Category Archives: Friday Focus

7 Strategies to wait less at the doctor’s office

                On Monday I gave a brief overview of why you wait in the doctor’s office.  Today let’s be practical.  Here are 7 strategies to lessen your wait time:

  • Schedule the first appointment of the day or the first after lunch.   Pretty simple.  In the morning there’s no appointment ahead of you to run over.  And after lunch gives the doctor and staff time to catch up from the morning.
  • If you have an afternoon appointment, call ahead.   An hour or so before you’re due, call the office and ask if their running on schedule.  If they’re running late, ask when you should show or if you can reschedule.
  • Arrive early.  Give yourself time to fill out any necessary paperwork and if the office is running ahead of schedule, get in early.  Are you chronically late?  Well, then you’ll probably be chronically waiting.
  • Ask about the office’s scheduling policies.  Find out how they allocate their time for appointments, how they handle same day appointments, when is the best time to schedule an appointment, etc.  Just ask what you need to do to help ensure the best chance appointment times are kept.  Believe me, they’ll tell you.  They may even do back flips just cause you asked.
  • Consider rescheduling.  If your issue isn’t urgent and you’ve been waiting too long, ask to reschedule.  Typically, they’ll give rescheduled appointments priority times.
  • Change doctors.  Some doctor’s offices run better than others.  Sometimes it’s the office staff’s fault, sometimes the doctor just habitually runs long.  If they are ALWAYS late and you’ve asked how you can help and nothing changes, consider switching doctors.  Really like the doctor?  Well, not having to wait isn’t everything.
  • Get a Smart Phone.   Seriously, all those apps and games?  I can wait at least 3 hours.  Ever play Angry Birds?  

 

Insulin: Why 500 calories is better than 400 calories

You’ve probably heard about insulin; especially in relation to diabetes.  What you may not know is insulin is also the main hormone in charge of energy use in the body.  Understanding how insulin works makes it clear, all calories are not created equal.

Controlling blood sugar is job #1

When you eat, your body starts pumping out insulin to control the surge of blood sugar on its way.  Actually, your body starts producing insulin as soon as you think about food.  (Which you’re probably doing right now) 

Insulin takes the sugar (glucose) from your meal out of the blood and moves it into the cells so it can be used for energy immediately.  When glucose goes into fat cells it is converted to fat to be used for energy later. 

Fat is an energy source

One of the main functions of fat is to provide energy between meals.  Sugars (which are carbohydrates) are much easier for the body to burn for immediate energy after a meal.  Fat is used when those sugars are gone to provide our body a steady stream of energy. 

How insulin regulates fat

The sugar surge from our meal is gone.  Insulin did its main job of moving glucose so it could be used immediately or stored as fat.  Now it’s time to use that stored energy. 

Insulin interacts with two main enzymes to make this happen:

Enzyme #1 (Lipoprotein Lipase(LPL))- LPL is found on the outside of cells.  Its job is to bring fat (certain fats called fatty acids) in the blood into the cells for storage. The more “active” LPL is, the more fat comes into the cell.  The more insulin is present, the better LPL stores fat.

Enzyme #2 (Hormone-sensitive Lipase (HSL))- HSL lives inside fat cells.  It breaks down fat stored inside the cell into forms that can leave the cell and be used for energy.  The more insulin is present, the less HSL breaks down fat.

This is all interesting (um, kinda).  What does it have to do with my diet?

The levels of insulin in our bodies respond to the amount and types of carbohydrates in our diet.  Taking in lots of crappy carbs (read: processed sweets and snacks) causes our blood sugar to skyrocket and fall dramatically.  Insulin doesn’t like this. 

As blood sugar levels skyrocket, we pump out huge amounts of insulin.  Then blood sugar plummets, and there’s too much insulin around with nothing to do.  Except keep us from burning fat as we should (see above).

Um, my diet?

Alright, alright.  Geez.

