Workout Weight Gain

Q. I started exercising and have gained five pounds! My BMI is still within the healthy limits (barely). But I’d like to lose—not add—more weight! Why is exercise making me heavier instead of lighter? What am I doing wrong?

A. Not all exercise is the same. So without knowing what type of exercise you’re doing, how much and how often—and for how long you’ve been doing it—it’s hard to speculate as to why you might be gaining weight.

Are you going to yoga class seven days a week? Are you doing 50 crunches every morning (and nothing else)? Are you walking on the treadmill for 20 minutes, but only twice a week? While each of these approaches may improve your fitness level, they don’t add up to a large enough calorie burn to significantly affect your body weight. The type of exercise and how much of it you do makes all the difference when it comes to shedding pounds.

LOW CALORIE BURNERS vs. HIGH CALORIE BURNERS

Generally, the fitness recipe for weight loss is to increase the amount of cardio you do in order to burn a significant amount of calories per session. Theoretically (assuming you don’t eat more than usual), if you burn 3,500 calories, you will lose one pound of fat.

Muscle-conditioning activities tend not to burn many calories. You do burn extra calories from these workouts—it just might not be enough to see a difference in a short amount of time.

Consider this: You burn about one calorie per minute sitting. Exercises where you stretch or target specific muscles such as when doing ab work or pushups, for example, burn around two or four calories a minute. But walking, running or dancing can burn from five to 10-plus calories per minute.

Don’t be fooled into thinking that you’re burning lots of calories because you feel a burn and you’re breaking a sweat. You might be huffing and puffing because the room is hot and not because you are metabolizing lots of energy.

Moves that generate specific muscle fatigue (your arms quiver, your abs burn, your legs shake) may feel tough, but they still may not burn that many calories overall. For example, walking briskly—where you don’t feel a burn, but your heart rate increases because many muscles work in unison over an extended period of time—uses  up more energy than 100 crunches. That’s why you’ll decrease more fat in your belly from walking than from doing ab work, which may feel more difficult.

So, yoga, Pilates, lifting weights and other types of body conditioning workouts tend not to be calorific enough to make a big dent in fat stores. A 30-minute stretch and ab workout might burn around 60 calories, while a 30-minute walk might burn 150 calories, and a (higher intensity) 30-minute step class might burn about 250 calories.

HOW LONG TO LOSE 10 POUNDS?

In theory, to lose 10 pounds of fat (or burn 35,000 calories) by working out four days a week for 30 minutes, it would take:

• About 145 weeks (or almost 3 years) from yoga and ab workouts;
• Some 58 weeks (about a little more than one year) from short, moderate-intensity walks;
• Or 35 weeks (about eight months) from higher-intensity cardio such as a step workout.

Of course, eating slightly less while adding in the extra calorie burn from any of these workouts—or lengthening each exercise session—can speed up the weight loss.

While there is not yet a specific recommendation for exactly how much exercise results in weight loss, general recommendations are to include from 30 to 90 minutes of moderate to high intensity activity into your day, on most days of the week.

GAINING AT THE SAME TIME YOU START EXERCISING

Cutting calories from what you eat each day is easier than burning up extra calories through exercise: You can easily shave 500 to 1,000 calories off a day’s meals but cutting out soda, fried foods and sweets that you might normally eat. But burning this many calories from working out takes a lot more work—about one to two hours of exercise per day, depending on the type and intensity. That’s why people seem to feel that diets work better than exercise when it comes to weight loss—they work faster.

You’re not the first to feel like you are gaining weight from working out. Assuming that you are doing longer, calorie-intensive workouts more frequently, there may be other explanations:

Some people eat more when they start to exercise. There doesn’t seem to be evidence that your body actually gets hungrier, especially with lower intensity or shorter workouts. But there may be a psychological disinhibition: “Hey, I worked out, I can have that extra serving, or maybe even dessert.” Also, some research suggests that women may become less active when they add exercise to their day. This, too, may be some sort of psychological compensation: “I worked out, I can sit on my butt for the rest of the day.”

Sometimes, as people get fitter, their bodies become more efficient, especially at utilizing carbs better. So you develop the ability to store more glycogen, or carbs, in your muscles. Those molecules contain added water, which means that you MIGHT increase your water weight as you get fitter. This isn’t likely to make a huge difference on the scale, though.

Some people assume that they gain muscle and this makes them heavier, too. Unless you are lifting heavy weights and eating more, it’s unlikely that you’re gaining muscle weight. Even then, it might take six months to gain a couple of pounds.

Keep in mind, too, that body weight fluctuates by as much as three to five pounds daily. And you might even be shaping up more than you realize if your clothes are getting loser, despite what the scale says. (You can decrease body fat—helping your look slimmer—without losing much weight.)

Do you have a fitness or weight-loss question for Martica? Send e-mail to experts@microsoft.com. Please include Ask Martica in the subject line. Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.
Martica is a Manhattan-based exercise physiologist and nutritionist and an award-winning fitness instructor. She has written for a variety of publications including Self , Health , Prevention , The New York Times and others. Martica is the author of seven books, including her latest, – Cross-Training for Dummies . (Read her full bio.)

