yes, carbonated sodas (both regular and diet versions) have been demonstrated to adversely affect the liver by increasing the risk of fatty liver disease.

The reason:
–For sugary drinks: The fructose contained in them stimulates the process of liver lipogenesis (fat production).
–For diet drinks: There is some evidence that sugar substitutes and some colorants can increase insulin resistance and inflammatory processes which in turn affect the liver.

The result is that, keeping everything else the same (physicial activity, calorie intake, alcohol intake), drinking soft drinks seems to be associated with the increased risk of developing what we call “non-alcoholic fatty liver disease (NAFLD)”

Does this mean you cannot drink any at all? No. But I would definitely recommend limiting your intake (no more than 1-2 daily).

As for the carbonation itself (for instance, if you drank carbonated water), it does not harm the liver.

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Stress and Weight Loss

“Can a lot of stress make it more difficult to lose weight?”

The short answer: YES, chronic stress can make it more difficult to lose weight, even if you are an active person.

The reason:
You have probably heard of a “stress hormone” called cortisol. When a person is under repeated stressful situations (either physically or emotionally), the production of cortisol markedly increases.

This stress-induced cortisol affects your brain and body in several ways, but for most people, it sabotages their weight loss efforts by increasing not only their appetite but by triggering cravings for calorie-dense “comfort foods.”

Even if you don’t eat more and still exercise, high stress can affect the way in which your body stores fat…namely, it increases the accumulation of abdominal fat, therefore making it more difficult to shed the weight around the waist.

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Weight Loss and Weight “Set Points”

“What is the weight set point and how can you change it? I am having trouble losing weight and keeping it off.”

What is a weight “set point?”
– Your weight set point is the weight that your body thinks it should be at and where it fights to keep you through a balance of hormones that regulates your appetite and your metabolism. Most people hover around this point (For example, you may diet but then gain the weight back and you find it is close to where you started).

What determines your set point:
– Among other things, your heredity and your environment (your eating habits) are the main factors. Even if your genetic factors favor a certain weight, poor long term eating habits can actually change it, making your body “think” that it’s supposed to weigh more or less.

How to change this set point (for long-term weight loss):
– The 10% over 6 months rule: It has been observed that on average, the body will allow you to lose 10% of its weight before it starts to “fight back” and become resistant to further dieting. Therefore, aim to lose no more than 10% of weight over 6 months. After 6 months, your body will have created a new set point, so then you can work to lose 10% more of that weight, and so on…

What has been shown to work long term: Sustained change in eating habits and increased physical activity (both cardio and weight training).

Therefore, I encourage you to aim to develop healthier eating and exercise habits that will work for you long-term. At the same time, try to minimize stress and get enough sleep.

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Anemia and Iron Supplements:

“I am taking iron pills for my anemia. How do I know if they are working?”

On average, if a person’s anemia is severe enough that they are having symptoms (fatigue, weakness, headaches, shortness of breath with mild exertion), they usually will notice some improvement in their symptoms within the first week. If you only had mild or no symptoms to begin with, you might not notice a drastic change in the way you feel, but you can trust that it is definitely working to replenish your body’s iron stores.

A couple of important things to keep in mind:
– It takes about 2 months on average for your anemia to go away, but it can take up to 6 months for your body’s iron stores to be completely replenished. Therefore, don’t stop taking it until your doctor tells you to.
– For best absorption, take the iron pill on an empty stomach and with some source of Vitamin C (orange juice or Vitamin C supplement)
– If you cannot take it on an empty stomach (due to nausea/upset stomach), make sure not to take antacids (like Tums) or drink milk beforehand, as these will prevent absorption of iron.
– They can cause constipation: Therefore, supplementing with daily fiber or a mild non-stimulating laxative (such as Colace) can be helpful.

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Cancer Screening Recommendations for Older Women

“How frequently should women 55 and up get Pap smears and mammograms? Should I worry about the radiation?”

To answer I will address each test separately:

PAP SMEARS (Cervical cancer screening):
– If you are YOUNGER THAN 65: Please continue to get cervical cancer screening when your doctor asks you to. Usually this is every 3 or 5 years (depending on what tests were done and what the results were).
– If you are 65 AND OLDER and your recent pap smears were normal: You can stop!

• If you have had a hysterectomy:
  – History of a TOTAL hysterectomy for noncancer reasons: No more paps needed!
  – History of a total hysterectomy for a cancerous or precancerous condition: Still need pap smears (they check vaginal wall cells for abnormalities)
  – History of a PARTIAL hysterectomy: Still need paps (per above)

MAMMOGRAMS (Breast cancer screening):
– If you are 55 AND OLDER: I definitely still recommend getting them, but you can space them out to every 2 years.
– When to stop: Some physicians recommend getting mammograms for as long as you are healthy enough to have a life expectancy of at least 10 years. Some say it’s okay to stop when you’re 75 years old. Therefore, depending on how you feel about your health, your doctor can work with you to determine the best time to stop.
– Should you be concerned about the radiation: As for the dose of radiation exposure from a mammogram: it is very minimal, so I would not use that as a reason to not get one.

So to sum up what is a rather complicated issue: I would encourage any woman in the 55+ age group to ask their doctors directly about what they recommend given your specific medical history, and if you have concerns or reservations…let them know! That’s what they are there for.

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Calcium and Vitamin D for Osteoporosis

“What dose should I take for osteoporosis?”

For osteoporosis, the recommended dose of calcium is 1200mg with 800IU of vitamin D3.

Make sure not to take more than 4000IU total of vitamin D daily (unless instructed by your doctor) as this can increase your risk of vitamin D toxicity.

However, vitamin D and calcium alone are not sufficient treatments for severe osteoporosis, which usually requires a bone-forming prescription medication.

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*I hope you find this helpful. Like always, this is just for your information and should never be used to replace your doctor’s medical advice. Always check with your doctor before starting or changing medications.

♦

Phoebe Chi, MD

As a physician educator and the managing editor of Health + Inspiration, Dr. Chi aims to inform, empower, and inspire the reader community. She is the author of Being Empowered for a Healthy Heart: A personal guide to taking control of your health while living with chronic conditions, a poetry-infused health guide, and founder of Pendants for a Cause, a nonprofit organization with the purpose of raising funds to fight illness, provide care, and bring awareness to medically vulnerable populations around the world.