Have A Little Faith

We don’t get to know why.

There have been quite a few patients this week struggling with health issues large and small.  Since it’s Easter I’ve been thinking about their struggles and wanted to offer a few thoughts.

I’ve been trying to help patients move past the “why me” stage to the “what next” stage.  I’ve found the “why me” stage to be nonproductive.  It is very natural to be angry when things don’t go well.  However, when big things go down (like a cancer diagnosis for instance) time spent in the “why me” stage is time wasted.  It doesn’t help, there are no answers to that question, and asking “why me” doesn’t get questions answered that NEED to be answered.

When I have to give patients scary news I try always to have the next step planned out.  This gives the patient and their family something to focus on and a good exit from the “why me” stage.  I quite seriously instruct the patient not to panic.  Panicking does no good at all, and is a waste of effort.  (Of course I AM aware patients regularly disregard this advice, but at least I can try!)  Giving the next step in the plan (a scan, a test, a consultation with a specialist) helps to move things along in a productive way.

When you can’t see the next step on the path, and it’s scary to think about the future, it’s normal to question your faith.  Why would God do this to me?  Especially if you’ve tried your hardest to live a good life and follow your faith’s teachings, illness and injury can be a bitter pill to swallow.  Our condition as humans makes us open to illness and injury, but God doesn’t choose it.  However, our whole lives move to a pattern and He uses what happens for the good of us all.

Last Sunday during the Gospel of the Passion, I was struck by Jesus’s trip to the Garden before he was betrayed.  He left his friends and went off in private to pray.  The language is very striking, even in translation.  It says Jesus was “in agony” and prayed so hard his sweat fell like rain.  What was Jesus praying for?  He was asking God to spare him.  He was afraid!

Jesus was the Son of God.  He had been with God since before the world was made.  He was one with the mind of God and knew God’s plans for His creation intimately.  He knew exactly why he had to suffer and die on the Cross the next day.  He knew the purpose was to reunite God’s people with Him, to make one great Sacrifice to bring us back to Him.  And still He begged the Father to spare Him.

If God’s perfect Son was afraid and questioned and begged to be spared, how much more will we be forgiven for asking the same questions when illness and injury visit us?  So lighten up!  There’s nothing wrong with being angry and afraid and not wanting to deal with what is happening.  Ask questions, talk about your feelings with your doctor(s) and with your close family and friends.  Get the support you need when you need it.

On this Easter weekend please also remember that just as God was there as Jesus suffered He is with us as well.  As we take the difficult steps along our own Way of the Cross, remember that He has been there and is there again with you.  God bless you this Easter!

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The Good, The Bad And The Ugly

Continuing our theme with National Nutrition Month, I wanted to talk a bit about dietary fat.  There’s a lot of confusing information about what is good fat, what is bad fat, what should you avoid/reduce/eliminate from the diet, etc.  So I dove into some good old-fashioned data mining.

Most of this info is from articles in PubMed, the National Institutes of Health searchable archive of published research.  For some of the high-level overview stuff I checked with WebMD as well.  Hey, even docs visit WebMD sometimes!

Before I start talking about the different kinds of dietary fats, I want to make sure you all know that you NEED fat in your diet.  Your body needs good fats, the essential fatty acids that can’t be produced in your body.  Also, fat helps you absorb vitamins A, D, E and K from your foods.

THE GOOD

There are two main types of fat in the diet, saturated and unsaturated.  Saturated fats are solid at room temperature and unsaturated fats are liquid oils.  Typically people eat some of each type. People usually believe that oils are good and solid fats are bad.  This is actually an oversimplification:  there are good and bad elements to both types of fats.

First up are the oils.  The essential fatty acids are polyunsaturated fats called DHA, EPA and ALA, also called omega-3 fatty acids.  ALA can be converted to DHA and EPA in the body, although our cells aren’t very efficient at it.  ALA is found in flaxseed oil, canola oil, soybean oil and walnuts.  DHA and EPA are found in fatty fish (wild fish have higher levels than farm-raised fish) and also made by algae.

Other mono and polyunsaturated fats are found in other oils such as olive, peanut, safflower, sunflower, sesame and corn oils.  They are safer choices than animal fats in general.

The saturated fats in general should not be eaten to any significant extent.  The exception, however, is a substance called medium-chain triglycerides (MCTs).  These are fats that are rapidly metabolized in the liver rather than being stored in fat tissue.  They have been shown to promote satiety, making you feel full faster and longer.  They also seem to increase calorie expenditure after eating them and may have a role in promoting weight loss.  The richest dietary source of MCTs is, interestingly enough, coconut oil.  About 50% of the fat in coconut oil is in the form of MCTs.  Two other good dietary sources are butter and palm kernel oil.