When a Man’s Sex Drive Is Too Low

The male libido is always in overdrive, right? Wrong — one out of five men actually have a low sex drive.

Men. High sex drive. Panting sexual animals. We know what they want. And we know when they want it: right now.

Even doctors tend to see men as “sexual automatons,” hardwired always to want sex, says pioneering sex researcher Irwin Goldstein, MD, director of sexual medicine at San Diego’s Alvarado Hospital and editor in chief of The Journal of Sexual Medicine. “But that is not the case at all,” Goldstein tells WebMD Magazine. “Many, many men — about one in five –have such low sexual desire they’d rather do almost anything else than have sex.”

One in five men doesn’t want sex? How can that be true? And why haven’t we heard about it? Actually, many women have — the ones hearing the phrase “Not tonight, dear.” Goldstein says most people think that is a rare occurrence. “But in fact, almost 30% of women say they have more interest in sex than their partner has.”

The causes of low sex drive

So what’s behind low sexual desire? Aging plays a role, though many older men have a robust interest in sex, Goldstein points out. Like most other human traits, the sex drive varies. Most men are in the normal range; some are extraordinarily driven toward addiction-like sexual behavior. At the other end of the scale are men with very low sexual interest. These are men who suffer from hypoactive sexual desire disorder (HSDD).

“There are always men on both sides of the normal curve,” Goldstein says. “And a certain percentage — perhaps up to a quarter — will be considered to have HSDD for a whole host of reasons.” These include:

Psychological issues. Stress and anxiety from the strain of daily life, relationship or family problems, depression, and mental disorders are among the many factors that can affect sexual desire.

Medical problems. Diseases such as diabetes; conditions such as obesity, high blood pressure, and high cholesterol; and HIV drugs, some hair-loss remedies, and other medications can negatively affect sexual desire.

Hormonal causes. “Testosterone is the hormone of desire, arguably for women as well as for men,” Goldstein says. Low testosterone levels usually mean low sexual desire. Levels dip as men age; other causes include chronic disease, medications, and other drug use. Other hormones can play a role, too, such as low levels of thyroid hormone or, rarely, high levels of prolactin, a hormone produced in a gland at the base of the brain.

Low dopamine levels. Sexual desire obviously involves the brain — and the brain’s chemical messaging system is intimately linked to sexual desire. One of those messengers is dopamine. Doctors have noted that Parkinson’s disease patients treated with dopamine-stimulating drugs had increased sexual desire. Goldstein says these drugs help some men with HSDD.

Each cause of low sexual desire has its own treatment. When the root cause is psychological, sex therapy can offer men specific techniques and strategies for regaining their enjoyment of sex. “It is not psychotherapy; it is psychology counseling focused on sexual issues,” Goldstein explains.

In cases where the problem is low testosterone, men can take testosterone supplements if they have measurably low levels. About 25% of men go for weekly testosterone shots, Goldstein says, but most opt for skin patches or gel formulations applied directly to the skin of the chest, shoulders, or abdomen.

When Goldstein suspects low dopamine levels are at the heart of a man’s low sexual desire, he might prescribe dopamine-increasing drugs, though this treatment is not currently approved by the FDA and has risks.

However, a new drug now in clinical trials — for women — does increase dopamine levels while decreasing a specific kind of serotonin in the brain. Early clinical studies suggest the drug could help women with low sexual desire. Goldstein thinks this new treatment has promise. And if it’s approved for women, he says, it will likely be tested in men.

In the end, the choice for men who’ve lost their desire for sex is not between being a panting sexual animal and being a eunuch. Instead, the real choice is whether these men are ready to regain a vital source of intimacy with their partners — and a key part of a healthy life for themselves.

Non-starchy Vegetables

Eat more! You don’t often hear that when you have diabetes, but non-starchy vegetables are one food group where you can satisfy your appetite. Vegetables are full of vitamins, minerals, fiber, and phytochemicals – and with so few calories and carbohydrate, everyone can enjoy more!

There are two main types of vegetables – Starchy and non-starchy. For this section, we are going to focus only on the non-starchy vegetables. Starchy vegetables like potatoes, corn, and peas are included in the Grains and Starches section because they contain more carbohydrate.

What are the best choices?

The best choices are fresh, frozen and canned vegetables and vegetable juices without added sodium, fat or sugar.

General tips:

• If using canned or frozen vegetables, look for ones that say low sodium or no salt added on the label.
• As a general rule, frozen or canned vegetables in sauces are higher in both fat and sodium.
• If using canned vegetables with sodium, drain the vegetables and rinse with water then warm in fresh water. This will cut back on how much sodium is left on the vegetables.

For good health, try to eat at least 3-5 servings of vegetables a day. This is a minimum and more is better! A serving of vegetables is:

• ½ cup of cooked vegetables or vegetable juice
• 1 cup of raw vegetables

Tips for Carb Counters
Generally, non-starchy vegetables have about 5 grams of carbohydrate in ½ cup cooked or 1 cup raw. Most of the carbohydrate is fiber so unless you eat more than 1 cup of cooked or 2 cups of raw at a time, you may not need to count the carbohydrates from the non-starchy vegetables.