Excess carbohydrates cause too much insulin to be released.  Decreasing fat burn.  I don’t advocate for eliminating carbs from the diet.  They’re essential.  Good carbs like fiber keep insulin steady.  Instead, eliminate those processed carbs made from refined white flour. 

Processed carbs not only add empty calories, but they work against our body’s natural fat burning mechanisms.  Therefore, you’ll ultimately burn more fat by eating a 500 calories meal made up of whole foods like grilled chicken breast and veggies, than a 400 calorie bag of chips.

Make sense?

 To learn more, check out these books by Gary Taubes: Good Calories, Bad Calories or Why We Get Fat. (Why We Get Fat is written in more user-friendly, lay person style)

 

 

 

 

 

GMOs: What’s all the fuss?

As I said on Monday, GMOs have become a hot button topic.  But why?  What is all the fuss about GMOs?  Here are the three main points/counterpoints in this debate.

Point: With little studies available we don’t know what GMOs will do to our bodies.  Since GMOs have only been around for a dozen years, we don’t know what effect this experimentation will have on our health.  And since all studies for safety are conducted by the GMO creators, the data cannot be trusted.

Counterpoint: N0 evidence exists against safety.   Pure and simple argument from GMO manufacturers.

Point: The use of GMOs is designed to allow for increased use of pesticides, further damaging the enviornment and our health.  Avoiding agricultrual toxins is difficult enough, creating mutant, chemical-resistant seeds that allow for increased pesticide/herbicide does not help.

Counterpoint: Some GMOs are designed to be resistant to crop-killing bacteria, allowing for less pesticide use.   

Point: The lack of labeling for GMO products, eliminates a consumers right to choose.  The only way to tell if a product is non-GMO is by buying organic.  The United States is the only industrialized nation that doesn’t require GMO labeling.

Counterpoint: The ubiquity of GMO use makes labeling unproductive and unfair.  Since the most used crops are near or above 90% GMO use, labeling would be unneccesary.

My Take

Personally, I’m most concerned about increased use of agricultural chemicals due to GMO use.  While it’s possible eating GMO food products may be bad for you, I think the more pressing concern is the amount of pesticides and herbicides in the enviornment.

I believe it is certainly appropriate to require GMO labeling on products so consumers have a choice.  Until that occurs here are some guidelines and resources to avoid GMO food products:

A Guide to Interpreting Nutrition Labels

In my Eat by Stars initiative I provide selected nutrition facts for each food.  Here’s what I look for on a nutrition label:

Calories per serving: A quick and easy way to get a picture of a food’s healthfulness. (Be sure to be mindful of serving size and servings per package)

Total Fat: Anything under 5g per serving is decent, but check to see the fat wasn’t replaced by sugars. 

Sodium: Some seemingly healthy foods can pack a huge amount of sodium.  Recall my salt post and avoid these foods.

Total Carbohydrates: One of the most important things to watch is the amount of sugars.  Check total carbs and look at dietary fiber, the difference is sugars.  The higher the sugar, the more processed, the worse it is for you.

Total Protein: Protein does a body good.  Anything over 10g is a great choice.

Vitamins and Minerals: With food fortification common, I don’t pay close attention to these numbers.  Get your dietary vitamins and minerals from foods that don’t come with nutrition labels (veggies, fruit, meat, etc) and from a quality multi-vitamin supplement.

Ingredient list:  A great rule of thumb is the more ingredients, the worse it is for you.  Also pay attention to the first ingredient listed, it’s the ingredient used in the highest quantity.

In summary

When watching a movie there are several factors that go together to make a quality flick: acting ability, actor chemistry, plot, direction, camera angles, pace, and uniqueness. (These combined for a crappy The Hangover Part 2)  

Same thing goes for food. 

No one factor is more important than another.  Rather, it is mix of these factors that creates the overall health profile of a food.  Like watching movies you’ll develop a feel for this judgement with practice.

