MD Musings: What my patient taught me when she went vegan

Every day, I learn something new from my patients. Every day, they surprise and inspire me. I’ve decided to highlight some of their stories (with their permission of course! No HIPAA violations over here, sir!)

Before I enter the exam room, I always review the patient’s vital signs (blood pressure, heart rate, weight) and compare them to the vitals from the last few visits. So, the other day when I noticed the 15 lb weight loss in 6 weeks by my obese middle-aged patient, I skipped into the room and immediately asked “how did you do it?”. We’d been working on her weight loss for months without significant results. She smiled smugly, her eyes twinkling with satisfaction.

” I went on a vegan diet” . 

“Really? Are you finding it easy to maintain?” 

“Yup! Much easier than I thought once I put my mind to it!”

This is a patient who grew up in a culture where a meal wasn’t a meal unless it included a meat protein, and cheese=life. But she substituted these things with vegan-friendly products like tofu, and didn’t feel like she was missing out. And best of all, she noticed positive changes to her energy level, sleep quality and just overall felt better. All from changing the way she eats!

So here are some important reflections from this patient encounter that I’d like to share:

  • The most important part of embarking on healthy eating lifestyle is deciding you want to do it, and then taking action to achieve your goal
  • Healthy eating does not necessarily have to feel restrictive, or like you’re missing out on stuff you love.
  • You can find healthier substitutions for the things you enjoy , rather than eliminating it altogether 
  • Once you start reaping the benefits of a healthier diet, it will help fuel the desire to maintain it.

And now this lady has inspired me to challenge myself and institute “Vegan Days” into my diet. I’m not sure if I can personally maintain a pure vegan diet (because, bacon…sigh) but I do believe that even small changes matter , and that ultimately a plant-based diet has irrefutable benefits.

Do you want to join me on my “vegan days” journey? I’ll post any tasty recipes or foods that I discover and let you know how it makes me feel!

 

MD Musings: Why are we always looking for a Magic Pill?

If I had to list the top 2 ailments where people come in to my office asking me to prescribe “something”, it would be “something” for WEIGHT loss and ENERGY.  Of course, I’ve also been asked for “something” to help fix a range of ailments like insomnia/bloating/ hot flashes/body aches/you get the idea.

Every time I get these requests, it strikes me as very strange, and an insight into the nature of our culture. How have we gotten to the point where we think the solution to our physical ailment must always be some external treatment, some prescription med or supplement?

Why is it so surprising to people when they hear;  what you actually NEED is not a Magic Pill, but to be mindful and purposeful about what food you’re putting in your body. You NEED to get up and get your heart pumping and your joints moving. You need to take care of yourself; body, mind and spirit.

I like to remind people that when we are not feeling well, this is usually a sign that something is awry in our bodies. And a Magic Pill may sometimes help improve certain things, but some changes have to come from US. When I draw labs on a patient and I see high cholesterol, elevated sugars, reduced kidney function…I can certainly whip our the prescription pad for a statin, a diabetic pill, an ACE inhibitor (which are all evidence-based medications), but the conversation should never stop there. At the same time I have to take a step back and say “but WHY are these things all out of whack?”

The answer usually has something to do with that patient’s  weakness for white bread, pepsis, 11 pm binge eating when they’re stressed out. It usually has something to do with poor sleep, lack of exercise, sometimes depression. There is ALWAYS something about a person’s lifestyle that can be modified to help fix some of their health problems. And I love being able to help empower people to take control of their own bodies and health through education.

So why are you on 15 different drugs, instead of a weight loss regimen? Part of the reason is because as doctors, we are extremely well-versed in the use of prescription medications . We’re comfortable prescribing medications because we know the mechanism of action (mostly), we understand the pharmacokinetics, side effects etc. We learned a lot of cool things in med school about medications. What most of us DIDN’T learn a whole lot about is diet, nutrition, exercise. We know these “lifestyle modifications” matter, but we’re not so great in teaching our patients how exactly to modify their lifestyle.

And of course, when your blood pressure is 180/110 we’re worried about you having a heart attack or stroke, so we feel good about throwing you on blood pressure meds. They work, and we get measurable results . So you’re happy, I’m happy…until you end up on 10 medications to treat various problems, then one of those medications are making you dizzy, so I need to add another medication to counteract that…but then THAT new medication is making your mouth super dry….you get the idea.

So, what’s the purpose of this post? I think it’s just me throwing out my thoughts. It’s the beginning of a conversation we need to have as a society, as a culture. A conversation I have with my patients every day. Sometimes the answer is so simple. Sometimes the answer is helping that person lose 10% of their body weight, and voila! Lower sugars, better blood pressure and cholesterol, and less knee and back pain!! But no….there also isn’t a Magic Pill for that 10% of weight loss. Like I tell everyone, if there was a magic pill that works so well, everyone would be on it and we’d all be walking around looking like Naomi Campbell. And even Naomi has to work out, you guys.