Tips for the Plate Method
Enjoy the colorful variety of vegetables to brighten your plate. With half of your plate filled with vegetables, your options are endless for delicious combinations. If you are still hungry after the plate on your food is gone, try having a salad with a low-calorie dressing to satisfy your appetite and get an extra serving or two of vegetables in at the same time.

Grains and Starchy Vegetables

There is no end in sight to the debate as to whether grains help you lose weight, or if they promote weight gain. Even more importantly, do they help or hinder blood glucose management? One thing is for sure. If you are going to eat grain foods, pick the ones that are the most nutritious. Choose whole grains. Whole grains are rich in vitamins, minerals, phytochemicals and fiber. Reading labels is essential for this food group to make sure you are making the best choices.

Every time you choose to eat a starchy food, make it count! Leave the processed white flour-based products, especially the ones with added sugar, on the shelves or use them only for special occasion treats.

What is a whole grain?

A whole grain is the entire grain — which includes the bran, germ and endosperm (starchy part). The most popular grain in the US is wheat so that will be our example. To make 100% whole wheat flour, the entire wheat grain is ground up. “Refined” flours like white and enriched wheat flour include only part of the grain – the starchy part, and are not whole grain. They are missing many of the nutrients found in whole wheat flour. Examples of whole grain wheat products include 100% whole wheat bread, pasta, tortilla, and crackers. But don’t stop there! There are many whole grains to choose from.

Best Choices
Finding whole grain foods can be a challenge. Some foods only contain a small amount of whole grain but will say it contains whole grain on the front of the package. For all cereals and grains, read the ingredient list and look for the following sources of whole grains as the first ingredient:

• Bulgur (cracked wheat)
• Whole wheat flour
• Whole oats/oatmeal
• Whole grain corn/corn meal
• Popcorn
• Brown rice
• Whole rye
• Whole grain barley
• Wild rice
• Buckwheat
• buckwheat flour
• Triticale
• Millet
• Quinoa
• Sorghum

Most rolls, breads, cereals, and crackers labeled as “made with” or “containing” whole grain do not have whole grain as the first ingredient. Read labels carefully to find the most nutritious grain products.

For cereals, pick ones with at least 3 grams of fiber per serving and less than 6 grams of sugar.

Best Choices of Starchy Vegetables
Starchy vegetables are great sources of vitamins, minerals and fiber . The best choices do not have added fats, sugar or sodium. Try a variety such as:

• Parsnip
• Plantain
• Potato
• Pumpkin
• Acorn squash
• Butternut squash
• Green Peas
• Corn

Best Choices of Dried Beans, Peas and Lentils
Try to include dried beans into several meals per week. They are a great source of protein and are loaded with fiber, vitamins and minerals.

• Dried beans such as black, lima, and pinto
• Lentils
• Dried peas such as black-eyed and split
• Fat-free refried beans
• Vegetarian baked beans

Tips for Carb Counters
Starchy foods are one of the main sources of carbohydrate in our diet — along with milk, fruits, and sweets. For most grains and starches, 1/2 cup or 1 oz contains 15 g of carbohydrate. A few exceptions are 1 cup of winter squash and pumpkin and 1/3 cup of rice has about 15 grams.

For the Plate Method
About 1/4 of your plate should come from starchy foods. Remember, only the depth of a deck of cards! This is usually about 3/4 to 1 cup of a starchy food.

For using the Glycemic Index
The general rule of thumb when using the GI to select foods is that the closer to nature, or less processed a food, the lower the GI. For example, whole rolled oats have a lower GI than instant oatmeal. Dried beans, lentils and starchy vegetables all have lower GI values. Potatoes are an exception but a small serving can still fit into your meal plan.

Diabetes Food Pyramid

The Diabetes Food Pyramid is another meal planning option that some people use. It is less popular compared to both carbohydrate counting and the plate method for diabetes management.

The Diabetes Food Pyramid divides food into six groups. These groups or sections on the pyramid vary in size. The largest group – grains, beans, and starchy vegetables – is on the bottom. This means that you should eat more servings of grains, beans, and starchy vegetables than of any of the other foods. The smallest group – fats, sweets, and alcohol – is at the top of the pyramid. This tells you to eat very few servings from these food groups.

The Diabetes Pyramid gives a range of servings. If you follow the minimum number of servings in each group, you would eat about 1600 calories and if you eat at the upper end of the range, it would be about 2800 calories. Most women, would eat at the lower end of the range and many men would eat in the middle to high end of the range if they are very active. The exact number of servings you need depends on your diabetes goals, calorie and nutrition needs, your lifestyle, and the foods you like to eat. Divide the number of servings you should eat among the meals and snacks you eat each day.

