health

Wellness Wednesday: Healthy Communication Skills

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Communication skills are intrinsic to our wellness. They are central to our relationships and our effectiveness in life. I have distilled a list of six main steps in healthy communication. I discovered I have lots of room for improvement. Hopefully you will find something helpful too. 

1. Attitude adjust.

  • Consider your purpose in the conversation. 
  • Assume the best intentions in everyone. 
  • Stay positive - honest, patient, optimistic,  sincere. 
  • Value everyone equally. 

2. Check physical factors.

  • Put away distractions like phones. 
  • Make comfortable eye contact.
  • Watch your body language.  
  • Watch your tone. 

3. Listen actively.

  • Listen first.
  • Ask open ended questions.
  • Set aside judgement while listening. 
  • Listen actively -  Don’t interrupt; read back, aka clarify and reflect. 

4. Guide your reaction. 

  • Use empathy; Try to see the other person’s point of view.
  • Practice self awareness -recognize emotions and stresses as they arise and rather than react to them, handle them appropriately. 

5. Say your piece. 

  • Pause and ponder. Think before making a point.
  • Understand how your message might be received.
  • Tailor your message to your listener.
  • Use empathetic assertiveness. 
  • State needs, express feelings; Value your own point of view as well. 
  • Be direct; Be BRIEF - Give the "b"ackround, "r"eason,"i"nformation, "e"nd, and "f"ollow-up.

6. Connect and conclude. 

  • Connect personally.
  • Encourage the other.
  • Focus on the result.
  • Ask for input and feedback. 
  • Follow up with a plan. Close the loop. 
  • Show appreciation for the person and the conversation.  

 

Awesome references that expand on these tips: 

http://lifehacker.com/top-10-ways-to-improve-your-communication-skills-1590488550

http://www.lifehack.org/articles/communication/9-tips-to-improve-communication-skills.html

http://www.wikihow.com/Develop-Good-Communication-Skills

http://www.skillsyouneed.com/ips/improving-communication.html

http://www.skillsyouneed.com/general/emotional-intelligence.html

http://www.skillsyouneed.com/ips/improving-communication.html

http://www.inc.com/kevin-daum/8-ways-to-improve-your-communication-right-now.html

http://www.citehr.com/11334-6-good-tips-increase-your-communication-skills.html

http://advancedlifeskills.com/blog/14-very-effective-communication-skills/

http://www.wfm.noaa.gov/workplace/Comp_Conf_Handout_1.pdf

http://www.helpguide.org/articles/relationships/effective-communication.htm

Food Friday: Fast Food

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Woman pouring smoothie looking.jpg

I am loathe to miss a meal and can hardly tolerate missing a snack. My patients know they aren't supposed to either. Metabolism, energy, a bright outlook, ability to exercise, blood sugar control, weight management and sharp thinking all depend on it. So often my patients say they don't have time to eat, especially breakfast. These are the same folks who are struggling with their weight. So instead of repeating this point, I am going to give you my down to earth, personal go to suggestions when you really have next to no time to make and eat food. 

First, however you have to shop correctly. Remember super basic is key, and one real cooking episode is needed: dinner. Most people don't struggle with dinner. Cook extra at dinner so you will have leftover protein rich foods and cooked vegetables. 

Here is my basic grocery shopping list for fast food, by section.

Freezer: 

  • Lean meat, chicken, turkey, fish, shredded cheese
  • frozen fruits for smoothies: mixed berry, mango, blueberry etc 

Fridge: 

  • Milk, cottage cheese, plain yogurt, sour cream, cheese, kefir, eggs
  • salsa, condiments like pickles 
  • whole grain low carb wraps
  • nuts like walnuts and almonds 
  • healthy broth mix 

 

Pantry: 

  • whole grain bread, corn tortilla chips, oat bran cereal, healthy cold cereal like muesli 
  • canned salmon, canned tomato products, sauce and stewed
  • your favorite complete protein powder
  • dried fruits like craisins 
  • oils - olive and canola 

Produce: 

  • cooking greens like chard, kale and spinach
  • Salad greens like spinach and lettuces 
  • cucumbers, tomatoes, broccoli, green beans, zucchini, carrots, colored peppers, avocados
  • Strawberries, watermelon 
  • apples, bananas, oranges  
  • red and green grapes 
  • stone fruits in season 

 

"Recipes"

 

Breakfast : 

  • bowl of cottage cheese or plain yogurt with any fresh or frozen fruit. optional : nuts, craisins
  • healthy cold or hot cereal with dollop of yogurt, and some fruit
  • chopped fresh or leftover veggies with a couple scrambled eggs with or without cheese. Dress with salsa, sour cream or avocado. 
  • wrap with leftovers 
  • 2 cups milk with protein powder 

Snacks: 

  • hardboiled egg, cheese, dairy, fish chicken or meat with fruit or veggies like carrot sticks

Lunch: 

  • Salad greens with  hardboiled egg, cheese, dairy, fish chicken or meat. Try mixing canned salmon with mayo olives and pickles for a great spread. On a cold day, make soup with broth and leftovers. Make it the blender to speed up the process. 

Dinner: 

  • Main protein rich dish, green salad, cooked vegetable and fruit for dessert. Cook extra for wraps later.

Note:

  • A hefty blended smoothy with yogurt and protein powder, fruit and even vegetables can substitute for any meal. 

 

Give some of these fast foods a try. Bon appetite. 

 

 

 

Medical Monday: ACOG weekly news

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I have noticed that this is not the most popular column. I thought hard about reducing to three posts per week, eliminating this one. For now I have decided to keep it since it helps me keep up to the minute on news pertinent to the field of Obstetrics and Gynecology. Please let me know what you think.

The state of Delaware has banned the dispensation of formula from the hospital to new moms in an effort to promote breastfeeding. Some mothers have weighed in with opposition saying that many workplaces stigmatize breastfeeding making formula feeding necessary. Two comments: those little sample from the hospital aren't enough to make or break your formula supply. Buy your own formula if you want to. And, wouldn't it be better to help the whole situation by introducing some sort of " Freedom to Breastfeed" program in the workplace ?