 

 

 

 

 

How to prepare for your doctor’s appointment

So this post is part of a series of tidbits that are not directly medical, but still related to patient care that I think are helpful. If you like this type of topic and have other questions, email me!

As someone who has been a patient myself, I understand all too well the frustration of going to the doctor’s office: possibly long wait times, feeling rushed during the visit, leaving the room with a sense that you forgot to tell the doctor something super important. And as a physician I totally empathize with all this. Let me tell you a secret: every doctor would love to spend an hour sitting and chatting with their patient so we can really get to the bottom of things. But the reality is, we simply don’t have enough time in the day. Too many patients who need our help, too few doctors (especially in primary care) to take care of everyone.

So, I’d like to give some advice that I give all my patients on how to maximize your visit with your doctor. Ready? Here goes

  1. Come on time to your appointment : Unfortunately, this has to be said. If your appointment time is 8:00 am and your doctor sees patients every 20 mins, and you arrive at 8:10 am …half your appointment time is already up! And the patient who came in at 8:20 am is here on time. Most people understand this, but unfortunately we sometimes get the chronically late patients who still expect to be seen (and expect a 20 min visit when they do!). Don’t be that guy, please
  2. Bring a list of your concerns:  I can personally attest having left my GYN office more than a couple times , and an hour later recalling something I totally forgot to mention. I love to see when patients break out the notepad, where they diligently listed all their issues so that they didn’t forget to mention at the appointment. So organized, Mrs Smith!
  3. Figure out which concern is the most important to you: If you have a list of 2 or 3 (or 10) concerns, please be realistic and understand that your doctor cannot fully address everything on that list in the space of 15-2o mins. So bring up your biggest concern first. Better yet, give a brief summary of all your concerns and you and your doctor can decide which 1 or 2 is the most important to discuss on that visit, and which ones may have to wait until next visit.
  4. Bring your pill bottles: This one is relevant especially for my elderly patients who are on multiple medications. This way, I’ve discovered that patients aren’t taking their meds correctly/ran out/ are taking old meds that have been discontinued. Your doctor should be reviewing meds with you on every visit
  5. Take notes: This one is a biggie ! Studies show that people retain less than 50% of what is discussed during a doctors appointment. Especially if there is a discussion about complicated health issues or your doctor gave instructions/ advice,  it’s crucial to make sure you understood your doctor clearly, and write things down so you can refer to your notes later.
  6. Ask for clarification: Unfortunately, sometimes we doctors forget to speak in layman’s terms, and a medical jargon may slip out from time to time. If we’re talking about aortic atherosclerosis and you’re thinking “umm, what?”, don’t be afraid to speak up! It’s our job to communicate things clearly 🙂

How do YOU prepare for your doctor’s visit?

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A DOCTOR’S DETOX DIET TIPS

Every now and again, patients come to my office declaring that they plan to start a “detox”, and proffer a bottle of some new product they found at a health food store, so I can review the ingredients and reassure them that it’s safe. The product usually involves some claim of being a “detox”, “improving digestion”, “weight loss” etc.

When people talk about starting a “detox” they are usually referring to a fairly restrictive diet , with ingredients that claim to eliminate toxins or cleanse the body. I can’t lie; some times I get to a place where I feel bloated and sluggish after a carb binge (WHY don’t our bodies ever go on, like, vegetable binges??) and I feel like I need to do something to reset my body, so I definitely understand the desire.

However, in general I am very reluctant to endorse any product that endorses detoxifying properties, especially in patients that already have health issues or take medications. I’m also uncomfortable with the concept on relying on a Magic Pill to clean out your system, since many of the ingredients are just glorified laxatives. And p.s, our bodies already have mechanisms to naturally detoxify itself. We just have to optimize what we ingest to allow our body to do its job!

So, my usual response is ” honestly I can’t say for sure this product is safe”, and then lead the conversation to safer ways to reduce toxins, cleanse and reset our bodies. Here’s what I suggest for a safe “detox”!