The Diabetes Food Pyramid is a little different than the USDA Food Guide Pyramid because it groups foods based on their carbohydrate and protein content instead of their classification as a food. To have about the same carbohydrate content in each serving, the portion sizes are a little different too. For example: you will find potatoes and other starchy vegetables in the grains, beans and starchy vegetables group instead of the vegetables group. Cheese is in the meat group instead of the milk group. A serving of pasta or rice is 1/3 cup in the Diabetes Food Pyramid and ½ cup in the USDA pyramid. Fruit juice is ½ cup in the Diabetes Food Pyramid and ¾ cup in the USDA pyramid. This difference is to make the carbohydrate about the same in all the servings listed.

Following is a description of each group and the recommended range of servings of each group.

Health by Chocolate – How enjoying a little chocolate might actually help your health.

“Take two squares of dark chocolate and call me in the morning.” I’d be all over those doctor’s orders! Can eating chocolate really be good for your health?

Well, if it is, I’m certainly in great shape. I rarely let a day go by in which I don’t enjoy a little bite of chocolate. I crave a little bit a day, much like those people who MUST have two cups of coffee in the morning.

The craving usually hits me mid-morning or right after lunch. A couple of squares or a small handful of chocolate-covered nuts, and I’m good to go. I just love the smoothness and the flavor of chocolate. No other food quite compares to it.

Chocolate and Your Health

The possible health benefits of chocolate stem from the antioxidant flavonoids. Chocolate comes from the cacao plant, and cacao is extraordinarily rich in flavanols, a type of flavonoid phytochemical. (Other plants rich in flavanols include tea, grapes, grapefruit, and wine.) That sounds simple enough, but some forms of chocolate have a lot more flavonoids than others.

So here’s Health by Chocolate Rule of Thumb #1: The more nonfat cocoa solids a chocolate product contains, the more antioxidants it tends to contribute.

And what about the fat found in the cacao bean? It’s true that cacao contains some saturated fat. But most of it is stearic acid — which studies have suggested doesn’t elevate blood cholesterol levels as much as other saturated fatty acids. The other fatty acids in cocoa butter are monounsaturated fat (considered a desirable fat) plus another saturated fat called palmitic fatty acid. But here’s where it gets confusing: chocolate products can have other types of fat added, like “milk fat” or “partially hydrogenated vegetable oil” or even coconut or palm oil (both naturally saturated oils), in addition to “cocoa butter.”

So here’s Health by Chocolate Rule of Thumb #2: If the chocolate contains fat ingredients other than cocoa butter, it might contain the more harmful saturated fats and trans fats, rather than stearic acid.

One tablespoon of cocoa butter oil contains:

• 8 grams of saturated fat (4.5 grams of which are from stearic acid and 3.5 grams of which are from another saturated fatty acid).
• 4.5 grams of monounsaturated fat.
• 0.4 grams of polyunsaturated fat (most of which is omega-6 fatty acids).

The Possible Health Benefits of Chocolate

More research needs to be done, but recent studies suggest four possible health benefits of dark chocolate and cocoa.

1. They May Reduce the Risk of Heart Attack.

A few squares of dark chocolate a day can reduce the risk of death from heart attack by almost 50% in some cases, says Diane Becker, MPH, ScD, a researcher with the John Hopkins University School of Medicine. Becker’s research found that blood platelets clotted more slowly in people who had eaten chocolate than in those who had not. This is significant because when platelets clump, a clot can form, and when the clot blocks a blood vessel, it can lead to a heart attack.

The Possible Health Benefits of Chocolate continued…

“The flavanols in cocoa beans have a biochemical effect of reducing platelet clumping, similar to but much less than aspirin,” Becker says in an email interview.

After reviewing 136 scientific publications on chocolate and its components and heart disease, researchers from Harvard University School of Public Health concluded that short-term studies suggest cocoa and chocolate may reduce the risk of cardiovascular disease by:

• Lowering blood pressure
• Decreasing LDL oxidation
• Anti-inflammation action

2. They May Decrease Blood Pressure and Increase Insulin Sensitivity

Researchers in Italy recently fed 15 healthy people either 3 ounces of dark chocolate or the same amount of white chocolate — which contains no flavanol phytochemicals — for 15 days. They found that insulin resistance (a risk factor for diabetes) was significantly lowered in those who ate the dark chocolate. Systolic blood pressure (the first number in a blood pressure reading), measured daily, was also lower in the group eating dark chocolate.

3. They May Improve Arterial Blood Flow

Healthy men who consume flavanol-rich cocoa may see improvements in the flow of blood through their arteries, according to recent research. The researchers found that when healthy men consumed the flavanol-rich cocoa, the ability of their blood vessels to relax improved significantly. And arterial blood flow is important for cardiovascular health.

4. They May Help People with Chronic Fatigue Syndrome

In a small study in England, 1 1/2 ounces of 85% cocoa dark chocolate was given to a group of adults with chronic fatigue syndrome every day for eight weeks. In the study, which has been submitted for publication, the participants reported feeling less fatigued after eating the chocolate. Surprisingly, no weight gain was reported in the chocolate-eating group, according to researcher Steve Atkin, PhD.

How might it work? The researchers believe that chocolate enhances the action of neurotransmitters, like serotonin, which help regulate mood and sleep. More research needs to be done to confirm a benefit in this area.