An entirely useless article came out about a number of mortalities among those who experienced complications during Robot surgery. Non medical media didn't bother to compare these numbers with the numbers of mortalities in those with complications from non Robot surgeries. Also, it is unclear whether or not attention was restricted to new resident doctors, of whom a greater percent use the robot, seasoned surgeons, or both. It would obviously make a difference. 

Recent studies indicate breast cancer survival is aided by aromatase inhibitors, as well as good old fashioned bisphosphonates like fosamax. Cheap help ! 

Republicans want to defund Planned Parenthood in the wake of the recent videos discussion the disposition of the products of conception after abortion. Some say the videos are controversial, some say they aren't. The republican House speaker, John Boehner, has stated he wants the " facts first". FYI Planned Parenthood also does routine check-ups, cancer screening and provides birth control at low cost. 

Breast cancer death rates have declined 33.5 %  from 1988 to 2010 !  Good news. I bet it has decreased more since then. 

Finally, 60% of women over 60 are sexually active. Stereotypes be gone ! 

Stay tuned for next week's Medical Monday ! 

 


Food Friday: Food Joy and Fat ?

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Food joy. Does all this enthusiasm about food contribute to the obesity epidemic ? Consider everything hot now in food : food magazines, the food channel, food trucks, street food, farmer's markets and local food ! Vegan, Paleo, Pegan, organic. 

I say a resounding NO. All this food joy is a great step in the right direction. It does not contribute to the obesity epidemic. I have no data here. I only have 30 years in medicine, most of which is focused on women’s health. 

Those with poor nutrition and problems with obesity are most often those who have not discovered the joys of food. Many times they are those that eat whatever food they can get. This ends up being the stereotypical top ramen, soda pop and boxed mac and cheese, or the iconic white bread. I remember unkind comments from adults I knew as I was growing up, as they wondered how people with so little money could get so much food to get so big. This reflects a profound misunderstanding of nutrition poverty and obesity.

Many times overweight people do not eat very much. They have little and eat little. What they do have is cheap carbohydrate, and they need to eat it as their whole meal since protein sources and fruits and vegetables are or are perceived as less available. Because of this diet, these folks suffer from chronically low metabolism and have low energy. They therefore become less active. Their extra weight compounds their insulin resistance, which results in more fat deposition. It is very hard to get out of this vicious cycle.

Many times I see young women in this predicament while they are pregnant. In this instance they have access to better resources such as food stamps as well as nutrition teaching. I have found that they are as eager and able as anyone else to learn. Once they do learn about the correct composition of meals, as well as the correct timing and quantity, they are astounded about several things. First, they are astounded about how much they enjoy their new diet. The are almost universally shocked at what large quantities they are supposed to eat. And, given this, they are amazed that their pregnancy weight gain levels out appropriately. Finally, they begin to enjoy food preparation, but note that it is a time commitment that they did not have before.

Some have odd reactions from significant others, and find themselves isolated. The partners may not want to change the way they eat. Sometimes partners even make fun of the one trying to be healthy and tease or taunt them back down to their level of poor nutrition. 

Most of the time this change toward nutrition awareness, and eventually toward food joy, is life altering. They never want to go back. Sometimes it becomes a source of pride and accomplishment in the family, and mealtimes become social in a way that they had not been. 

To me, the final stage of food joy is the social and cultural aspect. I took a walk down my own Main Street. I was amazed at what our little town had to offer. We had artisanal breads, real sushi, Thai food, genuine French macarons, and handmade watermelon chili sorbet all on one block. Granted, most of these delicacies were treats. But they were foods that made people appreciate food, other people, and other places. I saw people clustered in cafes, and out on the sidewalls. I saw people working on laptops, socializing, and flirting, all the while over special foods and drinks. They all seemed rather vibrant. 

It appears that people who take the time to walk about to find beautiful food like this are not apt to “ waste” their calories or carbs on junk. They become conoisseurs who are interested in the best for themselves. 

It is always a step in the right direction when people start to focus on quality, in nutrition, food, or even cuisine. When people focus on quality in one dimension of their lives, it tends to spread to others. My favorite part of this whole process is watching patients start to embody quality and enthusiastically take good care of themselves. 

 

Wellness Wednesday: Exercise Statistics

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Most people who come into my office for an annual exam report that they live an active lifestyle. Of course this means different things to everyone, but it is an interesting starting point of discussion. 

Our impressions of our exercise patterns are rarely accurate unless we take the time to chart them. I am going to devote this post to a reality check for us collectively. Number lovers are in for a treat. 

Children: 

  • Only 1 in 3 children is physically active every day. 
  • Only 6 of the 50 states require PE in each grade. 
  • The CDC recommends children be physically active for one hour each day. 
  • One third of high school students plays video games for more than 3 hours per day. 
  • In 2013 only 27 % of all high school students had 1 hour of physical activity in each of the preceding 7 days. Fully 15% of high school students reported NO physical activity in any of the prior 7 days. 
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Adults: 

  • Less than 5 % of adults get 30 minutes of physical activity each day. 
  • Only 1 in 3 adults gets the recommended amount of physical activity in a week. 
  • The 4 states where adults have the highest incidence of exercising 3 or more times per week are: Vermont, Montana, Alaska and Hawaii. In these states about 60 % of adults meet this criteria. 

Appropriate physical exercise comprising both cardio and weight bearing exercise has numerous mental and physical benefits for children, adults, and seniors. Exercise these days has become more evidence based. We know more than ever about how to tailor it to a patient's specific health needs. Exercise certainly does not need to be onerous or miserable. Without exception, people who exercise regularly derive great satisfaction from it.

Check with your local health club or YWCA. Get some exercise DVDs for home use. Find my DVD recommendations in the RETAIL THERAPY section. Learn more in our section on FITNESS. 

Food Friday: Healthy Substitutions

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Eating well is not about dieting or deprivation. It is about understanding food and physiology. It is also about taking a little extra time to obtain and prepare great tasting and healthy food. Some people worry about all the things they would have to give up to eat healthfully. But I’d rather think about all the substitutions that both taste better and are better for you. 

