Tag: Preventive Care

Eating Well: The Balanced Plate

The Atkins Diet. The South Beach Diet. The Paleo Diet. The Mediterranean Diet. The Keto Diet. Jenny Craig. Weight Watchers. Awaken 180. Isagenix. Most of us have heard of at least some of these diets and meal replacement programs. While each has its supporters and detractors, they share the common goal of improving our well-being via healthy eating habits. “Which one is best for me?” is a question that commonly arises in our office. To explore the ever-growing list of options, I reached out to Marc O’Meara, our nutritionist at PersonalMDs.

Brad: How do people know which diet is the “right diet” for them?

Marc: Rather than advocating a specific diet or meal replacement program, I encourage my patients to focus on the nutritional content of their meals.

Brad: What does science tell us about the general principles of a healthy diet?

Marc: A plant-based diet is the best place to start for healthy eating habits with some animal products included. This means a diet that contains a lot of vegetables, nuts, seeds, and fruits. A plant-based diet filled with healthy nutrients is associated with a lower risk of cardiovascular disease and diabetes. Think of nutrients as an army that enters our bodies to protect our organs.

Phytonutrients (plant nutrients) are the best soldiers in this army. Fruits and vegetables with a deep color or strong aroma contain the most healthy nutrients. For example, blueberries and pomegranates have a dark, saturated color throughout and contain more nutrients than bananas which have a more pale color. Vegetables with deep, vibrant colors such as spinach, kale, and swiss chard are also very nutritious.

Some phytonutrients have anti-oxidant properties. This is analogous to a car with its protective paint. Oxidation in our bodies is similar to the rusting of a car. We try to prevent our cars from rusting to protect the metal underneath. The anti-oxidant effect of phytonutrients helps keep our organ systems healthy. Some phytonutrients reduce the amount of cholesterol that becomes oxidized. Oxidized cholesterol has been associated with an increased risk for developing clogged arteries. Other phytonutrients may help reduce the abnormal proliferation of cells and blood vessels which can reduce the risk of some cancers.

Brad: Are there certain foods we should try to avoid?

Marc: There are no foods I tell patients to avoid. I encourage people to limit white foods and products such as processed breads and sugar. These generally contain a lot of carbohydrates that have low nutrient value and thus are not a balanced food product. They do not provide much benefit for our bodies.

Brad: I’ve heard you counsel our patients that carbohydrates should always be accompanied by a protein. Why do you advise this?

Marc: When one eats a meal that contains just carbohydrates, the sugar rushes into our bloodstream, resulting in a rapid spike in our glucose levels, followed by a rapid decline. This places a strain on the pancreas, as the pancreas suddenly needs to release a lot of insulin to counter the glucose spike. Not only is this unhealthy for the pancreas, but it also can leave us feeling hungry soon after the meal is consumed.

Including a protein and/or a healthy fat with the carbohydrate slows the absorption of the carbohydrate. The protein acts like a dam which prevents the carbohydrate from suddenly rushing into the bloodstream. Avoiding this carbohydrate rush can result in more sustained energy, improved brain function, a better mood, and gives one’s body time to burn it off. If the carbohydrates come flying in at once, it is difficult for our bodies to use them. Unused carbohydrates often get stored as fat. However, if the carbohydrate is absorbed more slowly, there is a better chance that our bodies can utilize the carbohydrate without converting it into fat.

This is the concept of a low glycemic index diet. By slowing the rate of carbohydrate absorption into our bloodstream, we have a better chance of managing our glucose levels and, secondarily, our weight. Avoiding a sudden sugar rush lessens the demand on the pancreas.

Brad: What about eating fruit? Some of my diabetic patients have been told to avoid eating fruit because they are high in sugar.

Marc: While fruits do contain sugar, they also have a lot of healthy nutrients. People often eat fruit alone as a snack. I advise my patients to pair fruit with a protein or a food with both a protein and a healthy fat, such as nuts, Greek yogurt, or a piece of cheese. This slows the absorption of the sugar which leaves one feeling more satiated from the snack, and gives the body more time to burn those calories.

Brad: What does a healthy plate look like?