Not All Chocolate Is Created Equal

While the amount of the healthy antioxidant flavonoids varies from one type of chocolate to another, there’s one guideline you can take to the bank: The more nonfat cocoa solids in a chocolate product, the more antioxidants it likely contains.

So which type of chocolate has the most flavonoids? The highest levels are in natural cocoa powder (not Dutch cocoa, though, because it is alkalized cocoa). The type second highest in flavonoids is unsweetened baking chocolate. Dark chocolate and semisweet chocolate chips rank third, with milk chocolate and chocolate syrup at the bottom of the list.

Keep in mind, though, that flavanol levels in types of chocolate can vary based on:

• The cocoa beans selected.
• The processing of the beans and chocolate.
• Storage and handling conditions.

Perhaps in the near future, labels on chocolate products will list amounts of flavanols.

Which Type of Chocolate Has the Most Calories and Fat?

By far the lowest-calorie, lowest-fat form of chocolate is cocoa (the unsweetened type). A serving of 3 tablespoons has about:

• 60 calories
• 1.5 grams fat
• 0 grams saturated fat
• 3 grams fiber

The equivalent in unsweetened baking chocolate is 1 square (1 ounce), which contributes:

• 140 calories
• 14 grams fat
• 9 grams saturated fat
• 4 grams fiber

By comparison, a typical 2-ounce serving of semisweet or milk chocolate (with sweetener and other ingredients added) contains:

• 270 calories
• 17 grams of fat
• 10 grams of saturated fat

Semisweet chocolate adds around 3 grams of fiber per 2 ounces, while milk chocolate typically contributes zero. The mostly insoluble fiber in cocoa comes from the seed coat on the unprocessed cocoa bean.

All of this brings us to Health by Chocolate Rule of Thumb #3: For a better flavonoid-to-calorie ratio, choose cocoa powder whenever possible for baking and making hot chocolate.

Don’t Forget the Calories

One thing most chocolate bars have in common is calories. An ounce of sweetened chocolate will cost you about 150 calories — that’s about six to seven chocolate kisses. Here’s my take on it as a chocolate lover: Those six kisses are worth every calorie.

But here’s a word of caution: The health benefits of chocolate may disappear if you are adding the calories above and beyond your regular intake. This could mean you’re adding pounds along with the flavonoids.

Researchers from the University of California at Davis said it best in a scientific review on cocoa and chocolate flavonoids published in the Journal of the American Dietetic Association. They concluded that people may benefit from including a variety of flavonoid-rich foods as part of a healthful diet — and dark chocolate, in moderate amounts, can be part of this plan.

New and Improved Chocolate Products

Now that the word is out that chocolate may have health benefits, special chocolate products are hitting the shelves. Two examples are CocoaVia and Hershey’s Cacao Reserve.

1. CocoaVia (by Mars Inc.)

This product contains cocoa powder with a higher amount of flavanol than your average chocolate bar. The company has also added cholesterol-lowering soy sterol esters (similar to the type in Benecol and Take Control margarines). They have also added B-vitamins and calcium and two antioxidant vitamins, C and E.

Whether all this leads to much health benefits remains to be seen. I can tell you that the products I’ve tried taste worthy of your attention. If you are interested in trying CocoaVia, try to find them on sale because as the amount of nutrients and flavanols went up, so did the price.

There are several types of CocoaVia bars. The Original Chocolate Bars contain (per 22-gram serving):

• 100 calories
• 6 grams fat
• 3.5 grams saturated fat
• 9 grams sugars

2. Hershey’s Cacao Reserve

Want some of the benefits of dark chocolate but with the flavor of milk chocolate? Try the milk chocolate bars in the Cacao Reserve line by Hershey’s. I found them in my drugstore. I tried the Milk Chocolate with Hazelnuts with 35% Cacao. It was delicious, and a cross between a milk chocolate bar and a dark chocolate bar, I think.

Per 1 ounce (that’s a little more than 28 grams):

• 162 calories
• 11 grams fat
• 5 grams saturated fat
• 11.8 grams sugars

Chocolate Recipes

If you’re ready to cash in on the possible health benefits of chocolate (or at least the taste benefits), here are a couple of lighter dessert recipes to fulfill your chocolate cravings.

Chocolate Raspberry Pound Cake

WebMD Weight Loss Clinic members: Journal as 1 portion medium dessert

Dust this cake with powdered sugar and serve with fresh raspberries and a dollop of Light Cool Whip or whipping cream, if desired. If you don’t want to use Splenda, increase the sugar to 1 1/2 cups.

