About Barak Gaster, MD

Primary Care Physician

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• Comment on Barak Gaster, MD's answer…

  0 0 Very reasonable to try Wellbutrin first. Chantix would be a very reasonable next try if Wellbutrin doesn't work. (But Chantix is much more expensive - but still less than cigs - and Chantix may be less good than Wellbutrin for someone who tends towards depression). If you do end up trying Chantix then re-read Alan Carr at the same time - because the way Chantix works (removing the pleasure from the nicotine) actually jibes perfectly with the Alan Carr approach. Barak Gaster, MD commented 9 months ago

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  Does Wellbutrin really help with quitting smoking?

  5 0 It's definitely worth a try, since good carefully done research shows that it improves people's chances of quitting. It's especially the best option for someone who is also suffering from low mood, since Wellbutrin has also been shown to be effective improving mood in people with depression. (Interestingly, it seems that what happens in the brain with acute nicotine withdrawl is somewhat similar to what we think happens in the brain in people with depression, which is why it can work for both things.) Specific tips to help Wellbutrin work: 1) Start it at least 3-4 weeks before your quit date. 2) Start at a low dose at first for a few days then increase the dose slowly 3) Avoid taking the last dose after 3pm to reduce chances that it could affect your sleep. 4) Use it together with the nicotine patch as they work well together. (Even if you didn't find the patch helpful before, it might just do the trick in combination with Wellbutrin since they work by different mechanisms). 5) Make sure you get the cheap generic version (bupropion) and not one of the more expensive brand names (Zyban or Wellbutrin) Good luck! Barak Gaster, MD answered in Drugs & Supplements 9 months ago Answer, comment & read 4 more answers »

• Follow Following 1 Advice about choosing someone to clean heating ducts? ... Barak Gaster, MD asked in Home Fix & Maintain 11 months ago 2 Answers by Tracy M , Vinnie…

• Follow Following 1 Do you have any out of the mainstream suggestions about hypersomnia? Elle Elle asked Barak Gaster, MD in Doctors & Providers 11 months ago

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  Why are head colds always worse at night?

  5 0 There are probably a few factors which could contribute: 1. Probably the most important is simply fatigue at the end of the day weakening your body's compensating mechanisms. During the day, these mechanisms were allowing you to keep yourself together and overcome the illness and function through it, but at night as you get tired, these "hold up the fort" mechanisms start to falter, allowing the symptoms of the illness to come to the fore and seem to worsen. 2. Another possible factor is that starting to feel better leads you to push yourself too early, to exert yourself more, especially into settings that are more demanding, stressful, noisy, or cold or smoke/alcohol laced, leading to an over-doing-it-too-soon set back. 3. An important factor for the common situation in which things get worse *at home* at night (rather than while bowling) is that the night-time is typically a time when all kinds of symptoms of all kinds of health conditions seem to get worse. This phenomenon has a lot to do with the general distractions of the day falling away, leaving us more attention capacity to be aware of our bodily symptoms. 4. Another *at home* issue can come into play when coughs worsen at night - an effect that can sometimes be due to lying flat while in bed making it harder to keep airways clear. Barak Gaster, MD answered in Aches, Pains & Illness about 1 year ago Answer, comment & read 3 more answers »

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  What Can I Do To Live?

  1 0 If you're in the Seattle area your best bet is to go to the King County online listing of community health centers: http://tinyurl.com/4ruu95n Hope you're able to find some help. Barak Gaster, MD answered in Get Fit! about 1 year ago Answer, comment & read 3 more answers »

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  How Effective is Hypnotherapy for Smoking Cessation?

  0 0 Hard to say how well it really works. The little bit of research on the topic has been mixed - some showing it might work other suggesting it's not any better than just meeting with a general counselor. There are so many things to try to quit, and it's hard to predict what will work for who. Best to start with what feels like it might be a right fit for you and go from there. Using bupropion (Zyban/Wellbutrin) or Chantix or nicotine replacement (especially the patch) have the best scientific evidence behind them, so I would say that they are probably better places to spend your money if you're not sure what to do next. If you do think you'd like to try hypnosis for smoking cessation, here are the names and numbers of three local people in Seattle who have been recommended to me: Tom Wall 206-325-5700 Ron Slosky 206-525-5700 Joseph Barber 206-328-2919 Barak Gaster, MD answered in Get Fit! about 1 year ago Answer, comment & read 4 more answers »

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  Should I see a nutritionist?

