Month: February 2022

For many of us, a trip to the doctor’s office produces anxiety: What do my blood results mean? Will my doctor think this bump is cancer? The physical exam can make us feel vulnerable and may involve mild discomfort, so we may shower, shave, and put on better-than-average clothes before heading out for our physical in an attempt to minimize this discomfort.

However, it’s the intimate discussions — whether a crushing depression, escalating alcohol use, or sexual problems — when our palms really start to sweat. These difficult discussions can be more comfortable and productive when we know what to expect.

Sex

Most people do not volunteer their sexual history, so be prepared for your doctor to ask you a few questions directly as part of your comprehensive exam. Doctors ask all patients about their sexual history, regardless of age, gender, and marital status. (This blog post has some tips for talking about sex with your doctor if you are in the LGBTQ+ community.)

As a psychiatrist, I routinely discuss sexual activity with my patients, as changes in mood, substances, and many medications can affect sexual functioning. For example, the most commonly prescribed class of antidepressants, the selective serotonin reuptake inhibitors (SSRIs), are more likely to lower libido than to treat depression. (They achieve remission in approximately 30% of patients — but they cause sexual dysfunction in 60% to 70%.)

What your doctor may ask: The five Ps: partners (number and gender), practices (what kind of sexual contact), protection (method of contraception), past history of sexually transmitted infections (STIs), and pregnancy. Your doctor may also ask about medications or supplements that can affect libido.

What your doctor needs to know: Your doctor needs to understand your risk of getting an STI, including any risky behaviors or substance use. In addition, your doctor needs to hear about any changes in libido, problems achieving orgasm, difficulties maintaining an erection, or a delay in ejaculation. This information helps your doctor think through contributing causes, including your hormone levels, medical conditions, and medications.

Substance use

This is another tricky topic, as almost everyone minimizes their substance use. Most people understand that smoking or excessive alcohol is not good for them — it’s not a matter of education. In fact, patients may avoid revealing their use because they don’t want their doctors to “educate” them.

People using substances often experience shame, one of the strongest negative emotions we can feel, and something people go to great lengths to avoid. It’s helpful to remember the role of your doctor: it’s not to judge, and certainly not to reprimand. Assuming you trust your doctor, it can help to think of your doctor as an ally. Together you can brainstorm ways to decrease use (harm reduction) or to discontinue use altogether, when you are ready.

What your doctor may ask: It is standard practice to ask about tobacco, alcohol, and illicit drug use. If you drink alcohol, smoke, or use substances, be prepared for your doctor to ask detailed questions about the quantity, frequency, attempts to cut down, and cravings.

What your doctor needs to know: The truth! Try to think about the past week and count the total drinks/cigarettes/pills consumed. Also let your doctor know whether you are interested in cutting down or discontinuing use altogether. Your doctor can work with you to optimize your treatment, whether it’s medications to reduce your cravings or connecting you to support groups.

Mental health

Most primary care clinics routinely screen all patients for depression, and some may screen for anxiety disorders as well. If you screen positive, your doctor will almost certainly ask you more questions about your mood, whether you are experiencing anxiety, and even whether you have experienced hallucinations or paranoia. This is not because your doctor thinks you’re crazy; rather, these symptoms may accompany severe illness and could affect treatment decisions.

What your doctor may ask: To assess for depression, your doctor will ask about your sleep, appetite, interest in activities, feelings of guilt, and any changes in concentration or energy level. Your doctor will also ask whether you have experienced thoughts about ending your life. These questions can feel probing and intimate — especially if you came to the doctor’s office for an unrelated complaint, such as heartburn. However, your doctor is asking these questions to develop a better understanding about the length and severity of your symptoms in order to make the correct diagnosis. Here too, it’s helpful to think about your doctor as an ally. If you’re worried about this information going into your medical record, you can request this information to be marked as sensitive. No one is allowed to see your medical records without your permission, unless they are caring for you.