3/4 cup less-sugar raspberry preserves
1 cup whole-wheat flour
1 cup unbleached white flour
1 cup granulated sugar
1/2 cup Splenda
3/4 cup baking cocoa
1 1/2 teaspoons baking soda
1 teaspoon salt
1/2 cup less-fat margarine (with 8 grams of fat per tablespoon), preferably with plant sterols added
3 tablespoons raspberry-flavored liqueur (fat-free half-and-half can be substituted)
16 ounces fat-free sour cream
2 large eggs (use higher omega-3 type, if available)
1 1/2 teaspoons vanilla extract
Powdered sugar (for dusting)

• Preheat oven to 350 degrees. Coat an angel food pan (tube pan) with canola cooking spray and dust lightly with flour. Place the raspberry preserves in a small microwave-safe bowl and heat on HIGH for 15 seconds or until softened.
• Add whole-wheat and white flours, sugar, Splenda, cocoa, baking soda, and salt to large mixing bowl and beat on low to blend well. Stop mixer and add margarine, liqueur, sour cream, eggs, vanilla, and softened preserves all at once. Beat on medium speed for two minutes, scraping sides of mixing bowl after a minute.
• Pour batter into prepared pan and bake for 50-60 minutes, or until cake tester inserted in center comes out clean. Cool in pan 10 minutes, then remove cake from pan and place on serving plate to cool completely. When ready to serve, dust powdered sugar over the top. Serve with fresh raspberries and a dollop of whipped topping or whipping cream. if desired.

Yield: 16 servings

Per serving: 195 calories, 5 g protein, 36 g carbohydrate, 4 g fat, 1 g saturated fat, 3 g fiber, 311 mg sodium. Calories from fat: 18%.

Chocolate Truffle Bars

WebMD Weight Loss Clinic members: Journal as 1 portion of light dessert + 1 tablespoon nuts

If you would rather not use Splenda, simply delete it. These brownie-like bars have a wonderful texture, too.

2/3 cup less-fat margarine (with 8 grams of fat per tablespoon) like Take Control
1/3 cup fat-free half-and-half
7 ounces (7 squares) unsweetened baking chocolate, chopped
1 1/2 cups granulated sugar
1/2 cup Splenda
2 large eggs (use higher omega-3 type, if available)
1/2 cup egg substitute
1/2 cup whole-wheat flour
1/2 cup all-purpose white flour
1 1/2 teaspoon vanilla extract
1 cup walnut pieces

• Preheat oven to 350 degrees. Lightly coat a 9 x 13-inch pan (or two 9-inch square baking pans) with canola spray. Set aside.
• Add the margarine and fat-free half-and-half to a medium nonstick saucepan and melt the butter, stirring constantly, over medium-low heat. Once the margarine is melted, remove the pan from the heat.
• Add the chopped baking chocolate to the melted butter, stirring constantly with a wooden spoon until chocolate is completely melted. Add the sugar and Splenda and stir to blend well.
• Add the eggs, one at a time, stirring vigorously after each. Add egg substitute and stir to combine. Add the whole-wheat and white flours and stir to combine. Stir in the vanilla extract and walnuts.
• Pour batter into prepared baking pan(s) and bake for 23-25 minutes (20 minutes if using two pans). The brownies will still look somewhat soft and shiny. Remove from the oven and place on cooling rack.

Yield: 24 bars

Per serving: 130 calories, 3 g protein, 15 g carbohydrate, 7 g fat, 2 g saturated fat, 2.5 g monounsaturated fat, 2.5 g polyunsaturated fat, 13 mg cholesterol, 2 g fiber, 31 mg sodium. Calories from fat: 50%.

Treatments for Depression

The good news about depression is that you have a number of excellent treatments to choose from. More than 80% of people who get treatment for depression say that it helps them feel better.

Here’s a rundown of some of the most common approaches. Many people use a mix. For instance, you might try medicine and therapy at the same time. Some studies show that using both together is better than using either one alone.

Talk Therapy for Depression

Talking with a trained therapist is one of the best treatments for depression. Many studies show that it helps. Some people choose to be in therapy for several months to work on a few key issues. Other people prefer to stay in therapy for years, gradually working through larger problems. The choice is up to you. Here are some common types of therapy.

• Cognitive behavioral therapy helps you see how behaviors — and the way you think about things — play a role in your depression. Your therapist will help you change some of these unhealthy patterns.
• Interpersonal therapy focuses on your relationships with other people and how they affect you. Your therapist will also help you identify and change unhealthy behaviors.
• Problem solving therapy focuses on the specific problems you currently face, and on helping you find solutions to those problems.

Antidepressant Medicines

Medicines are the other key treatment for depression. There are now dozens of antidepressants that your health care provider can choose from. They include:

• SSRIs (selective serotonin reuptake inhibitors.) These common medicines include some well-known names, like Lexapro, Paxil, Prozac, and Zoloft. Side effects are generally mild. They include stomach upset, sexual problems, insomnia, dizziness, weight change, and headaches.
• Researchers have developed many types of antidepressants in recent years. These include drugs like Remeron, Wellbutrin, Cymbalta, and Effexor. Cymbalta and Effexor may also ease chronic pain in people with depression. Side effects are usually mild. They include stomach upset, sleep problems, sexual problems, dizziness, and weakness.
• Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) were some of the first medicines used to treat depression. While they work well, they can cause serious side effects and interact with some drugs and foods. Because newer medicines work just as well, these drugs aren’t used as often anymore. But if you can’t take newer medicines for some reason, your health care provider may suggest these.