Here are some specific examples to make this easier: 

Drinks: 

  • Instead of cheap caffeinated coffee, use water process decaf made strong in a french press. Or, for lower cost, try decaf Earl Grey tea. 
  • Instead of sugary or artificially sweetened soda, use club soda, plain Pellegrino or Perrier with a light splash of pure fruit juice and citrus wedges. 
  • Instead of a milkshake, have a smoothie with real fruits, plain yogurt, and ice. 

 

Snacks: 

  • Instead of forgetting snacks for work, bring a week’s worth on Mondays. Include easy things, like raw nuts, cheese, and long lasting vegetables. 
  • Ditch the granola bars in favor of sweets like fruits with plain yogurt or cheese. 
  • Steer clear of office sweets by having your own vegetables, dips and nuts. 


Breakfasts: 

  • Instead of an Egg McMuffin, saute mixed veggies like peppers, onion and tomato then cook with a couple eggs and a little cheese. 
  • Instead of a sugary cereal, have a low sugar whole grain high fiber cereal with skim milk and piled with fresh berries or even slivered almond. 
  • Instead of no breakfast have the very quick banana and a glass of milk. 


Lunches: 

  • Have a breadless sandwich. We call it a salad with meat. 
  • Keep things like salad dressing at work so your lunch salads are more appealing. 
  • Watch cafeteria soup… it is full of fillers like starch and sugar. Make a big batch from scratch and bring it all week long.


Dinners: 

  • Instead of main dish, salad and starch, have main dish, salad and cooked vegetable. 
  • Instead of pasta or rice, have Zoodles, meaning noodles made from vegetables such as zucchini. 
  • Broil, grill or bake rather than fry. These methods require less tending and cleanup anyway. 

 

Desserts: 

  • Make a crustless or nut crust pie and reduce the sugar. 
  • Have plain yogurt or cheese with fruit for dinner. 
  • Make a conventional dessert but halve the portion size and make it beautiful. 

 

To learn more about the principles behind these modifications, see the following sections on our website: 

Wellness Wednesday: Beyond Relaxation to Renewal 

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Most of us are familiar with the recommendation to relax on a regular basis. We are all familiar with the ravages of stress and the problems associated with insufficient sleep. We generally think of relaxation as the antidote. To most people this means to physically rest or sleep , and to be quiet and still. There is no doubt that some of this kind of time is good on a daily basis, especially if it is done in a mindful fashion such as in meditation.

But sometimes we need more than relaxation. We need renewal. Renewal goes beyond relaxation. It is similar to relaxation in that it is a break from the usual work routine. However, after that, the similarities end. Renewal is more planned. It may involve physical activity, such as exercise, or an outdoor adventure. It may even involve a challenge. It often involves other people, especially people who are new to you. It involves unfamiliarity, learning and even getting outside of one’s comfort zone. 

Productivity experts are extolling such “ strategic renewal” as the newest productivity tool in the success toolbox. This concept can be utilized on different time schedules: daily, weekly , monthly, quarterly. 

Daily Renewals 

  • exercise 
  • meditation 
  • reading 
  • connect with close family and friends 

Weekend Renewals: 

  • connect with farther flung family and friends, socialize and entertain
  • patronizing the arts 
  • sports 
  • spiritual observance
  • volunteer
  • outdoors 
  • reading 
  • exercise 
  • creative pursuits outside of work 

Monthly or Quarterly renewal: 

  • adventures 
  • conferences 
  • different kinds of work projects 
  • travel

See to the basics first: adequate sleep, regular exercise, and good nutrition. Ensure some relaxation on a daily basis. But go beyond all this and try to start thinking about renewal as well. 

To learn more :

See our sections on Sleep Yoga and Meditation 

LIfehacker

Huffington Post 

New York Times 

Stanford University Cafe Science

What Most Successful People Do On the Weekend, by Lauren Vanderkam 


Wellness Wednesday: Bathing

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Did you know the in the Middle Ages, bathing was considered unhealthy? Indeed, they were not called the Dark Ages for nothing. 

Bathing has had a long history, dating back to ancient India, where it was done more than once per day for ritual reasons.  Elsewhere in the ancient world, Greece developed the ritual of bathing into a way of life, where it was integrated with the tradition of athletics and the life of the the gymnasium. Roman baths are famous as a social institution, where gossip and politics took place amidst the steam and the towels. Later as Christianity took hold, public baths went out of favor as being immoral, since they were associated with debauchery and hedonism. Bathing itself fell out of favor during the time of the plagues, as Medieval physicians felt it opened the pores and let in disease. Farther north, the Nordic people maintained a tradition of saunas, and unlike the other public bathing environments around the world, theirs bore no association with immorality or disease. 

During these dark times others kept the practice of bathing alive. European explorers marveled at the cleanliness of the Mesoamerican people. Across the sea, Japan had a rich bathing culture, using rock pools, furnace baths, and heated rocks with seawater to make steam. In later years the Japanese would refine the art of the public and the private bath, requiring separate cleansing beforehand, then a clean soak to establish tranquility before family dinner time. 

Today we use baths for cleanliness, relaxation and therapy. It is a simple intervention with pleasant results. With only a few precautions, baths are a great strategy. The precautions are these: 

Pregnant women in the first trimester should not take hot baths. This is because there is an association between elevation of core body temperature with failure of the neural tube to close, and conditions like spina bifida. 

No bath should be very hot, since this increases risk of heart attack and fainting in the susceptible. Very hot baths also dry the skin and can precipitate headaches. 

Bathing in warm plain water is best. However a tiny bit of scented essential oil or salt may be used. Bubble baths are hard on our tissues as is the use of soap, which should be restricted to the shower only for truly dirty or greasy skin, and never the perineum. The face should be cleansed twice a day with cleanser, not soap, and should be moisturized before fully dry. 

Enjoy bathing as a stress reliever. As Sylvia Path once said, 

"There must be quite a few things that a hot bath won't cure, but I don't know many of them."

 

References: 

http://www.history.org/foundation/journal/autumn00/bathe.cfm

http://www.brainyquote.com/quotes/quotes/s/sylviaplat107968.html

https://www.aad.org/dermatology-a-to-z/for-kids/about-skin/taking-care-of-your-skin/washing

 

Wellness Wednesday: Music and Health

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Yesterday Apple debuted its all encompassing music service. With a subscription, one can listen to the entire contents of the iTunes music store 24/7/365. There are infinite permutations and possibilities for creating playlists and stations. It is the music service to end all music services. 

