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!

 

Sinus congestion

If I were to charge friends and family for all the medical advice I give, I’d be able to shop at Sephora a lot more often (which, in retrospect, probably is not a good thing). My last medical question went something like this “so this sinus infection has my face and teeth hurting for a week. What do I do? ”

When our nasal passages and sinuses get congested, all of a sudden you have a greater appreciation for your sense of smell, don’t you?  And now you’re a mouth breather, you have a headache, your nasal passages are taking turns being blocked…UGH.

Usually around this time of year, congestion can be caused by a number of things:
1. An upper respiratory infection (90% of the time viral, not bacterial btw)
2. Irritation from dry, cold air
3. Seasonal allergies

Figuring out the underlying cause of congestion is important to be able to target underlying problem, but in general the regimen for clearing up your sinuses is the same:

1. Saline irrigation (either from OTC spray, or an irritation system like a neti-pot). P.S only use purified or distilled water!
2. Oral or topical (spray)  decongestant – some of these may not be safe for those with cardiac issues so ask your doc.
3. Humidifier – if dry air is exacerbating symptoms

A Word on Antibiotics

Often when patients come to the office complaining of congestion, the conversation inevitably leads to the “do I need an antibiotic for this?”.  And the answer 90% of the time is “you definitely do not”. As I mentioned before, congestion can be caused by things other than infection, and  only 10% of actual sinus infections are bacterial. However, there IS a time and place for antibiotics in some cases.  Based on the guidelines; I may break out the prescription pad if someone has:
– Fever
-Facial pain
-Symptoms ongoing > 2 weeks despite conservative treatment, or initially improved then suddenly worsened again (which can suggest a superimposed bacterial infection).

So for example, for my friend I mentioned in the beginning, since she was experiencing a lot of facial pain ,she might be an appropriate candidate for an antibiotic, in addition to the other methods for decongestion.

When your “cold” is actually allergies

Around this time last year, mommy dearest started getting frequent colds. She would feel like she was coming down with something; malaise, cough congestion, sneezing. She was treated a few times by her PCP for an “upper respiratory infection”, and when she described her symptoms to me, I agreed with the diagnosis. However, after feeling better for a few days,  poor mom would come down with yet another “cold”.

Then her PCP then decided to try another approach, and prescribed my mother an antihistamine… and ta-da! All cured. I’m surprised it took so long to figure out she might have been suffering from allergies. Probably because she’d never had seasonal allergies before, and so many of the symptoms overlap.

So how do you know if it’s allergies or a cold? Actually, I was going to write a whole article on this, but my friend who is also a blogger and ALLERGIST, already wrote a great article about this (click HERE). Thanks, Dr Gupta!

But to give a one-liner: if your symptoms seem worse depending on the environment, if you are experiencing itchy or runny eyes, and seems to occur around the same time every year…it may be allergies! Be cautious about self-diagnosing and treating with OTC allergy meds, especially if you are elderly. Talk to your doctor about what treatment is right for you!

In the next post we’ll overview how to treat sinus congestion/ congestion…stay tuned 🙂

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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Making sense of the cold and flu aisle

So you’re coughing. You have a low grade fever, pounding headache, stuffiness, sore throat. Basically…..you’re feeling crappy. So you drag yourself to the pharmacy (or better yet, somebody awesome who loves you volunteers) to get something to make you feel better.

My last post mentioned the types of ingredients that may be helpful in shortening the duration of cold/ flu symptoms. In this post, I help make sense of the products that are available over-the-counter (OTC) to help treat the symptoms. Again, it’s worth mentioning that these medications just help you to feel better while your body fights off the enemy virus that has invaded your system, but are not technically cures. 

Firstly, keep in mind that the best treatments always include REST and HYDRATION. It takes a lot of energy for your body’s immune system to mount its defenses so take it easy, seriously. And drink lots of fluids to replace what you will lose while sweating and eating less (cuz who feels like eating when they’re sick).

Next, the trick is to get products that treat the symptoms you have. Some cold/flu treatments target congestion, some target pain, cough etc. If you have all of the above, then a combination treatment (that has multiple ingredients) may be right for you. But if all you have is a cough, then you don’t need to take medication with a pain reliever. Check the label for the ingredient list. Here are the common ingredients for each symptom, and read all the way to the bottom to see which meds may NOT be safe for you!