Marc: I’m a proponent of a balanced plate. Half of the plate should consist of vegetables or salad, while a quarter of the plate contains a protein, and the remaining quarter has a carbohydrate. Carbohydrates that have a color and contain fiber are healthier. The carbohydrate portion of the plate should not be larger than the protein. I advise fruit as a healthy carbohydrate choice, followed by whole grains such as quinoa, farro, or whole grain breads.

Brad: What type of animal protein do you recommend?

Marc: I encourage lean proteins which include all types of seafood and poultry. I prefer skinless poultry. Dark poultry is OK too. I advise people to limit their intake of saturated animal fats. Red meat is not as healthy as leaner meats because of the saturated fat content, which can increase one’s cholesterol and risk of heart disease.

Brad: What are common misperceptions of what constitutes a healthy diet?

Marc: I often hear that eggs raise one’s cholesterol. This theory has been debunked. Dairy fats such as cheese, butter, and ice cream contribute to elevated cholesterol much more than eggs.

Some people think that almond milk is healthier than regular cow milk. While almond milk is low in calories, it contains only carbohydrates so it should be consumed with a protein. Cow milk is more balanced than almond milk, as cow milk contains protein. Now, almond milk can be easier to digest – less bloating, less abdominal discomfort, and less gas – so it is preferred by some who have lactose intolerance.

Another common misconception is that we need to maintain a low fat diet. This trend developed in the 1990’s. I try to encourage my patients to eat healthy fats which are plant-based. Avocado, olive oil, and clear salad dressings (vinaigrettes) are some examples. Mayonnaise is also a healthy fat – it is made from vinegar and oil. The Mediterranean diet is high in healthy fats and has been shown to be beneficial for our health. As we entered the 2000’s, the pendulum shifted away from a low fat diet to a diet that contains healthy fats. Healthy fats make food taste better and slow gastric emptying, which allows food to be digested over a longer period.

Many people think that breakfast cereals are healthy, but oftentimes they are not. Lots of cereals are transformed into sugar after they are digested. If you enjoy cereal for breakfast, the portion size should be small and it should be accompanied by a protein such as nuts. Fiber-containing cereals do not control blood sugar as well as protein and healthy fats do. It is common for cereal eaters to become hungry before lunch. For those who do eat cereal, I recommend oatmeal and the higher fiber cereals as they take longer to absorb. Our bodies need to digest the fiber first before absorbing the carbohydrate inside.

Brad: What are your thoughts about the many diets that have been promoted over the years? The Atkins diet? The South Beach diet? The Paleo diet? The Keto diet?

Marc: I consider these diets to be short-term solutions because they are difficult to maintain. What does one do when they are no longer able to adhere to the diet? A modified Paleo or a modified Atkins sometimes work better because they are easier for people to sustain. Most of these diets are about keeping healthy blood sugar levels.

Brad: Your thoughts on intermittent fasting?

Marc: A fasting diet is all about caloric intake. Eliminating food for an entire day keeps your calorie count low, but it doesn’t rid your body of toxins. Some people report that they feel good on their fasting days, but this may reflect how they are eating on their non-fasting days.

Brad: Are meal replacement programs such as Isagenix or Optavia effective for achieving weight loss?

Marc: Some of these programs can be effective because they provide balanced meals with a low glycemic index. These diets are mainly targeted for those who are trying to lose weight. The question is: what happens when an individual stops one of these meal replacement programs?

Brad: Should we continue to count calories?

Marc: Calorie counting helps with weight loss, but it’s only effective if one can keep their calories low and still feel full.

Brad: What happens to our metabolism as we get older?

Marc: Our metabolism starts to slow around age 40. If we do not stay active and maintain muscle mass, our metabolism slows more quickly. When we lose muscle, we lose some of our capacity to burn the calories we ingest. Our metabolism is fastest around noontime and slows down in the evenings. This is why I advise my patients to avoid eating large dinners.

There was a study that showed that those who eat snacks late at night have a more difficult time losing or controlling their weight compared with those who do not snack after dinner. If you eat a balanced dinner, you should not need to snack afterwards. I ask my patients, are you snacking after dinner because you feel hungry or is it a habit? Snacks at night more easily turn into fat because our metabolism is slower, we may not need these extra calories, and we therefore do not burn much of what we eat.

Brad: Are juices and smoothies healthy?