The association of Apple Computer with music has been long and fundamental. Much of their product inventory has been about consuming and even creating music, and other forms of art such as as film. There is a belief within Apple and indeed, within many decades of California Bay area culture that music is essential to the good life. I believe modern science is beginning to substantiate that belief. 

Listen to music.jpg

 

 

Since I have been totally immersing myself in music since the services inception 18 hours ago, I decided to learn more about what is happening to me when I listen to music. What follows is a characteristically nerdy report on the relationship between music and health. It's amazing and stirs hope. 

A rather casual Google search promptly unearthed a plethora of research and commercial articles on the subject. I will give you the "digest" form and, of course, the references. The oldest work I evaluated was from 2009. Study designs varied, but many were randomized and controlled. Many of the studies were done in the setting of assessing benefit to peri-operative or hospitalized patients. 

 

 

 

In short, exposure to "pleasant" music, self chosen or otherwise, was associated with the following: 

  • decreased preop anxiety,
  • decreased post op cortisol levels, blood pressure, heart rate, pain level, thus decreased requirements for post op sedation and pain medications 
  • decreased pain and depression in fibromyalgia patients 
  • decreased heart rate and pain in hospitalized pediatric patients 
  • improvements in both branches of the immune system, cellular and humoral, in the elderly 
  • improvements in athletic performance 
  • improved sleep 
  • improved cognitive function 

 

 

How does our body and mind produce all these responses through music? The precise science is not entirely worked out. However, studies using measurements of hormones and neurotransmitters by blood tests and targeted neuroimaging reveal the involvement of the dopamine, serotonin, and adrenal pituitary axis systems, among others. 

The cardinal work on this matter seems to be an article produced by one of my old college housemates, Dan Levitan, and his colleague Mona Lisa Chanda. (See reference below.) They evaluate and ultimately support the claims that music produces its effects through the bodies systems for reward, motivation, pleasure stress, arousal, immunity and social affiliation. And these responses, of course, work through various brain centers which produce the aforementioned hormones and neurotransmitters. 

So how you feel on music is very very real. So I suggest you indulge yourself. Find your music and bring it into your life. Better yet, make your music. And if you have small children, do everything you can to get them into music education as early as possible. It helps develop the brain and enhances the power of all the good things music can do for us. 

 

 

Medical Monday: Insulin resistance

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This is one of those chicken and egg things. It turns out that being insulin resistant makes you gain body fat. But, it also turns out that gaining body fat makes you more insulin resistant. What a vicious cycle! No wonder it is hard for people to lose weight. 

Recall that insulin is the hormone produced by the pancreas which is responsible for getting glucose from the circulation and into the cells, where it can be used for energy.

Recall that glucose is the final breakdown product of all carbohydrates (carbs) like bread, rice, pasta, potatoes, etc. If too much glucose is in the circulation, either because too much has been consumed at once, or because the insulin cannot move the glucose into the cell or both, high levels of glucose in the blood stream get turned into triglycerides and fat. Atherosclerotic plaques can form in the vessels and cardiovascular disease results. This is part of what we call metabolic syndrome. 

In a normal person, insulin rises in response to a meal and diminishes in-between. Moreover, it rises in proportion to need. Insulin would spike if you drank a coke, but just gently ebb if you ate some strawberries. Why? Because the sugar of coke just jets into your bloodstream, unnaturally rapidly. Your body cannot cope with it. A strawberry has structure and the sugar and nutrients release slowly. Said another way, the glycemic index of coke is high, and that of a strawberry is relatively low. 

I recommend that my patients eat low glycemic all the time. What about treats? When a person eats low glycemic consistently, their ambient insulin levels decrease. Insulin levels are related to cravings, and their cravings diminish. A "treat" will bring the cravings back, since it may cause insulin levels to spike. If you think you can have an occasional treat and then resume your healthy low glycemic diet and resist cravings, more power to you. 

How do you turn this vicious cycle into a virtuous cycle? First visit with your doctor if you have diabetes, the condition which is the mother of all insulin resistance. Visit with her if you have been told you have polycystic ovary syndrome. This also entails some degree of insulin resistance. 

Second, learn about how to keep your blood sugar low and steady, with three meals and three snacks every day. Add protein each time to buffer your carbohydrates. Add exercise everyday to boost your muscle mass, burn fat, increase your insulin SENSITIVITY and increase your metabolism. 

Here's the flip side of the coin: If you lose fat, you will become more insulin sensitive. And, if you become more insulin sensitive, you will make it easier to lose weight! 

To learn more, check our sections on 

NUTRITION 

CHRONIC ESTROGENIZED ANOVULATION

For more reading check THIS out from Live Science. 

 

Structure Sunday: The Structure of Grocery Shopping

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I am interested in grocery shopping since it has a great deal to do with what we eat. What we eat has a lot to do with our health. Since this is all so very important I am going to break it down into ridiculous but useful detail. The following is a primer on how to go grocery shopping. 

First reflect: 

First and foremost, think about your nutrition goals for the week. Remember that Dr. Gina wants you to consume primarily meat, fish, chicken, vegetables and fruits in three meals and three snacks every day. Review our Nutrition section if you have questions. Think about some of the awesome healthy dishes you would like to make. Include those ingredients on your list. 

Inspect, tidy and make lists: 

Be brave and look into the depths of the fridge. Find any science projects (spoiling food in containers) and get rid of them. If you consolidate things like ketchup bottles and wipe out the refrigerator shelves a little bit it will make you feel so much better. You will see that feeling better is actually important, since it will help you avoid buying things you don’t need. Look in the freezer, and all the cabinets too. Make room for the new groceries. Go to your laundry room and your bathrooms, and check and tidy there as well. After you are done inspecting and tidying, make your lists of all the things you need to buy. You can group them any way you want, either by store like I do, or by store section. Make your list on paper or on your phone. I tend to lose paper lists. 