What your doctor needs to know: Sometimes depressed mood and anxiety can be related to an underlying medical illness such as heart, lung, or thyroid problems. Mention any physical symptoms you have noticed, even if they seem unrelated. If this is your first episode of feeling anxious or depressed, think about any life events that could be contributing (such as a recent break-up, job loss, or move), as this may help your doctor in differentiating between an adjustment disorder and a major depressive episode. Talk about your coffee habits and alcohol use, which can affect sleep and anxiety.

The bottom line

Sharing the most intimate details of your life with your doctor is understandably nerve-racking. Rest assured your doctor will keep this information confidential, unless there is a risk you could seriously harm yourself or others. It helps to realize that doctors talk about sex, substances, and mental health with almost all of their patients, and they will meet you where you are. Try to relax, take a deep breath, and remember: the doctor is on your side.

For the longest time, your milk choices were whole, 2%, 1%, and fat-free (or skim). Today, refrigerator shelves at grocery stores are crowded with plant-based milks made from nuts, beans, or grains, and include favorites like almond, soy, coconut, cashew, oat, and rice. Yet the fertile ground of the plant-milk business continues to sprout new options, such as pistachio, pea, and even potato milk. It seems if you can grow it, you can make milk out of it.

So, are these new alternatives better nutritionally than the other plant milks — or just more of the same?

A few facts about plant-based milks

Plant-based milks are all made the same way: nuts, beans, or grains are ground into pulp, strained, and combined with water. You end up with only a small percentage of the actual plant — less than 10% for most brands. Nutrients like vitamin D, calcium, potassium, and protein are added in varying amounts. “Still, many alternative milks have similar amounts of these nutrients compared with cow’s milk,” says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.

Plant-based milks are considered “greener” than dairy and emit fewer greenhouse gases during production. However, growing some of these plants and making them into milk requires great quantities of water. Most plant-based milks are low-calorie. On average, though, these milk products cost more than dairy.

Nutrition, calories, and other benefits of newer plant-based milks

Here’s a closer look at three new members of the alternative-milk family.

• Pistachio milk is not green like the nut, but rather an off-brown color. Because it contains little actual pistachio, you miss out on the nuts’ essential vitamins and minerals, like thiamin, manganese, and vitamin B6. Yet pistachio milk contains less than 100 calories per cup, which is similar to skim cow’s milk and other plant-based milks. One extra benefit of pistachio milk is that it’s a bit higher in protein than other plant milks (which can be light in the protein department compared with cow’s milk).
• Pea milk is created from yellow field peas, but has no “pea-like” flavor. Its color, taste, and creamy consistency are close to dairy, so people may find it more appealing than the sometimes-watery texture of other plant milks. Pea milk has a decent protein punch — at least 7 grams per serving — and each serving adds up to about 100 calories. It also requires less water in production than other plant milks, and has a smaller carbon footprint than dairy.
• Potato milk looks more like regular dairy milk than other plant milks because of the potato’s starchy nature. It’s arguably the most eco-conscious plant milk, because growing potatoes requires less land and water than dairy and other plants. Potato milk also is low-calorie: 80 to 100 per serving.

What’s the best plant-based milk for you?

There doesn’t appear to be a huge difference between most plant milks. Ultimately, three issues drive your choice: digestion issues, environmental impact, and personal taste.

Digestion issues. Plant-based milks are a quality alternative for people with lactose intolerance or lactose sensitivity whose bodies can’t break down and digest lactose, the sugar in milk. This causes digestive problems like diarrhea, gas, and bloating. (However, lactose-free and ultra-filtered dairy milk are available for those who prefer dairy.)

Environmental impact.One study in Science found that dairy milk production creates almost three times more greenhouse gas than plant-based milk. However, some plant milks, predominantly almond, demand much water to produce. (Some research suggests the water demands of almond milk are about equal to cow’s milk, according to Dr. Willet.)

Still, if you want to do your part to fight climate change, buying plant-based instead of dairy is the greener choice.

Personal taste. Plant-based milks can be an acquired taste, but with multiple choices, there is a good chance you can find one that satisfies your taste buds. Manufacturers try to overcome the taste dilemma by pouring in extra sugar, sweeteners like vanilla and chocolate, and other additives. So always check the total and added sugar amounts and keep the amount per serving below 10%. Of course, the lower the amount, the better.