  1. Water water water: I feel like this goes without saying that water helps flush and optimize our bodies better than anything else. If you feel the need to detox, then up your water intake. Personally, I feel best when I start the day with a tall glass of warm lemon water. Not sure why it works but I definitely feel better afterward. For people like me who “forget” to drink water throughout the day, a good trick is to make sure to drink a full glass before every meal and snack, first thing in the morning and right before bed…at the very least. Aim for 8-10 glasses a day.
  2. Eliminate refined carbs : This will help reduce the fluctuating blood sugar levels that contribute to feeling sluggish, and reduce inflammation which can wreak havoc on our finely tuned system.
  3. Cut out the Sweet N Lo: Don’t be fooled that because you substituted sugar for artificial sweeteners, that you’re doing something healthier for your body. Sucralose, aspartame and other artificial sweeteners are hard to digest, can disrupt our gut microbiome (more on this below),  screw our metabolism and lead to weight gain, and there’s still the pesky suspicion of possibly causing cancer (the official FDA guidelines say they are safe in small  quantities, for what it’s worth). At the very least, cut down during your detox period, and then try to limit everyday use as much as possible.
  4. Increase fiber intake: The typical western diet is woefully low on fiber,  which helps regulate digestion. Increase your oatmeal, flax seed, fruit, vegetable and bean intake for natural sources of fiber, or try over the counter options like Metamucil.  Note: abruptly increasing fiber intake can cause bloating so do this gradually.
  5. Put down the wine glass: As great as your prosecco makes you feel in the moment, facts are facts: alcohol is toxic to the body, and since it metabolized mainly by the liver,  which is one of the body’s largest detox organs, it’s counterproductive to drink alcohol during this period. After the detox period is over, remember to stay below the recommended alcohol intake (click here)
  6. Consider a probiotic: The topic of probiotics is an emerging one in the world of medicine, as well as the concept of the gut microbiome.  New data is constantly being published endorsing the benefits of a healthy diverse population of bacteria in the gut. I’m sure I’ll be writing MUCH more about this in future posts, but for now check out THIS LINK. So if your digestion is off, consider taking a probiotic supplement, or eating foods like kombucha, kefir and yogurt which have live bacterial strains (before doing this definitely speak with your doctor, since probiotics may not be safe if you are immunosuppressed).
  7. Exercise: Optimize the blood flow to your organs, and sweat it out!

Following these simple steps for 3-7 days can do wonders to help give our bodies a healthy kick-start, and of course continuing these healthy practices daily will help to maintain us so that no more “detoxes” are needed ;).

Have you tried these tips, how did it make you feel?

 

Cutting through the Fat: Weight Loss/ Healthy Eating (Part 2)

So you’ve read Part 1 of our weight loss clinic series, and now you know so much more about calories; how many are in foods you eat, how many LESS you need to ingest to lose weight. Great! But now you need to come up with an actual game plan to enhance healthy eating.

Like I said before, I’m definitely not here to endorse a particular fad diet. But the end of the day, all diets have something in common: tips on what to eat LESS of, and MORE of. Many diet plans can be super-restrictive (for example, although I know people who’ve been successful on a Paleo diet, I’m very wary of a plan that endorses a lot of red meat, and eliminates healthy foods like legumes). For people that don’t want to be on a DIET, but want to know how to to eat HEALTHY (which should naturally help cut calories), these are 4 things you can do.

EAT MORE WHOLE FOODS: That is, non-processed 1 ingredient foods you can look at and tell what it is. Example: an Apple is a whole food. An apple pie is not. Old-fashioned rolled oats is a whole food, Quaker Oats Fruit and Cream oatmeal packets are not. Following this rule will naturally lead to eating more fruits and vegetables, and maybe then you’ll get your recommended 5 servings a day. Honestly, if you just follow this one rule, and eliminate processed foods from your diet, you’ve already won half the battle.

EAT LESS RED MEAT/ PROCESSED MEAT: As a lover of beef and bacon this pains me to say. But the more I read the data that processed meats are known carcinogens, and red meat probable carcinogens. , the more resolve I feel about cutting back. Note how I said “eat less” and not “stop eating”. Just because I know cutting out altogether is hard, since these types of meat are staples in many cultures. I don’t know if there is a safe minimum amount of meat, but I would personally aim for once or twice a month at most.  My personal goal is to totally eliminate red meat from my diet in 2018. Let’s see how it goes…

STOP DRINKING YOUR CALORIES: Seriously, the amount of hidden sugar in juices and sodas is incredible. And thanks to smart marketing, many people think that a glass of Snapple Ice tea is healthy compared to a Pepsi. What if I told you that Ice tea has as much sugar as a pack of Milk Chocolate M&Ms? If you’re serious about losing weight, juices and sodas have to go. Yes, even no-sugar added orange juice. Just eat the orange instead, and get the added benefit of fiber!