The idea here is that with a list you will buy only what you need, and nothing that you don’t need. Sure enough, you may run into excellent and discounted produce you didn’t know was in season, and that I believe is a legitimate reason to go off list, but just any old bargain is not. 

Prepare yourself to shop: 

Research clearly shows that we often suffer from “needs confusion”. When we are tired, hungry, bored or angry, we soothe ourselves with retail therapy. Buying, like many pleasant things, produces a surge of potent neurotransmitter, not dissimilar to those felt with accomplishment or good fortune. In unpleasant states, we are more vulnerable to marketing ploys and subliminal suggestion, and we are anxious to resolve our uncomfortable state. So, I suggest that you work out, shower, dress and eat at least a healthy snack before going out to shop, hereby calling up happy neurotransmitters in more legitimate ways.  

Pack for the trip: 

Make sure and collect all your reusable and attractive shopping bags. Get rid of the ugly downer bags, my goodness. Life is too short for ugly shopping bags.

Bring healthy snacks so you will not fall prey to the samples. Bring all the equipment and healthy snacks you need to keep kids happy. This will help both kids and parents resist child-initiated impulse buying. 

When to go: 

I am a firm believer in twice per week shopping. Any more is onerous and any less results in a lack of fresh food, which is so important. I have chosen Sundays and Wednesdays since that is easiest for me. 

Where to go: 

Assuming you have already gone to your own garden, your own freezer, and your own farmer’s market first, you must then consult your list. To get exactly what I want (and I am very picky) I have to go to at least two stores. Usually one is Costco, which has more organic food all the time. The other is my local organic/natural/whole food store. 

 

Once you get there:

Understand that everything in the store environment is designed to get you to buy. This goes from the print, the colors, the displays and the music. Use your own mind. You have already decided what you need.

  • Be skeptical, stick to your list, and be a label reader.
  • Be wary of health claims on product packaging.
  • Stick to real fresh food, which is mostly located on the periphery of the store. Stay out of the middle of the store without good reason.
  • Be cautious about budget brands. They may be cheaper for market reasons, or because they use cheap fillers which are not healthful. 
  • Be cautious about coupons and sales. Do not let these cause you to buy something you don’t need or more than you can use. 

 

 

 

 

 

Enjoy yourself: 

Your nervous system is right. You have every reason to feel a thrill right down to your neurotransmitters when you pick up you a big crate of ripe strawberries. Eating is one of the great joys of life. To be able to acquire beautiful varied foods as we do is unprecedented in human history. Think about what it takes to bring us this food: all of the people and places and knowledge that come into play. It is nothing short of amazing. 

 

 

 

 

For more reading : 

 

How to Buy Food, at Bon Appetite

The Psychology of Shopping: How Grocery Stores Make Rational Shopping Nearly Impossible

Supermarket Psychology, by Weight Watchers 

Surviving the Psychology of Sneaky Supermarkets, at National Geographic 

A Few More Ways that Supermarkets Mess with Your Mind, at Business Insider 

11 Psychological Tricks of the Supermarket Trade, at Food Network

Ten Ways your Local Grocery Store Hijacks Your Brain, by Psychology Today 

 

 

 

 

Food Friday: Cool Dinners for Hot Days

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It’s summer and the weather is hot. It’s great to turn to festive cold dishes. But they often contain lots of simple carbohydrates, which most of us should avoid. Here are some tips to help you avoid the same old sandwiches, crackers and pasta salads. 

Some recipes, especially these which are high in protein, require a little preparation in advance. 

With advance cooking: 

  • Prepare any kind of meat, chicken or fish in surplus. Use in any of the following ways: 
  • Season liberally and toss into a leafy green salad for a balanced meal, e.g Taco salad. Serve with fresh corn rather than chips.
  • Season liberally and toss with firm vegetables such as cubed carrots, steamed broccoli, carrots, peas, corn, peppers, tomatoes. Dress with a vinaigrette in advance to marinate, flavor and soften. Add raw nuts to any salad but be sure about allergies. 
  • Make wraps and include vegetable, garnishes, salsas and condiments. Consider rice, seaweed or iceberg lettuce wraps with toothpicks. 
  • Use hard boiled eggs as a protein rich garnish to leafy salads, or mix with olive oil vinegar, mustard lemon and spices to make a rich dressing. Traditional Cobb Salad and Salade Nicoise are made this way. 
  • Make an egg salad with lots of vegetables like celery, pickles, relishes, peppers, etc. 
  • Make “meat” balls of chicken, meat or even fish (called gefilte fish traditionally), and serve on sticks with flavorful cold sauces for dipping. Find recipes that have high flavor since flavor is more subtle in cold dishes. 
  • Make chicken salads, e.g. curried chicken salad or Waldorf salad. 

 

With no advance cooking: 

( Remember, deli meats are not for pregnant women.) 

  • Meat deli trays.  
  • Cheese Deli trays. 
  • Smoked fish or poultry platter. Any of these can go with all the trimmings, i.e.fruits, vegetables, condiments. Try not to resort to all the crackers. Build hor d’oevres on slices of cucumber, small tomatoes halves or slices of firm cheese.
  • Toss cubes of feta, mozarella or other cheese with leafy or firm vegetable salads. Dress attractively with flavored vinaigrette or a creamy homemade dressing. 
  • Make cold fruit soup with a yogurt or kefir base. 
  • Use canned salmon or your favorite canned meat fish or chicken to make spreads, dips and additions to salad. Think "tuna salad” but better. 

 

Once you’ve got a protein rich cold main dish figured out, it’s easy to think of cold side dishes. Make any kinds of fruit or vegetable salads; try your hand at a cold Gazpacho. Those who can tolerate legumes (beans, tofu, etc) can make many more protein rich dishes, though one must bear in mind that to constitute complete protein, legumes must be combined with whole grains. 

To keep your cool dinner healthy, steer clear of soda, fruit juices and excess alcohol. Lightly sweetened herbal iced teas flavored with lemon wedges and mint leaves are always appreciated. You can also use just a splash of fruit juice with cold and very economical club soda, at a fraction of the price of commercial gourmet sodas. 