  • Fever/ pain (body aches, sore throat, headache):
    • acetaminophen
    • non-steroidal anti-inflammatory drugs (NSAIDS): lots of different kinds, like Ibuprofen (Motrin), naproxen (Aleve)
  • Cough:
    • dextromethorphan
    • guaifenesin (for a productive cough, helps loosen and bring up phlegm)
    • honey
  • Congestion/ runny nose
    • guaifenesin
    • pseudoephedrine
    • phenylephrine
    • diphenhydramine
    • oxymetazoline (usually in nasal spray form)
    • **also, these may help treat cough if  the cause of your cough is post-nasal drip **

Now, as I always mention, always check with your health care provider before using any new meds. It may sound silly because they are available OTC, but even OTC meds may not be safe in certain circumstances (depending on what medical conditions you have, what medications you’re already taking that may interact etc).  For example, NSAIDS are potentially dangerous in people with kidney disease, cardiovascular disease, who are taking blood thinners or have a history of bleeding. Similarly, many of the decongestants listed can potentially affect the heart in high-risk patients. It never hurts to ask!

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Doc, these cold/ flu symptoms are killing me. How do I cure it?

Every doctor has gotten the “I have a cold/ flu but I really need to feel better by tomorrow. What can I take to nip this thing in the bud?”. In general, when people ask for a “cure”, they are asking for something  that will quickly kill the infection and immediately improve their symptoms. And here’s the deal: if I had a CURE for the cold or flu, I would be swimming in cash right now. And I’m not, so clearly…

Most of the treatments for cold/ flu are what we call “supportive measures”, meaning, things that helping alleviate the symptoms (cough, congestion, fever, body aches etc) while your body works hard to fight off the infection.  How long it takes to bounce back depends on many factors: age, strength of your immune system, strain of virus etc.

There are whole aisles in many stores and pharmacies dedicated to Cold and Flu treatments, and in general these over-the-counter options are good enough (next post will delve more into the specific ingredients over the counter that may help). Sometimes, certain symptoms may require a prescription.

But for now I want to focus on products that claim to help shorten the duration of the cold or flu, and lessen the severity of symptoms. Are these things legit?  So again, talking about evidence-based studies, unfortunately there isn’t strong evidence to support the following ingredients in TREATING cold/flu symptoms:

  • Echinacea
  • Vitamin C
  • Ginseng
  • Garlic
  • Vitamin D
  • Vitamin E

However, there IS some evidence for the following:

  • Zinc: When used at the first sign of an infection, zinc may help shorten the length of a cold by up to a day. There’s no evidence that taking zinc lessens the chance on catching an infection.  Personally, I always keep some Zicam around and take religiously at the first sore throat or tickle. Sometimes it seems to nip things in the bud, but not always.
  • Elderberry: I’ll admit I just recently learned of this myself during my research for this post. Some smaller studies shave recently shown promising evidence that elderberry extract (sambucol) may shorten symptoms of influenza by up to 2 days.  Of note, the studies were specifically for the flu, and didn’t study other viruses.
  • Sleep: already discussed in last post, but there’s a reason why you get so tired when you get sick. Your body is waging war with the foreign invading bug, and this takes up a lot of energy. So rest up and give your body a fighting chance so you can recover more quickly.

And I just have to emphasize, that a cold/ flu is caused by viruses, and viral infections are NOT NOT NOT treated with antibiotics (there are very few cases when I would prescribe an antibiotic to someone with upper respiratory symptoms; for example in a patient with COPD, someone who I think developed a superimposed bacterial infection etc. 99% of the time no antibiotic is needed. Guess this deserves it’s own post). 

*note: never take any supplement before discussing with your doctor, since zinc and elderberry have been shown to interact with certain medications.

If you have a cold/ flu right now, I hope you feel better soon! And remember, although it’s not evidence based, a little chicken soup never hurt anybody  😉 .

How do I boost my immune system? The real deal on echinacea, vitamin C and other stuff

Right now, cold and flu season is in full force and is particularly brutal this year. Every day in clinic I have at least 2-3 patients calling or coming to the office because they’re suffering from the body aches, sniffles, congestion and cough that come with a nasty respiratory infection. So no wonder I’m getting so many requests for advice on what people can take or do to boost their immune system, so they can avoid catching the cold/ flu in the first place.

