Saturday, September 27, 2008

Fix it NOW, Doc!

Fast food medicine- that seems to be what people want these days. In all of our society, we have instant gratification. If you call John, and he's not there- call his cell phone or text him.  Many people answer their cell phones in public bathrooms, or worse, in the middle of a pelvic exam (seriously!) Snap a picture of your child, and immediately, they run to your digital camera to see it. 
Sadly, people are demanding this same instant fix in medicine, and doctors are providing it. Got heartburn? Grab the purple pill. Can't sleep? Your glass of wine didn't relax you enough? No worries- take a sleeping pill. Too tired in the morning? Slam back a Starbucks. Caffeine and alcohol causing heartburn? Back to the purple pill! And...repeat.
Let me give a ridiculous example to illustrate my point. Say you decided it was fun to pick up a rock and hit your knee repetitively (work with me, here.) Not surprisingly, your knee begins to hurt. You go to the doctor, and he or she prescribes a pain pill. Is this going to solve your problem? No, of course not! The problem is NOT the pain, the problem is you hitting your knee with a rock. 
So, why is it any different when you go to your doctor with heartburn, and you get a prescription for an acid blocking pill instead of education to at least temporarily wean off caffeine,  eliminate alcohol and nicotine, and avoid ibuprofen? (Hopefully, you'll get both, but I think we all know most people will pop the pills, get relief, and continue the habits that caused the problem.)
BOTTOM LINE: We have been trained by the media and our lifestyles to expect a quick and easy fix. Let's dig deeper and stop shopping for fast-food medicine. My next several posts will address common problems that we tend to band-aid with pills instead of lifestyle changes.

Sunday, September 14, 2008

It's impossible to eat that many fruits and veggies!

Okay,  before we move on to another topic, I thought I'd write one more entry on healthy eating. In the prior post I suggested you try improving your diet by focusing on eating 5-10 servings of fruits and/or vegetables each day. Often this advice is met with the response that with a hectic, working, "real" life that includes kids with different after-school activities, this is impossible. Well, I have that life, too, so I thought I'd give you some specific examples of how it IS possible! Here is what a typical school day in our home looks like:
First, the kid menu. Our two daughters have different preferences, so I'll list them both:

BREAKFAST: ( Kid #1) oat squares & Silk milk and a banana; drink: water 
(Kid #2) Toast (white wheat) with spray butter & bowl of blueberries; drink: Silk milk (kids are lactose intolerant, this is no slam on regular milk)
LUNCH: (Kid #1) Ham on white wheat bread, mandarine oranges, a cut up apple, and two homemade cookies (or one of the 100 kcal pre-packaged cookies)
(Kid #2) PB&J sandwich on white wheat bread, snap peas and mandarine oranges, cookies as above; plus she has a morning snack at school which is usually grapes or a cut-up apple
AFTER SCHOOL SNACK: (Kid #1- still at school because of post-school activities)  Fiber One Bar (chocolate is her favorite) or a Chewy granola bar
(Kid #2- at home) - often we make a smoothie- usually a banana, frozen strawberries and vanilla yogurt
DINNER: Chicken (baked nuggets if we're in a hurry), applesauce, broccoli (the bag that you throw in the microwave for 3 minutes.)
DESSERT: vanilla  frozen yogurt served over a sliced banana with a dollop of Cool Whip on top

BREAKFAST: vanilla yogurt with a serving of thawed frozen raspberries and 1/8 c Bran Buds (cereal) and a tablespoon of Cool whip  (if I'm in a hurry ) OR a scrambled egg with some onion, mushrooms, & tomato tossed in (I'm too lazy to make an omelette, so I throw the veggies in first with some olive oil, and when they are soft in a couple minutes, I add in the egg.)
SNACK: every work day, I take two sliced apples and a small serving of cashews or almonds or a cheese stick, and I eat that mid- morning so I'm not ravenous at lunch time.
[As the seasons change, I may take  mini carrots or grapes, but it has to be something quick that I can throw in a ziplock bag or tupperware container . I use one of those apple slicers that look like a wagon wheel to make it easy to cut up the apples.]
LUNCH: At work- two servings of salad or whatever vegetable might be available and one serving of the entree; if I'm at home, my standby currently is to heat up the skillet, add a tablespoon or so of olive oil, and toss in cut up onion (usually half of a large onion), shredded carrots (I love these, so roughly a cup), mushrooms (three or four), and whatever else I've got that appeals to me that day- some broccoli, snap peas, or zucchini, for example- and then some black beans (love the organic HEB brand) and some brown rice (around a cup). (I make the rice one day, and then stick it in a tupperware container in the fridge for the rest of the week). If we had chicken or beef the night before, I'll toss in some of that for extra protein.
After school snack with the kids: Love the smoothies!
Dinner: I try to put a green salad or at least a sliced whole tomato as an extra veggie; I aim to have a fruit and a veggie for the kids along with the main dish. This is very often applesauce for the fruit, and steamed broccoli or carrots for the veggie. 
Dessert: Our version of the banana split OR a Skinny Cow ice cream sandwich OR a glass of wine!
BOTTOM LINE: Go back and do the math- it IS possible to get in the 5-10 servings of fruits and vegetables per day IF you give it priority, think about it in the grocery store, and use the quick and easy products- frozen fruit, single serving applesauce/peaches/fruit cups or carrots/celery, or the pop in the microwave bags of broccoli, green beans, or mixes with cauliflower & carrots.

Wednesday, September 10, 2008

I can't lose weight, no matter what I do!

At least two or three times per week, my patients tell me that they can't lose weight, no matter what they try. Often, they feel their metabolism or hormones are to blame. They would like me to test their thyroid levels and other hormones. 
Well, for every one patient who legitimately is severely low thyroid or has their hormones "out of whack", there are a hundred who come back with completely normal lab values.
 So, how do I, as their physician, try and help these patients when it would be harmful to prescribe thyroid medicines or appetite suppressants? Many physicians fall back on the old standby of saying "there is no metabolic explanation for your problems." As true as that is- and I certainly do tell patients this- that is NOT all there is to say.
Ultimately, we all know that losing weight means burning off more calories than we consume. What I try to make clear to people is that they need to take ownership of what they are putting in their mouth as well as how many calories they are burning off. It is human nature (proven in study after study) that we will OVERestimate our exercise and UNDERestimate our calorie consumption. The only way to truly assess this is to log what you eat- and I mean MEASURE it and log it as the day goes along; do NOT rely on your memory, or you'll forget the handful of chips or M&Ms that you grabbed from your friend's house/desk, PLUS log in the amount of exercise- count minutes and/or miles- and MEASURE it. Patients tell me all the time that they walk 2-3 miles in a half hour, but never break a sweat. Hmm... I don't think so. Try it on a treadmill.
There are a dozen easy, free calorie counters on the web that will help you catalog your ins and outs daily- pick one!
OR... try this: simply count your servings of fruits and vegetables each day. You need 5-10/day. A serving is roughly what you can hold in your hand. So yes, a big person (big hand) gets a bigger serving than a kid. A huge banana, for example, is likely two servings.  An apple- usually one; a handful of berries or grapes- one. A huge lettuce/tomato/carrot/cucumber salad might be four or five servings. 
BOTTOM LINE: fill up on fruits and vegetables, ten servings per day, and the protein, fat, and carbs that round out your plate (should be only one quarter of a round plate) will still likely add up to fewer calories than you need, and the weight WILL come off.
P.S. The only people who maintain weight loss in meta-analysis studies exercise daily. Yes, that would be every day, seven days per week. It's not magic, it's habit. And yes, walking counts.