Archive for July 2009

Makeover your kitchen

Wanting to make over your body?  The best place to start is your kitchen.  Good nutrition is in part about knowing which foods are good to eat but it may be more about altering lifestyle habits.  Even if you know what’s good to eat, if those foods are not around, you won’t eat them!  So how do you start establishing a lifetime of good nutrition?  Well, start at home!  Your dietary willpower and discipline will be frequently challenged at potluck dinners, social events, lunch meetings at work, etc.  But, what matters more than an occasional non-nutritious meal is the other meals you are eating the majority of the time.  Start by making your home a “safe place.”

Here are some excerpts from Gourmet Nutrition by John Berardi, PhD, founder of Precision Nutrition.

“If a food is in your possession or located in your residence, you will eventually eat it.   That’s right, if you wish to be healthy and lean; you must remove all foods not conducive to your goals from your residence and replace them with a variety of better, healthier choices.  Now, before you go thinking that this is just a suggestion- one way to improve your body- we want to make it clear.  This is the only way to improve your body….We assure you that once you makeover your kitchen, your body will follow.”

Take a look in your fridge and pantry- is it filled with soft drinks, fruit juices, processed foods wrapped in colorful wrappers, boxes and containers?  If so, it may be time for a kitchen makeover.

The best way to get control of your stress

Since stress is an activation of our “fight or flight” or sympathetic activity, it is important to balance that with our “rest and digest” or parasympathetic activity.  I’ve heard many people say they exercise for stress relief.  While consistent exercise is a critical component to overall health and improving your body’s capability of coping with stress, it is yet another activiation of your sympathetic system.  In fact, competitive athletes consider recovery a valuable part of their training.  They understand the need for rest and relaxation to allow their body to recover from the stress it is put under during exercise and intense training.

So while we are unlikely to find a way to live in our world and eliminate all the sources of stress in our life, we can learn to increase our parasympathetic activity to balance that.  Here is the key: take 30 minutes a day to engage in some activity that allows your mind to go into a state of relaxation.  Choose activities that help you get quiet, restful and worry-free parasympathetic activiation.  Every person’s activity might be different.  One person could achieve that state by taking a bath each evening to relax but another might take a bath and allow their mind to spin with worries the whole time- that doesn’t count!  The key is to do what allows your mind and body to relax for 30 minutes each and every day.

Here’s a list of activities that might work for you:

Yoga or Pilates


Massage Therapy


Reading in a quiet spot

“Zoning out”

Listening to soothing music

Taking a bath

When you do this and have actually relaxed, you may notice tension in your neck, shoulder and back release.  You might experience a decrease in your heart rate and blood pressure and a sense of calmness.  If you do your activity before bed, you will probably be able to fall asleep faster and achieve a better night’s sleep.

Does it sound too simple?  It’s obviously not that easy to do because how many of us get 30 minutes a day of a truly relaxed state of mind. But remember all those effects of stress on your body and health- it’s important to allow your body to recover!  This is the best way to get control of stress- start today, make it a habit!

Are you stressed? What is it doing to your body?

A study done in 2003 showed that 80% of Americans reported feeling stressed out.  Are you one of them?  Take a look at what being stressed can do to your body.  Chronic stress can alter our biochemical state and have major effects on our health.

Being stressed puts our bodies in the “fight or flight” state which leads to high levels of cortisol and adrenaline.  When we are under chronic stress, the secretion of these hormones takes precedence over other functions like digestion, cellular repair, immune function, reproduction and liver function and detoxification.  So we end up with poor blood sugar control, sleep disruption, carbohydrate cravings (which worsens the poor blood sugar control), reduced metabolism, reduced thyroid function, alterered sex hormone activity, infertility, depression, alcohol and drug abuse.  Your immune system doesn’t work as well to fight off infections.  Stress has even been linked to heart disease.

Basically our bodies are in a state of hormonal imbalance and we simply are not able to function like we want to.  Not only that, but stress is also known to decrease the brains functionality causing difficulty thinking and solving problems or a loss of memory.  And, after a long time of your body pumping out so much cortisol and adrenaline eventually it wears out and chronic fatigue sets in.

diffi culty thinking creatively,
solving problems, or shift ing attention

So as you can see,  stress is not something to just blow off by saying “things will calm down when the kids are back in school” or “as soon as I get this project done at work my stress level will be a lot less.”  You are just continuing the cycle and setting yourself up for problems that are becoming more and more common in America- obesity, heart disease, infertility, irritable bowel syndrome, depression, alcohol and drug abuse.

The best time to slow down and relax is when you don’t have time for it!

Stay tuned for some tips on decreasing your stress level.