Fact is, our immune system naturally wanes with age, pregnancy and certain medical conditions. But there are clinically proven things you can do to optimize your body’s natural immunity. Note, I say “clinically proven” because there are a ton of websites out there touting ingredients and products that are natural immune boosters, but as a practitioner of evidence-based medicine I like to stick with the data that has been rigorously studied through clinical trials.

So this post will review ways to boost the immune system to PREVENT cold/ flu. In the next post, I’ll give you the scoop on cold/ flu treatment.

First, I want to talk about what HAS NOT been proven to actually help. Meaning; when these substances have been studied in rigorous clinical trials, there was no significant difference in the prevention of cold/flu in people that took the ingredient compared to people that did. Maybe more, larger studies need to be done before some benefit is found. But for right now, I’d say skip the following:

  • Echinacea
  • Vitamin C
  • Ginseng
  • Garlic
  • Vitamin D
  • Vitamin E

Just to note, there are many people who still swear up and down that these ingredients help their immune systems (anecdotal evidence), and may continue to take  these natural ingredients sound pretty harmless to take just in case it may benefit them. But to give you an example, garlic can interact with certain medications (blood thinners for example). So just because it’s natural doesn’t mean it is safe to take in large quantities. Double check with your doctor before any self-medication including natural supplements.

However, there IS some promising data for the following things:

  • Sleep: Catching your zzz’s is clearly associated with a healthy immune system. Think about it this way; lack of sleep actually stresses your body, and the chemicals produced by the body (cortisol, cytokines) cause a low-grade inflammation in the body. And inflammation =bad.  Moreover, studies show that the blood of sleep-deprived people tend to have lower numbers of blood cells that work to fight off infections, like T cells and NK cells.
  • Meditation: Along the same vein, since stress is associated with lower immunity it makes sense that things which reduce stress, like meditation, can help boost immunity. A small study actually showed that people who meditated during the study were less likely to catch a cold/ flu than people that didn’t. More studies need to be done to strengthen the data, but in the meantime, meditation (and other stress relievers like massage/acupuncture/exercise) can’t hurt!
  • Hygiene: Washing your hands, using hand sanitizer, sneezing in the crook of your elbow instead of your hands, wearing a mask if you’re sneezing or coughing (or if you want to protect yourself from someone who is). If you’re in a public place like a grocery store, beware of objects that are touched by everyone: not just shopping cart handles, but also doorknobs, credit card swiping machines…anywhere a virus can linger and stay alive up to 48 hours. All these practices can help prevent spread of these highly contagious bugs.
  • Getting your flu shot!!! : I’ve already dedicated an entire post to this (click for link), so nuff said.

Now that you’re armed with this knowledge, go forth and stay healthy! And stay tuned for the next post, where we review clinically proven ways to tackle cold and flu symptoms.

 

Sources:

https://nccih.nih.gov/health/flu/indepth

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/

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] 

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!

“I don’t believe in the flu shot”: Debunking Myths

So it’s December, and we’re well into flu season. Many people have already gotten their flu shot [ high five], but based on the statistics less than 50% of people receive the vaccine every year. Among those who don’t get vaccinated,  I tend to see the following types of personalities:

The Procrastinator– actually plans to get their flu shot but hasn’t gotten around to it yet

The Renegade- knows they should get it, but are taking their chances. Probably doesn’t wear a seat belt either.

The Superman – never caught the flu, so obviously are immune, right? (wrong)

The Skeptic- doesn’t think the flu vaccine works, or actually considers it dangerous.

As a primary care doctor, part of my mission is to educate on the purpose of vaccinations, and flu vaccine especially. Because I’ve seen first hand the devastating consequences of contracting the influenza virus (being hospitalized, intubated, dying from influenza pneumonia ). You may think that only high-risk people (babies, pregnant women, folks >65 years) can have complications, but it can happen even in young healthy people depending on the strain of flu.

So from personal experience, I’ve compiled a “most commonly asked questions” about the flu vaccine, and the answers that we doctors provide!

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