Finally, cool desserts are easy. Try fresh berries, melon or pitted fruit with cow’s milk or coconut cream. If you are feeing ambitious, prepare an exotic sorbet. Simple reliable ice cream makers are commonly available these days at any big box store, and make your recipe into ice cream in 45 minute or less. Just remember to freeze the cylinder well in advance of using it. 

Wellness Wednesday: Creativity and Health

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Yes! There is substantial connection between creativity and health. I started thinking about it today when my creative son Vale said he needs different parts in his day: some hardworking, others restful, and then finally, a creative time. The creative time is when he really recharges. I feel the same way. I crave that creative time almost as one would crave food or drink. 

What is the science behind this? To answer this, we need to remember that, on one level, we live in our nervous system. Our nervous system has two main parts: electrical and chemical. Chemical messengers called neurotransmitters convey information between neurons, long nerve cells, which then conduct electrical signals down their lengths. All our sensory input and thought output occurs this way. When we are creative, the brain is utilized in broad new ways, in a process that is both effort-requiring and pleasant. New neural networks are formed and older ones are kept healthy. More neurotransmitters are released. In fact, a Yale study (1) found that older "creatives"  have measurably more robust white matter of the brain, and tend to live substantially longer than non-creatives. Ok, so creativity seems to keep brain tissue healthy, which seems to be associated with longevity. 

It turns out that creativity also seems to impact the immune system. This was suggested in a small study of HIV patients, wherein writing was utilized as a therapy. Emotional writing versus non emotional writing was associated with a significant rise in CD4+ white cell counts. (2)

All form of creativity seem to be associated with positive health outcomes, from music, movement, to the graphic arts.

"There is evidence that engagement with artistic activities, either as an observer of the creative efforts of others or as an initiator of one's own creative efforts, can enhance one's moods, emotions, to other physiological states as well as have a salient impact on important physiologic parameters. " (3) 

Music has even been shown to help control pain. (3) 

Both being creative and experiencing the creative efforts of others improves measures of well being. On this basis, 

"... the arts are also being used to create safer hospital environments, introduce nature into medical settings and enhance aesthetics through hanging art on previously sterile space. And guess what? Patient/caregiver stress is measurably reduced, quality of care is increased, and costs of treatment go down. (4)

Numerous observational studies have shown associations between being creative  and the following outcomes: 

  • increased happiness/enhanced mood
  • less anxiety
  • increased resilience
  • better problem solving and mental acuity
  • improved self confidence
  • decreased tendency toward dementia
  • increased longevity

What of the person who says they are not creative? First of all I think this is misconception. Creativity may be something you are, but it is also some thing you do, and something you can develop. Though I cannot tell you exactly how to be creative, I can give you a few hints. Creativity involves the following two traits/practices: 

1. openness- meaning mental flexibility and willingness to entertain new ideas

2. conscientiousness - which means carefulness and perseverance. Malcolm Galdwell has postulated that 10,000 hours at something is required to achieve mastery, and of course mastery is associated with that pinnacle of creative states, FLOW, but that is a topic for another day. 

Meanwhile have a look at my latest creative endeavor: 

 

 

References: 

http://www.ncbi.nlm.nih.gov/pubmed/21840401

 http://www.ncbi.nlm.nih.gov/pubmed/22807062

(1) http://www.jneurosci.org/content/29/16/5319.full

(2) Psychosom Med. 2004 Mar-Apr;66(2):272-5. 37 pts 

(3) Am J Public Health. 2010 February; 100(2):254-263. 

(4)https://www.psychologytoday.com/blog/arts-and-health/201004/arts-in-healthcare-creativity-the-health-it

 

Wellness Wednesday: Weathering the heat

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Do you know how hot you are ? Do you even know how hot is too hot ? Find out here before things get too hot to handle. 

One of the body's main tasks is to maintain a constant internal temperature. Our physiologic functions depend on it. There may be fairly wide fluctuations in our external temperature, but our core temperature must stay quite steady, near 98.6 degrees F. If it does not, we can suffer heat exhaustion and heat stroke.  Per Outside Magazine (reference)" On average, nearly 700 people die each year from extreme heat. ". 

When are people at risk ? 

  • During heat index of 90 degrees or more 
  • During relative humidity of 60% or more 
  • When working in contact with hot objects, or wearing bulky protective clothing 
  • When in places of direct sun with little air movement 
  • When they are very young, very old or unhealthy

Heat exhaustion

  • Caused by loss of body water through excessive sweating
  • Symptoms of heavy sweating, weakness dizziness, visual disturbances, thirst, vomiting, diarrhea, shortness of breath, palpitations, tingling of hands and feet and collapse
  • Treatment- cool and hydrate the person by any means possible as quickly as possible

Heat stroke

  • Results when the body can no longer cool itself though sweating or other means and the core temperature rises to 104 or higher. 
  • Symptoms are confusion, agitation, irritability, seizures, coma and brain and other organ damage. 
  • Heat stroke victims usually do not recognize their own symptoms. 
  • Skin will be dry if heat stroke is caused by hot weather, but moist if caused by vigorous exercise. 
  • Skin is flushed, breathing is rapid and shallow. 
  • Heat stroke comes on quickly.
  • If heat stroke is suspected, it is imperative to call 911 to get immediate medical attention
  • Treatment- Cool and hydrate the person by any means possible as quickly as possible while waiting for the ambulance. 

Engineer shade, breaks and ample hydration into your summer activities to keep everyone safe and comfortable in the heat. 

References: 

http://www.mayoclinic.org/diseases-conditions/heat-stroke/basics/definition/con-20032814

http://www.webmd.com/a-to-z-guides/heat-stroke-symptoms-and-treatment

https://www.osha.gov/SLTC/heatstress/

 

Wellness Wednesday: Quantify Yourself

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I have always said that knowledge is power. This is especially true in this digital age since we have access to so much searchable knowledge. I have also always said that one of our primary goals in our medical practice is to empower women to take charge of their own health.  It is therefore natural that I am very interested in helping women to empower themselves through the use of technology.

It turns out that one of the most powerful things we can do to take control of and change our own behaviors is to observe, record and track them. This habit is called quantification. People who do this regularly as a part of their self improvement are participating in the "quantified self’ movement. Livescience.com defines the quantified self movement as a “movement which aims to measure all aspects of our daily lives with the help with technology.” 