Please feel free to contact me if you encounter food that puzzles you.  I’ll be happy to give it a star rating. 

Have a wonderful weekend!    

For more info check out the FDA’s in-depth explanation of the nutrition label at: http://www.fda.gov/food/labelingnutrition/consumerinformation/ucm078889.htm

The importance of Vitamin B12: Avoiding Deficiency

Roughly a dozen or so times a month I administer injections to patients at my pharmacy.  About half are shingles vaccinations, the other half are for a Vitamin B12 injections.  I don’t give injections for any other vitamins.  Why Vitamin B12?  It’s simple really…

Vitamin B12 deficiencies occur not from a lack of intake in the diet (except for vegans and, possibly, vegetarians), but because some individuals lack the ability to absorb vitamin B12 from the stomach.  Hence, they need to see me once a month so I can shoot their supplement into their arm.  (No dirty spoons or lighters required)

Deficiency Symptoms

As was discussed on Monday, Vitamin B12 plays an important role in cell growth, DNA synthesis, and nerve protection.  A Vitamin B12 deficiency (called pernicious anemia) is diagnosed through abnormalities in the blood (from blood cell growth being effected). 

The primary symptoms of deficiency are nerve related.  Numbness and tingling in the extremities is most common.  Memory loss and vision changes may also occur. 

Lack of energy, mood changes, and sleep difficulty are also associated with Vitamin B12 deficiency.

Due to Vitamin B12’s important role in cell division it is theorized a deficiency may aid in the development of cancerous cells.  This theory is not widely medically acknowledged.

Who’s at risk?

The inability to absorb Vitamin B12 is primarily due to a lack of hydrochloric acid in the stomach (which B12 needs to absorb).  Generally, as we age the stomach produces less hydrochloric acid.  Therefore, the elderly population (over 60, say) is at risk for Vitamin B12 deficiency.  Also, people who take an acid-reducing stomach medicine (Prevacid, Zantac, etc) are at risk for absorption problems.

As has been mentioned, individuals who avoid meat and/or animal products are at risk for deficiency.

How much Vitamin B12 do you need?

The Recommended Daily Allowance of Vitamin B12 is 3mcg.  Unlike other water-soluble vitamins, the body actually stores Vitamin B12 in the liver for future use.      

Due to the important roles Vitamin B12 plays in the body, advocates for supplementation have demonstrated a possible benefit with daily doses around 200mcg.  There is virtually no risk of toxicity from high doses of Vitamin B12. (The injected dose is 1,000mcg)

Foods high in Vitamin B12

Animal products, animal products, and animal products.  Remember, this is A Vegan’s Most Important Vitamin because plants cannot produce Vitamin B12.  Red meat, liver, eggs, dairy, and fish are full of the good stuff. 

In Summary

The roles Vitamin B12 plays in keep us healthy are quite clear.  It keeps our cells healthy, protects our nerves, makes our DNA, turns our fat into an energy source, and helps protect our body from a dangerous free-radical.  All in a day’s work for this super star vitamin!

Programming Note:  Taking off Memorial Day (I hope you are too) for pool lounging and an All-American BBQ.  Back Tuesday.  Have a wonderful weekend.

How are you Grillin’ your Chicken?

It’s everywhere you hear sermons about “healthy eating”.  It’s the de facto healthy meat to fill up your plate.  Skinny friends eat it four times a week.   Yes, grilled chicken is a solid choice for healthy eating, but it sometimes gets boring. 

We’ve all thrown the original white meat on the grill, and developed our own style. How are you grillin’ your chicken?

I’m no chef but here’s the tips I’ve learned that have made grilled chicken not so monotonous.  I’d love to hear the tricks you’ve patented.

#1 Pickin’ the Chicken

Those huge chicken breasts take forever to cook.  That usually leads to dry chicken.  Not to mention the portion sizes are huge.  I find getting cutlets or tenderloins allow for quicker cooking, juicier chicken, and more appropriate portions.  (Oh, and don’t forget to get organic!)