One great question to ask your doctor

Have you ever been concerned that your doctor makes a quick assumption about what you have without really thinking it through?  Or, concerned that he/she has been telling you the same diagnosis over and over but your symptoms persist despite treatments?  Well, as advised in Dr. Groopman’s book “How Doctor’s Think,” here is one question you can ask to help prevent your doctor from missing something-  “Doctor, what else could this be?”

Our goal as physicians is to arrive at the correct diagnosis, give the appropriate treatment and make the patient better.  But, sometimes a misdiagnosis can set you on the wrong path and delay the correct treatment.  No single remedy can prevent all mis-diagnoses.  But, asking that one simple question, “what else could this be?” can help your physician broaden the number of  possibilities to consider with a simple reminder of “the reality of uncertainty in medicine.”  It could help your doctor take a step back and think of a cause of your symptom that he might not have previously considered and make the correct diagnosis.

Vitamin D Part 2

billboardDriving from Birmingham to Huntsville, AL this weekend, I saw this billboard for “Sunset Tanz” encouraging you to tan to get Vitamin D naturally. In the upper right corner, it says “Tanning – look good, feel great.” And, “More Vitamin D than milk” referring to tanning.  It was a good example of what I was referring to in “Tanning to get more Vitamin D?” so I thought I’d post it here.  Don’t believe the tanning industry’s justification of putting yourself at a much higher risk of skin cancer when you could just take a Vitamin D supplement instead.

Interesting numbers on the swine flu

Here are some interesting numbers comparing the swine flu (H1N1 influenza) to past influenza outbreaks:

Seasonal influenza has about 3-5 million severe cases each year with 250,000-500,000 fatalities annually.  In the 1918 pandemic influenza there were 1-1.5 million fatalities. In the 1968 pandemic influenza there were 1 million fatalities. In the 2009 H1N1 influenza or Swine flu , there have been 40,617 confirmed and probable cases and 263 fatalities (as of July 17th).  Alabama has had 477 confirmed and probable cases of swine flu and no deaths.

A brief review of the timeline of the swine flu outbreak:

The first H1N1 patient in the US was confirmed on April 15, 2009.  The second patient was confirmed on April 17th.  On April 26th, the US Government declared a public health emergency.  On June 11th, the World Health Organization activated Phase 6 of their pandemic alert scale meaning that they officially recognized the virus is at the pandemic phase.  At that time, more than 70 countries had reported cases of H1N1 infection.  By June 29th, all 50 states in the US, District of Colubia, US Virgin Islands and Puerto Rico had reported H1N1 infection.

Nationwise US influenza surveillance systems seem to indicate that overall influenza activity is decreasing in the US. Although the 2009 H1N1 influenza has relatively low infection and death rates, the CDC continues to monitor the situation carefully.  They have already begun work on creating a vaccine that will be effective against the Swine flu in preparation for the flu season this fall.

Interestingly, spread of the swine flu through water is not likely this summer because the amount of chlorine used in swimming pools and even tap water is adequate to inactive the virus.  Human to human spread is still possible so protect yourself with handwashing and covering your mouth when coughing or sneezing!

Tanning to get more Vitamin D???

You may have heard in the news or from your doctor that there have been studies done that associate a low blood level of Vitamin D with some types of cancers, neurologic disease, autoimmune disease and cardiovascular disease.  Let me emphasize- the studies show an association, not that a low level of Vitamin D causes these diseases.  However, based on these studies there was an emphasis placed on educating patients to have their Vitamin D levels checked or talk with their doctor about getting more Vitamin D.

The two sources of Vitamin D are through the sun’s UV rays or through our diet by either food or supplements.  Some doctors had recommended that people spend more time in the sun without sunscreen to increase their levels of Vitamin D.  The American Academy of Dermatology has recently ammended their position on Vitamin D.  It is NOT recommended that people increase their unprotected UV exposure from the sun or tanning beds in order to increase Vitamin D.  Sun exposure and tanning are known causes of skin cancer.  Since there is another method of increasing Vitamin D in our systems through our diet, this is clearly the better choice.

There are currently ongong studies to determine if the current recommended adequate intake levels should be revised but for now we are using the levels shown in Table 2 of this link from The National Academy of Sciences Institute of Medicine (IOM) guidelines for vitamin D.

Some people with higher risk of having Vitamin D insufficiency are “dark skin individuals, elderly persons, photosensitive individuals, people with limited sun exposure, obese individuals or those with fat malabsorption.”

See the official statement here for further details: American Academy of Dermatology Position Statement on Vitamin D.

The best anti-aging cream…sunscreen!

Sun and tanning beds cause skin cancer and premature aging (wrinkles).  In fact, many skin products that are advertised as “anti-aging” actually have nothing extra but sunscreen added in.  In the midst of the summer time sun, here are a few reminders on keeping your skin protected from the sun’s rays.