CUT DOWN ON REFINED CARBOHYDRATES AND SUGARS: Very few diet plans don’t include this recommendation, and there’s a simple reason. Refined carbs and sugars are the devil. I generally don’t like to vilify an entire group of foods, but the vast majority of unhealthy foods contain loads of sugar and refined carbs (i.e.processed so the whole grain is no longer intact). I’m talking white rice, white bread, white flour. When you remove the whole grain, you remove the beneficial fiber and other nutrients, so it’s basically empty calories with a high glycemic index. Hello, high blood sugar!! Hello, inflammation! (remember my article about this?) Hello, metabolic syndrome!

At the end of the day, we can argue all day long about what it means to have the healthiest diet. Certainly, I haven’t weighed in on the healthiness of poultry, seafood, eggs, dairy, healthy vs unhealthy fats etc. These are all worth digging into later on for sure, but I truly believe that following those 4 tips alone is sufficient for losing weight, cutting down your risk of chronic medical diseases like diabetes, hypertension, hyperlipemia and a host of other benefits.

What do you think of the weight loss clinic so far? Any other topics you’d like to read about? Let me know, and tune in for part 3 (Reviewing your Food Diary, common Pitfalls!). Oh and don’t forget to subscribe at the bottom of the page 🙂 

[small disclaimer: this post is about eating healthily, and includes weight loss tips for those that need to get to a healthy weight. Always talk to your doctor before starting a new diet, especially if you have medical conditions or take medications] 

Cutting through the fat: Weight loss/ Healthy Eating (Part 1)

So I just stepped on the scale this morning, and didn’t like what I saw. Blame it on the holidays + my recent New Year’s vacation (darn you, daily brunch pomegranate mimosas!). Although I’m at a relatively healthy BMI (calculate yours HERE ), whenever I go above the weight that’s normal for me, it’s an indicator that I overdid it in the unhealthy eating department. So now I’m motivated to tune up my body and eat more healthily, as I’m sure many of us are. I bet there’s not one empty treadmill at the local gym right now! But as for going on “a diet”, it’s hard to know where to start.

Sooo many diets out there! (Intermittent fasting, CICO, HFLC, Atkins, Paleo, etc etc etc)…then of course there’s the miracle diet pill made from a leaf found on a tree that only grows in the Amazon), you get the idea! But look, I’m all about simplicity. Like I tell my patients, weight loss is simple, but hard.

SIMPLE because the concept is: take in less calories, your body will burn excess fat to give itself energy. Eat too many calories, you body stores the extra energy in the form of fat.

HARD because although this concept makes sense, we find it hard to lose weight for a myriad of reasons. Key issues I’ve identified from the people I treat are:

-Lack of awareness of calorie intake: humans are notorious for underestimating how many calories are in certain foods. Guess the number of calories in a McDonald’s Kale salad? It’s 730…. that’s about 3 packs of peanut M&Ms. See my point?
-etting fooled by marketing of “healthy foods”
-Over-reliance on exercise as a weight loss tool: How many times have I heard “I’m exercising 30 mins a day now and I’m not losing weight!!” Then I ask “have you changed what you’re eating? [crickets] As awesome as exercise is, it takes time to burn off that McDonald’s kale salad. In very general terms, probably about 2 hours doing most types of activities. Click HERE to see how many calories you would burn during various exercises

That being said, on my first visit with patients when discussing weight loss, I don’t dive right into weight loss tips. The first, most important part, is the Informational Gathering phase:

MAKE A REALISTIC GOAL: Losing 50 lbs in 3 months? Possible, but not likely without making drastic and likely unhealthy diet choices. I always emphasize; I don’t believe in dieting.  If there was an effective diet out there, everybody would be on it and we’d all look like Naomi Campbell or Jason Statham. I believe in lifestyle modifications that are sustainable. So realistically 1-2 lb a week is a safe goal.

KNOW YOUR DAILY CALORIE INTAKE LIMIT TO REACH YOUR GOAL: I love using this Calculator: input your data so you can calculate your personalized calorie goal.

START READING LABELS: Again, knowledge is power!! For any food you eat that has a label, you should know how many calories is in a serving, how many servings you’re eating, and I specifically like to see the amount of carbohydrates and fat in there. This practice starts building awareness.

KNOW YOUR FOOD’S CALORIC CONTENT: This one is tricky: I don’t like to overwhelm people with the concept of calorie counting because that can become obsessive, but I do think it’s important to ballpark that a banana is about 100 calories, 1 cup of white rice is about 200 calories etc. Because how else can we cut our caloric intake by 300 calories daily (the average amount it takes to lose a pound a week).  If  you’re into apps, I use MyNetDiary because you can type in your food item and see how many calories are in there, and then also use the app to….