#2 Marinades anyone?

I’ve yet to find an effective chicken marinade that didn’t need to soak for several hours.  I’m too impatient.  What say you?  Always marinate?

#3 Pre-fire seasoning

I find good ol’ fashioned seasoned salt and freshly ground black pepper.  I’ve also used seasoned salt, Tony Chachere’s Cajun seasoning, lemon pepper, thyme, and rosemary with great success.

#4 Hot and Fast

I’ve learned you gotta crank the heat up  before chicken meets grill so you get a nice sear.  Also, turning only once is a must.  Don’t play with your chicken!

I’ve also discovered that while caution handling raw chicken is necessary, the fear of salmonella from undercooked chicken has led to an epidemic of dry chicken.  Dry chicken is not, as Alton Brown says, Good Eats. 

There’s a nice window of 5-6 minutes a side for a medium-sized filet (4oz) that cooks it through but leaves the bird nice and juicy.

#5 The Sauce is the Boss

Plain old salt and pepper grilled chicken is great on salads and such, but as an entrée I like to toss my servings in sauce.  For me, basting while cooking is messy and unnecessary.  Tossing is fun and easy. I prefer fun and easy.

Remember, don’t ruin the health quotient by slathering on BBQ sauce high in sugar.  Also be wary of sauces high in sodium.  My go-to sauce is a sweet and spicy mix low in salt and calories, Hotlanta Hot Sauce.

That’s my easy go to method for making, as my little bro recently called, ‘The best chicken I’ve ever tasted!”  Such a refined palate for a 10-year-old.

To Salt or Not to Salt?

On Monday we discovered Uncle Louis’ salt shaker use wasn’t a big problem for his high blood pressure.  (Aunt Edna’s nagging, on the other hand.)  In fact, a study published in the Journal of the American Medical Association last week concludes Uncle Louis should consume MORE salt to lower his risk of cardiovascular related death.

More salt=Less risk?

The study followed 3,681 individuals over the course of roughly 8 years.  Participants were divided into groups based on their salt intake: low, medium, or high. The low salt group experienced fewer cardiovascular related deaths (1.9%) than the high salt group (4.1%).   Blood pressure remained similar across all study groups.

The Salt Institute, the industry’s lobby group, immediately called for a change in the dietary recommendations from the USDA.  Other salt industry supporters celebrated the study results as evidence of salt’s benefits.

Read the study abstract here; a study review by Food Safety Newshere.

Not so fast on the potato chips….

Naturally, the medical establishment immediately began refuting the study’s methods and conclusions.  The age of the participants (mostly under 40) and smallish sample size drew the most criticism.   Also under attack were the authors’ broad conclusions from a single correlation study.

Another point of view

Obesity doc Yoni Freedhoff, offered another possibility on his blog, Weighty Matters.  He spectulates maybe:

Sodium’s isn’t a causal agent of disease but instead given that processed foods are phenomenally high in sodium, is a useful biomarker for the degree of processed foods a person’s consuming, and that it’s the huge volumes of sugar and pulverized flour (that’s more often than not packaged with gobs of sodium) that’s actually causal for cardiovascular disease and death.

My Opinion

I take the study results with a grain of salt (ugh, sorry. I’m embarrassed).  But I don’t dismiss their findings completely.  As I said in my “truth” post, differing views in medicine are common, and not altogether a bad thing.  They ensure we continue to review medical dogma to ensure we didn’t miss something. 

Perhaps salt is horrible for our health.  Perhaps it can actually lower our risk of heart disease.  The truth is there is evidence to support both views, and both sides give compelling evidence.  I also can’t ignore underlying motivations (read: money) on either side of the debate.

Regarding salt intake my suggestion remains:  Avoid processed foods as much as you can.  Use the salt shaker to add flavor to meals. 

Follow those guidelines and you’ll ensure you take in a moderate amount of salt.  For better or worse.