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.
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
Reading in a quiet spot
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!
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.
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.
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.
Driving 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.
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!
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.
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.
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.
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.
Have you ever wondered what type of doctor you need to have? I hear lots of people say, “I just need a regular doctor.” But even with “regular doctors” there are several different specialties and so which one should you see?
When I tell people I am a family medicine doctor, most people say “oh, so you’re a general practitioner.” Actually, general practitioner or GP refers to a doctor that has been to 4 years of medical school and 1 year of residency. They are licensed as a physician but not board certified in any specialty. There are very few physicians who are GP’s now as the vast majority of residents complete a minimum of 3 years of residency (after the same 4 years of medical school) in order to become board certified in a specialty. Primary care physicians include internal medicine, family medicine and pediatrics. OB/Gyn doctors are also under the umbrella of primary care for women’s health. So what’s the difference in these primary care doctors?
Pediatricians of course are trained specifically in children’s health. Most pediatricians see patients from birth to 18 years old. Internal medicine doctors are trained with an emphasis on inpatient medicine meaning they learn how to treat adult patients in the hospital. Many of these doctors train for 3 years in internal medicine then go on in their training to become a sub-specialist in a more specific area of medicine like cardiology. Some practice only inpatient medicine, some only outpatient medicine and probably the majority practice both. Family medicine doctors are trained to treat children and adults with more of an emphasis on outpatient treatment (like when you go to your doctor’s office to get a check up on your diabetes or find out if you have the flu).Although actually, most of our residency is training in the inpatient setting similar to internal medicine. We are also trained in OB/Gyn and are able to care for pregnant women and deliver their babies. Many doctors who practice in rural settings where there is no OB/Gyn will take care of the OB patients too. Like internal medicine, family medicine doctors can practice in an inpatient and/or outpatient setting but have more of a focus on preventative medicine. They also are able to literally see the whole family since they are trained in children and adults.
So if you are looking for a “regular doctor” you are most likely looking for an Internal Medicine or Family Medicine doctor. Their training is very similar in many respects it’s just that an internal medicine doctor has been trained with more of an emphasis on hospital patients and a family medicine doctor on clinic patients and preventative medicine.
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.
Here’s a question I recently heard from an 8th grader…. How can you truly be happy with yourself as you are?
Wow, what an amazingly perceptive question. Isn’t that a question that people of any age are asking? If that 8th grader doesn’t find that answer now, he/she will still be wondering in high school and college and in his/her career or family life. Imagine the decisions we make that might be made differently if you were truly comfortable in your own skin, happy and at peace with yourself.
It seems at the root of that question is the belief that we need to be different in some way. Ask yourself, is that true? Can you really know that you would be better off if you were different in that way? How do you feel about yourself when you believe that you need to be different? It is fascinating to me that if you believe that, whether it’s true or not, your mind will find ways to prove it to you. If someone believes they need to be smarter, when they encounter any situation where they do not know an answer that’s the mind’s proof that yes, see, I need to be smarter. And the mind will totally disregard anytime someone tells that person, “good job” or “that was really smart.” It just doesn’t match with what the person believes about themselves so they say, “oh, they’re just saying that to flatter me, they don’t really mean it.” Have you ever thought that when someone complimented you?
Sit with this- I don’t need to be different. Does that feel as true? Make a list of all the reasons you should be exactly the person you are with all your strengths and weaknesses just as they were given to you. Your job is to be you and you are the only one that can do it!
“You are unrepeatable. There is a magic about you that is all your own…” D.M. Dillinger
When patients ask me what they can do to lose weight, the first question I ask is, “What do you drink?” It is amazing to realize how much of your daily calories can be “used up” in what you are drinking. For example, if you drink 2 regular cans of coke a day that’s an extra 280 calories to your daily total. If you do that every day for two weeks that adds up to 3920 calories just from cokes!! 3500 calories is about equivalent to 1 pound of weight gain. If you’re not burning that off in your calories expended during the day, you’ve put on an extra pound in two weeks just from a modest 2 cokes a day, not to mention the hamburgers, fries and sweets that you are likely washing down with your cokes, sweet teas or other sugar filled drinks. Extrapolate that over the year and those cokes have added up to 26 pounds of weight gain if not balanced with exercise.
I often recommend the first change you make in your diet is the zero-calorie drink rule. Save your calories for your food and drink water or other zero-calorie drinks like diet cokes or crystal light. I’ve seen people lose a fair amount of weight just by adding in some exercise and adhering to the zero-calorie drink rule. Next time you pick up that coke or sweet tea, ask yourself if that 12 ounces of pure sugar and preservatives is really worth it?
Keratosis Pilaris (KP) is a common, inherited skin condition in which keratin (a protein in the skin) forms plugs in the hair follicles. It is benign and often disappears with age. 40% of the population has keratosis pilaris! It is more common in people who have very dry skin or atopic dermatitis (eczema).
It is characterized by very small flesh colored or slightly red bumps that give the skin a sandpaper-like texture. Most frequently it develops on the backs of the upper arms but can also occur on the thighs, cheeks or other areas.
Click here for some pictures of KP: http://www.helpforkp.com/keratosis_pilaris_pictures.html.
Most people seek treatment because it occasionally itches (especially in the winter) or for cosmetic reasons. Moisturizers are soothing to the skin and may help the appearance. There are prescription topical treatments (skin creams) that you could ask your physician about; however, improvement may take several months and the bumps tend to come back. You could also try taking long, hot soaking baths and then rubbing the areas with a coarse washcloth. This can soften the hair follicles and unplug the pores filled with keratin. Good news though- this condition is completely harmless, usually self-limiting and tends to resolve with age.
Have you ever had the thought that your body should be different in some way? “I’m too fat, thin, short, or tall.” Or perhaps, “I should be healthy.” Do you notice the difference in the thoughts, “My body should be different” and “I should be different?” Is your body “you” in your entirety or is there more to “you” than that?
Your life would be better if you looked differently- can you really know that is true?
People would like you more if you were more attractive- can you really know that is true?
You would have a partner if you were more attractive- can you really know that is true?
You would be happy if your body was different- can you really know that is true?
These are simply questions but I am finding (through the work of Byron Katie) that my answer is I am not merely my body and my body should not be different. That doesn’t mean it will never change. Our bodies have been given to us to live this life in. And in my experience, it seems to be doing that job perfectly- I’m alive! You can go about your life believing “my body should look different” and if it doesn’t look different, it’s frustrating when you look in the mirror. Or, you can go about the same life believing “my body should not look different” and loving what you see in the mirror!
Brooke Uptagrafft, MD
Dr. Brooke is a family medicine doctor.