Quantifying ones habits such as hours of sleep, minutes of exercise, or calories eaten, does not necessarily need to be done with a high tech device. It can be done with paper and pencil. However, since smart phones are nearly ubiquitous, these records are most often kept on these small powerful personal devices.  Of course there is a proliferation of different apps for this, one for every topic and several for many parameters. Not only is there a proliferation of different software apps to help with quantification, there is a proliferation of different hardware such the Apple watch and the FitBit. 

If the patient and I decide to follow some detail of her health such as her blood sugar, we begin some sort of record keeping. The patient makes the measurements, records them and naturally evaluates them herself as she goes through the week. This alone often results in substantial improvement in her numbers, since she can begin to discern patterns and the reasons behind them. Taking measures to push the data toward better performance is gratifying day by day. It becomes like a game that the patient is determined to win. This is called ”gamification" and it too, it is powerful in behavior change.

When the patient comes in to review her data, she can get even more benefit when we analyze her data together. If we add another layer such as her diet, and superimpose it graphically on the blood sugars in her records, we can see a cause and effect relationship between what she eats and her blood sugars over time. Sometimes a third layer of data such as activity can be added into her records and we can use this variable to improve her blood sugar control even more. 

This kind of record keeping puts the facts and the control in the hands of the patient. It is much more effective than a doctor simply telling her to eat better and exercise more. It has been my consistent observation that all sorts of patients have success with this type of approach. Moreover, in reading about this "quantified self movement" it seems apparent that this technique can be used for many types of conditions, like weight, exercise, autoimmune activity, sleep problems and even mood disorders. It can also be used for broader issues of life performance, in relationships and on the job. 

I hope this introduction into the quantified self movement has inspired you to learn more. Here are some fun references which makes for very interesting reading.

The Quantified Self, a TED talk by Gary Wolf

The Quantified Self at Livescience.com

The Beginners Guide to Quantified Self, at Technori

Why You Should be tracking Your Habits ( and how to do it well) at Lifehacker.com

The Quantified Self: How Cold Hard Data Improves Lives, at Bloomberg.com

The Data Driven Life, at the New York Times 

How Self-Tracking Apps Exclude Women, at The Atlantic

Medical Monday: Skin Deep

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What does it take to be beautiful ? I mean physical beauty. It it feels so awkward to even ask this since, in general, beauty is mostly a matter of the heart.

 You might be surprised to hear about my idea of physical beauty. Basically, to me, physical beauty equates with health. Every face, every age, every body type, hair type or skin color is beautiful when it is healthy. 

Skin is especially telling. It is the first thing we see. The skin of the face is vulnerable and worthy of our protection. It is sun season again, and I would love to see everyone take pride in and care of their skin. 

 

What are the main steps to beautiful skin ? 

  • Optimize your fitness, nutrition and hydration. 
  • Cleanse and moisturize twice per day. 
  • Exfoliate once per week.
  • Sun (UV) protect ardently. 
  • Never tan. Never. 
  • Be assured sunscreen is safe.
  • Chose a broad spectrum sunscreen with SPF 30 or greater. 
  • Chose a water resistant brand. 
  • Apply 15 minutes before going out so it will soak in. 
  • Reapply every 2 hours. 
  • Consider a hat or SPF clothing. 
  • Get a partner to "watch your back" for any suspicious moles. 
  • See your dermalogist for any concerns. 
  • Enjoy summer. 
  • Be beautiful. 

Food Friday: The Joy Lunch Club

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Who doesn't look forward to lunch during a busy day tending kids at home or a hard day at work? I look forward to lunch. However, when I interview patients about their eating habits, I find all too often that patients skip meals, especially breakfast and lunch. 

I understand. We're busy. Sometimes we're not even hungry. We think skipping meals will help us lose weight. But as I have mentioned before, skipping meals actually causes us to lose muscle and slow down our metabolism and our thinking, making us feel sluggish and perform poorly. If we skip breakfast we are even less hungry than we would be had we jumpstarted our metabolism with a good breakfast. 

 

So, I have decided to promote the idea of a homemade workday lunch by issuing a challenge called the Joy Lunch Club. I will give the readers of this blog two weeks to submit a picture of their awesome lunch on a typical busy day. The best workday lunch photo at the end of two weeks will receive a custom "yoga girl" lunch box complete with containers and ice. To qualify, the lunch must be healthy, contain protein and produce like fruit or vegetables, be homemade, and if  brought to work, be in suitable containers. Photos may contain the lunch itself or you with the lunch. They should be posted to my office Facebook page linked to this website. Finally, to be eligible for the prize, you have to be subscribed to the site. (Please see the "Subscribe and Comment" section in the menu.)  At the end of the two weeks I will announce the winning photo, who's owner will then need to Facebook message me for the prize. Unfortunately I need to limit this offer to the US and Canada.

Others can order this unique lunch box through our Zazzle Store found HERE. Have fun, enjoy your lunch and good luck! 

Structure Sunday: The Structure of Time

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For life to be good, we need a rhythm in the day, the week, the month, the season and the year. These circles within circles allow us to feel accomplishment, and to look forward to celebration. These finite periods allow what is overwhelming to become manageable. Structuring time helps us take the one lifetime that is ours, and fill it mindfully. 

I need to feel I am making progress on my long term goals every year. I use the annual holidays like Thanksgiving and New Years for self assessment. I can look back at the same time one year back and see the changes. 

The seasons hold a different joy. Each time I am sad to see the leaves fall, I am, shortly thereafter, shocked by the beauty of frost and snow. I am reminded that all seasons hold beautiful surprises, and that I am foolish to imagine that nothing exciting is around the corner. 

My business cycle is the month. This is how bills are paid, and accounts are balanced. Accountability is examined month by month. Actual money is one representation of work and effort, and as such it is a useful tool to use in gauging how we are meeting our responsibilities. 

My work cycle is the week. I want a chance to get stuff done, and I want to be creative in that work. I try to pace myself all week long, with a lighter day midweek, then forge on to the weekend, when I would hope to be creative. 