Marc: If the juice or smoothie contains protein and is well-balanced, it can be part of a healthy eating plan. Fruit juices, however, cause significant spikes in blood sugar. Vegetable juices with a touch of fruit are healthier because they do not cause a sugar spike. Juices containing dark green vegetables have a lot of beneficial phytonutrients.

Brad: Protein bars: love ‘em or hate ‘em?

Marc: Some people replace breakfast with a protein bar. When choosing a protein bar, select one that has a good balance of protein and carbohydrates. Some protein bars are very good, but there are others that are just like candy bars. It is important to read the nutrition label to make sure the protein and carbohydrate are well balanced. A balanced protein bar contains a similar amount of protein and carbohydrate. For instance, Nature Valley granola bars contain 28 grams of carbohydrate with 2 grams of protein which is not good. This will cause a big-time spike in blood sugar. However, Nature Valley protein bars have similar protein and carbohydrate content which results in slower absorption, leaving us feeling fuller afterwards.

Brad: For those who are trying to lose weight, what is more important: diet or exercise?

Marc: Recent studies show that poor eating habits contribute 80%, while lack of exercise is responsible for about 20% of the problem. Many of my patients work out regularly and burn off their calories at the gym, but then they return home and eat unbalanced meals. They keep shooting themselves in the foot because their workout program is accompanied by poor eating habits, which keeps putting the fat back on. Exercise is important because it makes us feel better and allows us to maintain muscle mass which helps with our metabolism and bone density. However, unbalanced plates, large portion sizes, and evening snacks make it difficult for many to lose weight.

Brad: Thank you so much for providing your expertise and insight. I know this will be very informative for our patients.

Marc: I’m happy to help.

If you wish to learn more about how good eating habits can enhance your health and overall well-being, Marc is available by appointment for all members of PersonalMDs. He offers both individual counseling and group classes. To schedule a visit with Marc, you may send us an email or call our office, and we will be happy to facilitate an appointment.

Wishing you a healthy summer with good eating!
Brad Weiner, MD

This blog is for informational purposes only. It does not replace medical care from a licensed physician.  Please contact your doctor if you have any questions or concerns.

Understanding Obstructive Sleep Apnea

Mr. R is a 64 year old man who is experiencing fatigue.  He maintains a busy schedule both at work and home, but makes sure that he gets eight hours of sleep each night.  Despite setting aside this time to sleep, Mr. R does not feel well rested when he awakens each morning.  He becomes tired by the early afternoon and often naps in his office.   Mr. R’s wife has observed her husband snoring at night, but has also seen him choke and gasp in his sleep.  Mr. R meets with his physician who recommends a sleep study to evaluate for the possibility of obstructive sleep apnea.

What is obstructive sleep apnea?

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Under normal conditions, the muscles of the throat maintain airway patency.   For people with OSA, the muscles promoting this patency are overcome by forces that lead to transient collapse or blockage of one’s airway.

Estimates suggest that up to 15 percent of males and 5 percent of females in North America meet criteria for OSA.  Risk factors include advancing age, obesity, male gender, and upper airway abnormalities.  Smoking, alcohol consumption, and use of sedating medications are other potential contributors.

What are the symptoms of obstructive sleep apnea?

Snoring is one of the most common presenting symptoms of OSA.  Restless sleep, frequent awakenings, choking, and gasping are often reported.  Those with OSA sometimes feel fatigued upon awakening in the morning and may note excessive daytime sleepiness.

How is obstructive sleep apnea diagnosed?

When OSA is suspected, a physician may order a polysomnogram (sleep study).  During this study, the number of disordered breathing events per hour of sleep is measured and is called the apnea-hypopnea index (AHI).

Apnea is characterized by the complete cessation of airflow that is brief and resolves on its own.  Hypopnea is distinguished by a reduction in airflow without total stoppage of breathing.

Why should I treat my obstructive sleep apnea?

Untreated moderate to severe OSA is associated with a greater risk for developing high blood pressure, heart failure, coronary artery disease (CAD), and stroke.  An increased incidence of diabetes has been reported.  Untreated OSA may also contribute to difficulties with concentration, impaired cognition, and may escalate one’s risk for a motor vehicle accident.

How do I treat obstructive sleep apnea?