  1. The American Academy of Dermatology recommends wearing a sunscreen with an SPF of at least 15-30 depending on your skin type.

The amount of protection a sunscreen gives from the sun is measured by its SPF (Sun Protective Factor).  This is calculated by taking the amount of time required to cause redness with the sunscreen divided by the amount of time required to cause redness without the sunscreen.  So, for a person who normally would burn in 20 minutes, an SPF of 10 would protect that person from the sun for about 200 minutes before burning occurs.  This of course means that the same SPF does not work for everyone- it is dependent on your skin type.  Clothing helps protect you as well but keep in mind that a typical white t-shirt has an SPF of about 3.

2.  Regardless of skin type or SPF, sunscreen needs to be re-applied about every 2 hours and after swimming, drying off or sweating.

Sunscreens are just lotions, gels, sprays, etc that will eventually wear off- especially when you get wet or are just wiping it right back off when you dry off after a dip in the pool.  If you don’t reapply you are most likely loosing the effectiveness of wearing the sunscreen in the first place after the first 2 hours in the sun.  Some dermatologists say the higher the SPF the better, but regardless of the SPF you still need to reapply frequently.  (Don’t do the math and decide you can stay out in the sun for 12 hours without putting on more sunscreen!)

3.  Sunscreens should be applied 30 minutes to 1 hour before sun exposure. Give it time to be absorbed into your skin before you jump in the pool and wash it all off.

4.  Spend some time in the shade- especially between the hours of 10 am to 4 pm when the sun’s rays are the strongest.

Shortage of Primary Care Physicians in AL

It’s no surprise we are at a loss for primary care physicians in our nation.  Primary care includes the specialties of Internal Medicine, Pediatrics and Family Medicine.  Did you know that 98% of residents completing an internal medicine residency subspecialize to become cardiologists, gastroenterologists, pulmonologists, endocrinologists, etc?  85% of pediatric residents subspecialize.  On the other hand, 98.9% of family medicine residents stay in family medicine.

This July 284 residents started their training in Alabama.  Out of those 146 entered residencies in primary care.  74  in Internal Medicine,25 in Pediatrics, 42 in Family Medicine and 5 in a combined Medicine/Pediatrics program.  Given the percentages above that means that in 3 years when these physicians are beginning their practices we’ll have 41.5 family medicine docs entering practice, 1.5 internal medicine docs and 3.75 pediatricians.  The rest will be starting fellowships to further narrow their area of expertise.

So when I hear discussions from the powers that be about how to recruit more medical students into the field of primary care and specifically family medicine I am all for it.  Not everyone needs a cardiologist or rheumatologist but everyone does need their own doctor that knows their medical problems and medications, can see them when they get sick  and also treat their diabetes, congestive heart failure and other chronic diseases.  Everyone needs a doctor that they see for routine check ups to order the tests and procedures needed to prevent further disease down the road, and knows when they need to tap into the expert opinion of the specialists.  That’s what family medicine doctors provide, we call it a medical home for our patients.

Do anti-depressants treat a "chemical imbalance?"

Dr. Moncrieff wrote an article in BBC News titled “The myth of the chemical cure” where she discusses the reasons why it has been thought that anti-depressants work.  The reason most often sited is that people with depression, anxiety, schizophrenia etc. have a “chemical imbalance” in their brain and taking these medicines treats that.  I have told patients that myself.  The problem with that is there is actually relatively little justification for that view of psychiatric drugs.  The most compelling argument it seems is that they work so that proves there is an underlying biologic or physiologic reason why they work- we just don’t know what it is yet.

She suggests that psychoactive drugs (anti-depressants like  Zoloft or Lexapro or anti-anxiolytics like Valium or Xanax) “work by producing drug-induced states which suppress or mask emotional problems.”  She compares this to the drug induced state brought on by marijuana or alcohol.

This doesn’t mean they are not helpful.  For people with severe depression or anxiety, masking their problems with drugs could help them temporary deal with the real underlying issues.  And, that could be a very good reason for people who are severely distressed to take these medications.

But the way these drugs are described by physicians affects how many people want to take them.  If it’s sold as a pill that is reversing a chemical imbalance it sounds good.  It it’s sold as a pill that masks the thoughts and feelings although we really have no idea what’s going on in their brain, it might not sound so good.

It is up to the patient to make an imformed decision about whether or not psychoactive drugs are a good choice of treatment for their emotional struggles.  It’s the physicians responsibility to accurately portray what we know about how these medicines work.  Ultimately, dealling with the source of your depression or anxiety is the treatment.  Of course, some believe the story that actually dealling with your problems is harder than taking a pill to cover them up which may be one reason why anti-depressants are one of the most commonly prescribed drugs in America.