ECT (Electroconvulsive Therapy) for Depression

This is a safe and effective treatment for people with depression that is resistant to medication. It’s typically used on people who haven’t been helped by medicines or therapy.

In ECT, your doctor will use electric charges to create a controlled seizure. These seizures seem to change the chemical balance of the brain. It may sound scary. But during the procedure, you’ll be unconscious, so you won’t feel anything.

ECT tends to work very quickly. It also works well — about 80%-90% of people who receive it show improvement. The most common side effect is temporary memory loss.

You might have up to 12 sessions over a few weeks. Some people get “maintenance” therapy with ECT to prevent depression from returning.

Vagus Nerve Stimulation (VNS) for Depression

Vagus Nerve Stimulation (VNS) is a new option for people with severe, treatment-resistant depression. Approved by the FDA in 2005, it’s used only on people who haven’t been helped by at least four antidepressants.

VNS involves implanting a small electrical generator in your chest, like a pacemaker. The device is attached with wires to the vagus nerve, which runs from the neck into the brain. Once implanted, the device sends electrical pulses to the vagus nerve every few seconds. The pulses are then delivered via the vagus nerve to the area of the brain thought to regulate mood. The electrical charges may change the balance of chemicals in your brain and relieve depression.

The device must be implanted by a surgeon, but patients can usually go home the same day.

Alternative Treatments for Depression

Some people use herbs, supplements, and other alternative therapies for depression. However, none of these approaches has been proven to work. Herbs and supplements — like St. John’s wort — can have side effects and cause interactions with other medicines. Never start taking an herb or supplement without talking to your doctor first.

Other alternative treatments — like acupuncture, hypnosis, and meditation — may help some people with their symptoms. Since they have few risks, you might want to try them, provided that your health care provider says it’s OK.

Sexual Problems in Women – Topic Overview

What are sexual problems?

A sexual problem means that sex is not satisfying or positive for you. In women, common sexual problems include feeling little or no interest in sex, having problems getting aroused, or having trouble with orgasm. For some women, pain during intercourse is a problem.

Most women have a sexual problem at one time or another. For some women, the problem is ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.

There is no “normal” level of sexual response, because it is different for every woman. You may also find that what is normal at one stage of your life changes at another stage or age. For example, it’s common for an exhausted mother of a baby to have little interest in sex. And it’s common for both women and men to have less intense sex drives as they age. This is linked in part to hormone changes in the body.

What are some causes of sexual problems in women?

Female sexuality is complex. At its core is a need for closeness and intimacy. Women also have physical needs. When there is a problem in either the emotional or physical part of your life, you can have sexual problems.

Some common causes include:

• Emotional causes, such as stress, relationship problems, depression or anxiety, a memory of sexual trauma, and unhappiness with your body.
• Physical causes, such as hormone problems, pain from an injury or other problem, and certain conditions such as diabetes or arthritis.
• Aging, which can cause changes in the vagina, such as dryness and stiffening.
• Certain medicines that can cause sexual problems. These include medicines for depression, blood pressure, and diabetes.

What are the symptoms?

Sexual problems can include:

• Having less desire for sex.
• Having trouble feeling aroused.
• Not being able to have an orgasm.
• Having pain during intercourse.

How are sexual problems in women diagnosed?

Women often recognize a sexual problem when they notice a change in desire or sexual satisfaction. When this happens, it helps to look at what is and isn’t working in the body and in life. For example:

• Are you ill, or do you take a medicine that can lower your sexual desire or response?
• Are you stressed or often very tired?
• Do you have a caring, respectful connection with a partner?
• Do you and your partner have the time and privacy to relax together?
• Do you have painful memories about sex or intimacy?

Your doctor can help you decide what to do. He or she will ask questions, do a physical exam, and talk to you about possible causes.

Some women find it hard to talk to their doctor about sexual problems at first. Sometimes it helps to write out what you want to say beforehand. For example, you could say something like “For the past few months, I haven’t enjoyed sex as much as I used to.” Or you could say “Ever since I started taking that medicine, I haven’t felt like having sex.”

How are they treated?

Treatment for sexual problems depends on what is causing the problem. There may be one or more issues causing the problems. Many sexual problems can be worked out after you know the cause or causes.

Sex involves emotional, physical, and relationship issues. Successful treatment requires a high level of comfort between you and your doctor. Ideally, you and your partner will also be able to talk openly about sexual concerns. Treatment may include treating health problems, getting communication counseling, and learning about things you can practice at home. For example, you might take a warm bath to relax, have plenty of foreplay before sex, or try different positions during sex.

Sexual Health: Sexual Problems in Men

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or psychological problem.

• Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the geriatric population, which may be related to a decline in health associated with aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation — This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation — This is when ejaculation is slow to occur.
• Retrograde ejaculation — This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.

What Is Erectile Dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (hardening of the arteries); nerve disorders; psychological factors, such as stress, depression, and performance anxiety (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie’s disease (scar tissue in the penis) also can cause erectile dysfunction.

What Is Inhibited Sexual Desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses, such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties.