There are several strategies available to treat OSA.  The goal of therapy is to open one’s airway and, thus, restore normal airflow during sleep.   When developing a treatment plan, many factors are considered including the severity of the diagnosis (as measured by the sleep study), potentially reversible causes, and an individual’s medical history.

Mild obstructive sleep apnea:

For those with mild OSA, lifestyle changes may be all that is necessary.  Some of these interventions include:

  • Weight loss. Overweight individuals may benefit from weight loss.  Extra weight applies increased pressure to one’s airways, making it more difficult for air to pass through.
  • Side vs. back sleeping. Sleeping on one’s side may promote airway patency. Use pillows and other devices to help maintain a side position.
  • Exercise regularly. Exercise may help one lose weight and improve lung function.
  • Avoid alcohol and sedating (sleep) medications which may relax the airway muscles and thus contribute to sleep apnea.
  • Treat nasal congestion. Those with allergies and a stuffy nose may benefit from a spray or allergy medication to unblock their nasal passages.

Moderate to severe sleep apnea:

CPAP (continuous positive airway pressure) is the gold standard for those with moderate to severe OSA.  The CPAP device blows constant and continuous air through one’s nose and/or mouth.  This positive air pressure prevents airway collapse while sleeping.   For those who struggle to find a comfortable fit with their CPAP device, a mask fitting at a local sleep clinic may be beneficial.

Are there other treatment options?

Some individuals with mild sleep apnea may benefit from using an oral appliance made by a dentist.  These dental appliances help keep one’s airway open by advancing the mandible and preventing blockage by the tongue.  Oral appliances are not as effective as CPAP for treating OSA, but are an option for those who have difficulty tolerating CPAP.

Lastly, surgery is available for those with moderate or severe sleep apnea whose symptoms do not respond to the lifestyle changes and measures described above.

I encourage you to speak with your physician if you feel you are experiencing symptoms of sleep apnea.

Wishing you a happy and restful New Year,

Brad Weiner, MD

This blog is for informational purposes only. It does not replace medical care from a licensed physician.  Please contact your doctor if you have any questions or concerns.

Travel Health

You’ve purchased your airline tickets, reserved a hotel, and planned the itinerary for your trip.   Whether traveling for business or pleasure, you prepare in advance for your journey.   What clothes do I need to bring?  Should I stop delivery of the mail and newspaper?  Do I need my passport?  Have I packed my cables, chargers, and batteries?  Do I have all my toiletries?  Who will water my plants and feed the fish?

Here’s another important question to consider:  do I need any vaccines or medications before my journey?

Nowadays, travel to destinations both near and far is commonplace.  As a primary care physician, I want to make sure you are well prepared for a fun, safe, and healthy trip.

What vaccines or medications do I need?

Luckily for you (and for me), the Centers for Disease Control (CDC) and its team of infectious disease specialists, epidemiologists, and public health experts monitor disease trends around the world.  The CDC’s Travelers’ Health page (http://www.cdc.gov/travel) provides excellent, up to date information on the vaccinations and medications you may need to protect yourself.

Here’s a brief run-down of the vaccinations you should receive regardless of travel plans, assuming your childhood immunizations were up to date.

  • Tdap (tetanus, diphtheria, pertussis) or Td (tetanus, diphtheria) booster: one dose of Tdap is recommended for all adults, followed by a Td booster every ten years.
  • Influenza (flu shot) vaccine: one dose annually.
  • Shingrix (shingles) vaccine: two doses for all adults who are 50 years of age or older, given two to six months apart.
  • Pneumovax 23 vaccine: one dose is recommended for all adults aged 65 years or older. Both Pneumovax 23 and Prevnar 13 are advised for those who are 19 to 64 years old with an underlying medical condition that may increase one’s susceptibility to pneumonia.
  • Human papilloma virus (HPV-9) vaccine: recommended for all women and men through age 26.
  • Meningococcal vaccine: advised for those at increased risk for exposure to meningitis.  This includes college students living in dormitories, military recruits, and those with functional or anatomic asplenia (without a spleen).