My personal cycle is the day. I believe we all thrive with a good day's work. However, in my opinion, this includes some important health and productivity features. Consider the basics:  sleep , nutrition and exercise. Most people need at least 7 hours of sleep. With this, you will have more concentration, stamina and productivity. You might even have a better mood. Life is just more fun and you will be more successful with a modicum of sleep. 

Food is so important! It is your fuel. You should frontload your day with a healthy breakfast of protein, fruits, vegetables, and whole grains. That will turn on your metabolism and your brain. Later in the day, food can give you several healthful recharges: your midmorning snack, your lunch, and your afternoon snack. This way you will not tank your metabolism, feel sluggish, or hardly be able to think. Eating three meals and three snacks per day is a foundational principle of nutrition, and will help you feel better and perform better. 

Somewhere in the course of the day you must carve out at least a half an hour for exercise. It is best to schedule this formally, just like a meeting or an appointment, and to take it just as seriously. The magic of routines will reward you if you persevere. The more you do it, the easier it will be. 

 Everyone from a teen mom to the CEO of a large corporation needs a schedule. To achieve mastery over your time, you must invest in either a paper or electronic system. Smartphones generally come with everything you need in this regard, but the old school day runners can do just as well. But these alone won't do the trick. You must develop a routine of sitting down with the schedule to look it over and fill it in mindfully. I recommend looking at your schedule every Sunday to assess the coming week, and also looking every evening to prep for the next day. Make your schedule check a routine. The habit will stick better if you do it at the same time and place every day. 

Routine lowers stress. Breaking up goals and plotting them over time encourages success. These are among some of the most important things I want for my patients. The particulars I teach them about disease conditions and health maintenance will not help them unless they can follow through on the recommended treatment or prevention steps. Fostering patient success will continue to be a big thrust of this blog and the website in general. 

For more information, please see the hyperlinks in the text. Have a great week ! 

Food Friday: Manage your weight the counterintuitive way !

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It seems to make sense that to lose weight we should eat less. On the other hand we all know certain people who seem to eat all day long and are quite slim. Indeed, the French who are known for their small figures, have food as a centerpiece of their culture, a lot of it, and all day long, well into the night. 

How is it possible? It's all about metabolism. It's not about the calories you eat in one sitting, and it's not about the calories you burn in one exercise session. It is about the rate at which you feed calories into your system and your body's ability to utilize them as they come in. 

 

To have good energy all day, you must have a moderate steady input of calories all day long. If you have a span of time without enough fuel, you body will turn down your metabolic rate and you will feel fatigued and be sluggish. If we eat episodically, then binge, we create a slow metabolism, then overwhelm it with an excess. Such an excess is stored as fat, even though then total number of calories eaten in that day might have been low. This strategy leads to feeling sluggish, losing muscle, and gaining fat all in the course of one day. 

Anyone would rather feel energetic and improve their body composition, but few know how.  Surprisingly, you have to eat more of the right kinds of food, and eat them more often. This produces a steady release of calories. To accomplish a steady release of calories into your system, you need to choose foods which singly, or in combination, release slowly. Unprocessed natural foods tend to release slowly, whereas process foods release quickly. If you combine high quality carbohydrate containing foods like fruits and vegetables with healthy fats or proteins, then you will have energy even longer. 

The rate at which a food digests and release energy in the form of glucose is called the glycemic index. Slow release foods have a low glycemic index, and that is what we should be choosing. If we choose high glycemic foods like sweets or breads, we stimulate a spike in our insulin levels, which leads to cravings. Thus, the less we eat of high glycemic foods, the less we want them. 

Do you want to leverage the system even more? Build up some muscle through a mixture of cardio and resistance. Muscle is lean body mass and has a much higher metabolism than body fat. Either cardio or resistance will increase your metabolism all day long, far beyond your exercise session, but together, they synergize. 

If you are willing to eat three moderate meals and three small snacks composed of some protein, fruits, vegetables, healthy fats and low glycemic grains, you will have more energy and you will drift toward your ideal weight. If you are willing to do a half an hour of cardio and light resistance every day though a gym or a DVD available at any big box store, you will make progress even faster. 

To learn more, see this following section in our website. 

Nutrition 

Bon appetite! 

Medical Monday: Gardasil Gets an Upgrade

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Most of you are familiar with Human Papilloma Virus, aka HPV. This is the very prevalent virus which causes precancer and cancer of the human anogenital area. When I first started training in gynecology, fighting HPV seems like such an uphill battle, since it spreads so easily and is so prevalent. And then came the idea of a vaccine. It seemed too good to be true. 

Gardasil was developed and released. I am proud to say one of my friends was involved. It protects against two strains of HPV known to cause cancer, and two which cause condyloma or warts. Physicians all over the world rejoiced, but adoption rates weren't what we had hoped. 

Gardasil was initially studied in girls and women since the disease caused in women is more common and more severe. And so it was initially approved only for women. I got all my children vaccinated, and even the boys before it was approved for boys. One of my sons did some research after he got his shot, and approached me later, asking, " Mom isn't this just for girls ? " I reassured him that nothing bad would happen. It works just as well in boys and men, who distribute the virus, usually without having any disease themselves.  It eventually was approved for boys. 

Now Gardasil has been expanded to cover NINE viruses ! It is worth noting who is eligible to receive it: 

Boys ages 9-15.

Girls and women ages 9-26. 

 I expect that the age differential in eligibility between boys and girls is simple a case of what groups have had validating studies done, and I anticipate that the boys group will be expanded to the same age group as girls eventually. 

Chilling statistics anyone? 

" In 2013, coverage of at least one dose of HPV vaccine was 57.3% among adolescent girls and 34.6% among adolescent boys2. According to the CDC, for every year that coverage does not increase, an additional 4,400 women will develop cervical cancer3. Furthermore, if health care providers increase HPV vaccination coverage to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years." 

reference: ACOG Clinical Practice: The 9-Valent HPV Vaccine 

Gardasil has had a very good side effect profile, with just some arm soreness at the site. We believe its benefits far outweigh the risks. 

To learn more about HPV, please see Pap Smears, HPV and Cervical Health.