How Are Male Sexual Problems Diagnosed?

The doctor likely will begin with a thorough history of symptoms. He or she may order other tests to rule out any medical problems that may be contributing to the dysfunction. The doctor may refer you to other doctors, including a urologist (a doctor specializing in the urinary tract and male reproductive system), an endocrinologist (a doctor specializing in glandular disorders), a neurologist (a doctor specializing in disorders of the nervous system), sex therapists and other counselors.

What Tests Are Used to Evaluate Sexual Problems?

Several tests can be used to evaluate the causes and extent of sexual problems. They include:

• Blood tests — These tests are done to evaluate hormone levels.
• Vascular assessment — This involves an evaluation of the blood flow to the penis. A blockage in a blood vessel supplying blood to the penis may be contributing to erectile dysfunction.
• Sensory testing — Particularly useful in evaluating the effects of diabetic neuropathy (nerve damage), sensory testing measures the strength of nerve impulses in a particular area of the body.
• Nocturnal penile tumescence and rigidity testing — This test is used to monitor erections that occur naturally during sleep. This test can help determine if a man’s erectile problems are due to physical or psychological causes.

How Is Male Sexual Dysfunction Treated?

Many cases of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Treatment strategies may include the following:

• Medical treatment — This involves treatment of any physical problem that may be contributing to a man’s sexual dysfunction.
• Medications — Medications, such as Cialis, Viagra or Levitra, may help improve sexual function in men by increasing blood flow to the penis.
• Hormones — Men with low levels of testosterone may benefit from hormone supplementation (testosterone replacement therapy).
• Psychological therapy — Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual function.
• Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction.
• Education and communication — Education about sex and sexual behaviors and responses may help a man overcome his anxieties about sexual performance. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.

Can Sexual Problems Be Cured?

The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

Can Sexual Problems Be Prevented?

While sexual problems cannot be prevented, dealing with the underlying causes of the dysfunction can help you better understand and cope with the problem when it occurs. There are some things you can do to help maintain good sexual function:

• Follow your doctor’s treatment plan for any medical/health conditions.
• Limit your alcohol intake.
• Quit smoking.
• Deal with any emotional or psychological issues such as stress, depression, and anxiety. Get treatment as needed.
• Increase communication with your partner.

When Should I Call My Doctor?

Many men experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the man and his partner, and have a negative impact on their relationship. If you consistently experience sexual function problems, see your doctor for evaluation and treatment.

Safe Sex – Topic Overview

Sexually transmitted diseases (STDs) are spread by sexual contact involving the genitals, mouth, or rectum, and can also be spread from a pregnant woman to her fetus before or during delivery. STDs, which affect both men and women, are a worldwide public health concern.

Although most STDs can be cured, some cannot, including HIV (which causes AIDS), genital herpes, and human papillomavirus (HPV), which can cause genital warts.

STDs can be spread by people who don’t know they are infected. Always use protection every time you have sex, including oral sex, until you are sure you and your partner are not infected with an STD.

If you are in a relationship, delay having sex until you are physically and emotionally prepared, have agreed to only have sex with each other, and have both been tested for STDs.

Abstinence as prevention

Completely avoiding sexual contact (abstinence), including intercourse or oral sex, is the only certain way to prevent an infection.

Discuss safe sex with your partner

Discuss STDs before you have sex with someone. Even though a sex partner doesn’t have symptoms of an STD, he or she may still be infected.

Questions to ask someone before having sex include:

• How many people have you had sex with?
• Have you had sex without a condom?
• Have you ever had unprotected oral sex?
• Have you had more than one sex partner at a time?
• Do you inject illegal drugs or have you had sex with someone who injects drugs?
• Have you ever had unprotected sex with a prostitute?
• Have you had a test for HIV? What were the results?
• Have you ever had an STD, including hepatitis B or hepatitis C? Was it treated and cured?

Safe sex practices

Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood. Genital herpes and the human papillomavirus (HPV) can be spread when symptoms are not present. Even if you and your partner have been tested, use condoms for all sex until you and your partner haven’t had sex with another person for 6 months. Then get tested again.

• Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner’s genital area, or pain while urinating.
• Don’t have more than one sex partner at a time. The safest sex is with one partner who has sex only with you. Every time you add a new sex partner, you are being exposed to all of the diseases that all of their partners may have. Your risk for an STD increases if you have several sex partners at the same time.
• Use a condom every time you have sex. A condom is the best way to protect yourself from STDs. Latex and polyurethane condoms do not let STD viruses pass through, so they offer good protection from STDs. Condoms made from sheep intestines do not protect against STDs.
• Use a water-based lubricant such as K-Y Jelly or Astroglide to help prevent tearing of the skin if there is a lack of lubrication during sexual intercourse. Small tears in the vagina during vaginal sex or in the rectum during anal sex allow STDs to get into your blood.
• Avoid douching if you are a woman, because it can change the normal balance of organisms in the vagina and increases the risk of getting an STD.
• Be responsible. Avoid sexual contact if you have symptoms of an infection or if you are being treated for an STD or HIV. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.