Now, let’s take a closer look at some of the vaccines and prophylactic medications often recommended for travelers.  Depending upon your specific destination, your physician may recommend one or several of the following:

  • Hepatitis A vaccine: consists of two shots given six months apart. Recommended for those visiting parts of Africa, Asia, Central and South America, and Eastern Europe.  Hepatitis A is present in the United States and Western Europe, but is less common.
  • Hepatitis B vaccine: administered as three injections over six months. The hepatitis B vaccine has been included as part of routine childhood immunizations since the early 1990’s, but is also advised for travelers who have not been previously vaccinated.
  • Typhoid vaccine: available either as a single injection or four pills that are taken over eight days. This vaccine provides protection for up to five years.
  • Malaria prophylaxis: antimalarial medication is indicated for travelers visiting an area that is endemic for malaria. Several antimalarial medications are available;  medication choice depends upon local susceptibility and resistance patterns.
  • Yellow fever vaccine:  delivered via injection, this vaccine is advised for those visiting a country where yellow fever is endemic (parts of Africa, Central America, and South America).  Only specially authorized providers may administer this vaccine.  Those who receive the vaccine are provided with an International Certificate of Vaccination or Prophylaxis (ICVP).  Be sure to bring this with you as some countries require this for proof of vaccination.
  • Japanese encephalitis vaccine: transmitted via an infected mosquito, Japanese encephalitis is mostly found in rural agricultural areas in Asia.  This vaccine is recommended for those who plan to spend extensive time (multiple weeks) outdoors in an endemic, rural or agricultural community during Japanese encephalitis virus transmission season.

How soon before my trip should I meet with my doctor?

It is always wise to plan ahead.  I recommend that you start preparing at least four weeks before your trip, but even earlier would be preferable.  Antimalarial pills are started two days to two weeks before travel, depending upon the specific medication chosen. The oral typhoid vaccine should be completed at least one week before travel, while the injectable typhoid vaccine should be administered at least two weeks before potential exposure.  Similarly, the yellow fever vaccine must be given at least ten days before your trip.  The hepatitis A and B vaccine series are administered over six months.   If you’re reading this and suddenly realize that your trip is two weeks away, don’t fret.   I recommend that you start the hepatitis vaccines as the initial doses may provide some protection;  you may then schedule the remaining doses following your return home.

 Where may I find more information?

I recommend the following resources:

http://www.cdc.gov/travel

http://www.immunize.org

 

Wishing you safe travels,

Brad Weiner, MD

 

This blog is for informational purposes only. It does not replace medical care from a licensed physician.  Please contact your doctor if you have any questions or concerns.

The Flu Vaccine

Our New England weather has turned cooler over the past few days, reminding us that summer is coming to a close and winter is only a few months away. Soon the leaves will change into brilliant hues of yellow, orange, and red, followed by our first frost, our first snowfall, and then the start of influenza (flu) season.

Flu season usually reaches peak activity during January, February and March, but sometimes arrives as early as December.  Some important reminders about influenza:

What is the flu?

Influenza, or the flu, is a contagious viral infection. Typical symptoms of the flu include a fever (100-103F) for three to five days, shaking chills, diffuse muscle aches, and fatigue. A sore throat, cough, and runny nose may develop. Nausea, vomiting, and diarrhea may also sometimes occur.

How long does the flu last?

Typically, symptoms last for one to two weeks, but recovery may be slow. It is not uncommon to feel unwell for up to three to four weeks.

Why all the fuss over the flu?

While most people have a self-resolving illness, potential complications include pneumonia, dehydration, or an exacerbation of an underlying medical condition such as asthma, diabetes, congestive heart failure, or kidney disease, and in rare instances, death.

Who should get the flu shot?

Everyone older than 6 months. Young children, pregnant women, the elderly, and those with chronic illness are most vulnerable. Please check with your physician first if you have a fever or a severe egg allergy.

Why should I get a flu shot?

When you receive the flu vaccine, you are not only protecting yourself, but you are also protecting your family members, friends, colleagues, and other members of your community.

Does the flu shot work?

The quadrivalent flu vaccine offers protection against two strains of influenza A and two strains of influenza B. When the vaccine’s strains match those circulating in the community, the vaccine provides protection. Last year’s flu shot did not match all of the circulating strains, so people were still susceptible to the flu. Despite the lack of a perfect match, the flu shot still offered some protection and is therefore worthwhile.