  6 0 Mainly: you are absolutely right that if your blood pressure and blood sugar are really good at the weight you're at - and you're exercising so replacing fat mass with muscle mass and so you're weight is about the same - then you are going to be healthier and feel better about yourself and be happier. So it's fine to not sweat the diet issue at this point. But if you do get to a point where you also want to gently start approaching food in a healthier way - try some low level common sense approaches like this: 1) Think hard about stupid calories in your life that you do out of habit or distraction and cut them out. Most common offenders: soda pop, fruit juice, having bread with dinner, the cookies and candy that someone leaves out at work. Never fall for those traps. Wasted calories. 2) Rather than changing what you eat, try changing how much. Try starting with smaller portions on your plate. Make yourself do it and feel good about it. Then eat way more slowly than you're used to. Think about each bite and enjoy it. Never eat while watching TV - even reading is dangerous - distractions like that while eating will lead you to eat more than you need and you won't have enjoyed it. Right after you finish you'll feel briefly hungry still - but then WAIT 20 minutes after you're done before letting yourself go for a second helping - that's how long it takes your brain to realize that it's not hungry anymore. And only take more if you really truly still feel hungry. 3) Eating out: ask for a to-go box as soon as they bring the food and set half of it aside for tomorrow's delicious lunch. Serving sizes in restaurants are insane - typically way way more food than people need to enjoy a meal and not feel hungry anymore. So set aside half the meal at the start then proceed with #2 above. Good luck! Barak Gaster, MD answered in Get Fit! about 1 year ago Answer, comment & read 7 more answers »

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  How does Chantix work? Does it work?

  5 0 There are two main prescription drugs out there that have been shown to help people quit: bupropion (now available as a generic drug, previously known by the brand names Zyban and Wellbutin) and Chantix (not available as a generic). A small amount of research does suggest that Chantix might have a somewhat higher chance of working than bupropion, but it's also a lot more expensive (but then, so are cigs). Chantix is a "designer drug" in that scientists very carefully came up with its molecular structure to block the nicotine receptors in the brain to take the "high" out of smoking. So if you're really dedicated and motivated then it can absolutely help - especially if you use it together with another strategy such as the Alan Carr book and/or quitting together with a friend or starting an exercise program at the same time. The main side effect of Chantix is that it can cause some brief nausea in some people for a short bit after you take each dose. There are a few other mild side effects that can happen too - but a lot of those "side effects" might just be the effects of going through nicotine withdrawl - so it can be hard to say. So bottom line: Chantix is a drug that absolutely can help and that's worth considering. Although it's expensive, it's safe. And you'll save buttloads of money on cigarettes and feel great about yourself for kicking. Barak Gaster, MD answered in Get Fit! about 1 year ago Answer, comment & read 7 more answers »

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  Homeopathy and evidence-based medicine?

  5 0 @Arsenic: The studies I cite above are meta-analyses each reviewing several trials - all of which were peer-reviewed - which did, on repeat, yield positive results some of the time. But don't get me wrong: there are lots and lots of negative homeopathy trials out there. The best critique against citing three positive papers as I did above is that I'd rightly be accused of "cherry picking" some positives from among many other negative trials. But my main point is that the research on homeopathy is not all negative. Some of it is positive. Which is very hard to believe from everything we know about the laws of chemistry and why I personally believe that those positive trials are very probably wrong. But there are enough positive ones to allow me to keep a somewhat open mind that although the odds that homeopathy works better than placebo may be small the odds are not zero. Plus there are the other reasons I mentioned in my post above. For me personally I sure would like to always be recommending something to my patients that I was very confident was better than placebo. But that's not always possible. And like you say, people's personal openness to the uncertainty of efficacy and their reliance on their personal experience and their observed experience of others is a form of values and faith. Approaching a choice of therapy in this way is certainly much less compelling than being guided by a large body of solid repeatable scientific evidence. But there are enough people out there approaching their health in a less scientific way (which is generally safe and most of the time not too expensive) that it's important to me to encourage others to keep an open-mind - not necessarily an open mind about trying something themselves but keeping an open mind in terms of judging others who try such therapies. Barak Gaster, MD answered in Alt Medicine about 1 year ago Answer, comment & read 4 more answers »

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