START A FOOD DIARY: The goal of this is to increase awareness of exactly what’s going down your piehole (why does that word amuse me so much hehe). And somehow, it tends to make one more accountable; if you know you have to document that slice of cheesecake, maybe you think twice before indulging. It’s like psychological self-manipulation! Then, I like to review the food diary with patients on a regular basis and help identify patterns of poor choices, so we can make changes.

WEIGH YOURSELF FREQUENTLY: You wouldn’t believe how afraid people are of the scale. Many patients visit me monthly for their weight loss visits, and only get their weight checked at the clinic. Personally, I hop on the scale every morning at the same time (before breakfast), so I can see where I’m at and where I’m going; and if the scale is going in the wrong direction I’m more motivated to reign it in. However, if the thought of daily weigh ins are giving you palpitations,  I would then recommend at least once a week. Knowledge is power!

Once we’ve mastered Part 1, then we’re ready for Part 2, where we actually use the information to make a weight loss plan. Stay tuned!

 

[small disclaimer: this post is about eating healthily, and includes weight loss tips for those that need to get to a healthy weight. Always talk to your doctor before starting a new diet, especially if you have medical conditions or take medications] 

Kicking off the New Year Healthfully

There’s nothing like a New Year to encourage us to reflect on the successes and shortcomings of the year behind us. Personally, my reflections usually start sometime after the fourth trip to the work break room, which is permanently stocked with the delicious crap I counsel my patients to avoid. I like asking my patients what their New Year’s resolutions are, just to see where their head is at. Typical responses are to : exercise more, stop smoking, get down to their ideal weight. Sometimes it’s as profoundly simple as ” I just want to feel better” .

People also like asking doctors for tips on high-yield things they can do to be healthier, feel better and live longer. Read on for some evidence-based tips for a healthy 2018!

 

1. REDUCE INFLAMMATION IN YOUR BODY:

We are learning more and more that inflammation is being implicated in almost every major chronic disease. From the plaque that builds up in our arteries and cause cardiovascular disease, to chronic pain, to various cancers. This a major topic that surely deserves its own post, but for now check out these evidence-based links:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492709/

https://www.sciencedaily.com/releases/2015/08/150807092555.htm

So how do you reduce inflammation? Eat more anti-inflammatory foods, exercise, and rest.  

2.  TASTE THE RAINBOW

Make your plate more colorful… and I’m not talking about red velvet cupcakes! A simple way of ensuring you’re eating healthier is to enjoy a diverse range of colors in every meal. Green zucchinis, red apples, yellow squash, orange carrots…the color in fruits and veggies come from the awesome nutrients they provide. Nutrient deficiencies are rampant in the typical Western diet and can cause a range of ailments like fatigue, weakness, muscle cramps and memory problems. So if you want to feel more energetic in 2018, make your meals more nutritious!

3. GET OFF YOUR GLUTEUS MAXIMUS

We all know exercise is beneficial. Our bodies aren’t meant to sit at a desk or behind the wheel of a car all day long. When we do, we tend to feel more sluggish, tired and sad than if we are physically active. Exercise has a host of benefits including boosting mood, optimizing your cardiovascular health, increasing agility and balance, and can even stave off dementia. And remember, you don’t have to be at the gym. If you’re like me (I get incredibly bored running on a treadmill), then choose activities that don’t feel like exercise, like dancing, sports, swimming…anything that makes you move!

4. SHAKE IT OFF (the stress, that is)

Never in my life  would I imagine that someday  I’d quote Taylor Swift, but she’s got a point.  Our minds and bodies are connected, and psychological distress can manifest in our bodies. How many times have you developed a headache, stomach pains, or come down with a cold after a super stressful period? Its not in your mind; stress hormones like cortisol can wreak havoc on our bodies, and immune system. So if there is something in your life that is affecting your mental wellbeing, prioritize eliminating that stressor from your life in 2018. Your mind, and body will thank you for it. (More on this topic in a future post)

5. GO TO BED !!

Did you know that there is a 21% increase in heart attacks in the days following daylights savings time in spring when we lose an hour of sleep, and a 21% decrease in heart attacks when the clock falls back so we gain an hour? Chronic sleep deprivation is tied to cardiovascular disease, dementia, weight gain and every day we’re learning more.  So instead of pounding shots of espresso to stay awake, prioritize getting your Zzzz’s. Click here to see how many hours the National Sleep Foundation recommends. And importantly, try to maintain a consistent sleep-wake schedule even on weekends, so as not to disrupt your circadian rhythm.

Following these 5 simple tips will undoubtedly help your mind and body feel more awesome in 2018. How many of these practices are you currently following, and what are YOUR resolutions for 2018? Let me know!