Will the flu shot give me the flu?

No.  You cannot get the flu from the flu shot.  This type of vaccine contains an inactivated virus which is dead and cannot cause the flu.  Frequently, the “flu” that people develop after receiving the vaccine is another viral upper respiratory infection, but it is not influenza.  Remember, the flu shot is administered during the fall and winter months.  This coincides with the peak season of the common cold.  For those of you who develop an actual case of influenza shortly after the flu shot, you were going to get the flu anyways.  The flu vaccine takes approximately 10 to 14 days to “kick in” before it starts to provide you with protection.

How do I get the vaccine?

You may contact your physician’s office to inquire about receiving the vaccine. Many local pharmacies and some community centers offer the flu vaccine as well.

Wishing you a happy, healthy, and flu-free winter!

Brad Weiner, MD

 

This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

Advanced Care Planning: It’s Never Too Early

It’s always important to plan ahead for the future.  When we are healthy and active, it’s natural to avoid thinking about what may happen if we were to develop a significant illness or injury.  However, the best time to plan how our affairs will be managed during sickness is during times of good health.  If we become seriously ill, what type of medical care do we wish to receive?  Do we seek heroic measures, comfort care, or something in between?  Who will make these decisions for us should we become incapable of making them ourselves?  Fortunately, we have several tools at our disposal that make it easier to plan for such difficult times.

MOLST Form

The MOLST (Medical Orders for Life-Sustaining Treatment) form was implemented statewide in Massachusetts in 2012.  This form was created to help individuals document their goals of care should they develop a significant, life-altering illness.  It is a legal document that guides physicians, family members, and other providers who deliver medical care.

The MOLST form represents an important advance in planning for end-of-life care.  Until this form was adopted, health care providers relied on the DNR/DNI form which asked black and white questions about cardiopulmonary resuscitation (CPR) and intubation (breathing tube, ventilator) for life-threatening emergencies.  However, as we all know, decisions related to health care involve many areas of gray, and the MOLST form recognizes some of these nuances.

While the MOLST form does include questions regarding CPR and intubation, it also addresses other less invasive forms of medical care.  These questions include whether an individual wishes to receive intravenous fluids, artificial nutrition (feeding tube), non-invasive ventilation (bi-PAP or C-PAP), or dialysis.  There are queries regarding duration of treatment and whether a person wishes to be transferred to a hospital for medical care.

The MOLST form should be completed in consultation with your physician.  For more information, please see the following link:  http://www.molst-ma.org

Healthy Care Proxy

When healthy, we are able to make informed decisions about our own medical care.  What happens to an individual who becomes cognitively impaired and is no longer able to make such decisions? A health care proxy is someone who is given the legal authority to make medical decisions on behalf of another person.  The health care proxy is not “activated” until an individual is deemed incapable of giving informed consent to medical treatment.  When selecting a health care proxy, it is important to make sure the proxy understands a person’s wishes and goals of care should a serious illness develop.

The Commonwealth of Masssachusetts offers an easy-to-complete form by which a person may appoint two health care proxies (a primary health care proxy and a back-up).  This form may be found here:  http://www.massmed.org/healthcareproxy

Living Will

After completing the MOLST form and selecting health care proxies, some individuals choose to create a living will.  A living will is a written narrative by which a person describes their goals of care should they develop a serious illness.  It serves as a guide for the health care proxy and medical providers when an individual is no longer able to express their wishes or make informed decisions regarding their own care.

Who Should Keep These Documents?

After creating these documents, it is important that these papers be made accessible to all parties who may be involved in that person’s medical care.  This includes:

  • Health care proxies (both the primary health care proxy and the back-up)
  • Medical team (physicians, hospitals, home care providers)
  • Immediate family members or close friends
  • Estate attorney

Where Do I Get More Information?

Primary care physicians are available to guide patients with their decision-making process. Attorneys who specialize in estate planning may also provide counseling.   The following websites offer helpful information:

National Institute on Aging Information Center https://www.nia.nih.gov/health/publication/advance-care-planning

Centers for Disease Control and Prevention (CDC)     http://www.cdc.gov/aging/advancecareplanning

 

Wishing you good health,

Brad Weiner, MD

 

This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

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