THE BAD

Lard.  Sausage.  Bacon grease.  That yummy marbling on your steak or the layer of fat on the outside of your roast.  DON’T EAT THAT!!

The consumption of animal fat should be limited.  It throws your cholesterol out of balance and may promote hardening of the arteries.  If you’re going to eat meat, eat lean cuts of pasture-raised (also called grass-fed) beef and free-range poultry, which have much higher levels of omega-3 fatty acids than typical grain-fed animals.

THE UGLY

Now I want to tell you about some dangerous fats that you should avoid whenever possible.  First I want you to go get 3 boxes out of your pantry.  Cereal, crackers, cookies, whatever.  Also, get your margarine out of the fridge.

Now look at the ingredients list.  If there is anything in there that says “partially hydrogenated” please throw that away.  Hydrogenated and partially hydrogenated oils are man-made fats that were chemically altered to “harden” them and extend their shelf life.  They are very pro-inflammatory and should be eaten in very limited amounts if at all, especially if you suffer from heart or vascular disease, fibromyalgia, joint or back pain, or chronic fatigue.

Next look at the nutrition panel.  Look at the “trans fat” line.  Trans fats are a type of partially hydrogenated fat that not only raise LDL (bad cholesterol) like saturated fat but also lower HDL (good cholesterol) and may be even worse for your health.  Food manufacturers are allowed to say their product is “trans fat free” if there is less than 0.5 gram per serving.  However, if you see “partially hydrogenated” in the ingredients there are trans fats in there, no matter what the nutrition panel says.

Lastly I’d like to say a few words about genetically modified food crops.  In the USA it is difficult to find corn that is not genetically modified.  Soy, canola and cotton are also widely genetically altered.  Unfortunately the USA is not requiring (yet) the labeling of genetically modified foods, and there were no long-term safety studies done before the genetic alteration of food crops was permitted.  The USA is one of the only industrialized countries in the world which does not require labeling of genetically modified foods.

If you want to avoid genetically modified foods (and I’d say it’s a good idea) as of now there are only a few options.  First of all, buy organic, as organic foods cannot have genetically modified ingredients.  Second, you can buy products labeled “non-GMO” which are not organic but also can’t contain genetically modified ingredients.  Lastly you can avoid the four most commonly altered food crops above.

RECOMMENDATIONS

There are four common scenarios where fat is added to foods:  high-heat frying, low-heat sauteing, baking and as dressings.  There are specific recommendations for each situation.

For high-heat frying (which you shouldn’t be doing a lot, anyway) your best fats are butter and coconut oils.  They tolerate high heat the best without breaking down, and they contain medium-chain fatty acids which can help you eat less of those foods you’re frying 🙂

For low-heat sauteing, olive oil or sesame oil are your best bets.  Olive oil and nut oils (like sesame or walnut) also are excellent choices for dressing salads.

When you’re baking, you have a choice between lard, butter and margarine.  (Lard, ew.  No, thanks.)  My recommendation is to go with the butter, because it is unprocessed (i.e. does not have artifically hydrogenated fats) and, like with frying, has the medium-chain triglycerides which increase the metabolism and tend to be burned rather than stored.  Remember to limit your intake of the baked goods though!  Give away your Christmas cookies!

Remember, food should come from the farm and the field, not the factory and certainly not the lab!  Try to choose the most unprocessed options you can, and you’ll be rewarded with better health 🙂

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Tennis Anyone?

Hey guys!  Hope you all are having an awesome St. Patrick’s Day.  Please be safe!

I just finished a REALLY rough week on call, too many middle-of-the-night calls and not nearly enough sleep.  I’ve been thinking about it but I have been coming up empty for blog post topics.  Then what happened?  A friend had surgery for tennis elbow.  Thanks Mrs. T!  Instant topic 😀

So what’s “tennis elbow?”  Its medical name is lateral epicondylitis.  First of all, I’d like to describe some of the anatomy of the elbow and forearm.

Look at your open palm.  Take the fingers of the other hand and trace from the thumb all the way up to just above the elbow.  There’s a bony bump there that is called the lateral epicondyle (the matching bump on the inner elbow is called the medial epicondyle).

Nearly all the muscles that move the joints of the wrist and fingers are actually located in the forearm.  They send long tendons like hydraulic cables into the hand to move the joints.  The human hand is really an amazing engineering miracle!  In med school we spent a ridiculous amount of time on the anatomy of the hand, but it was worth every minute because it’s so incredibly elegant.

All the muscles that open the hand and extend the wrist (put your hand palm-down on a table, then lift the fingers so the hand rolls up on the wrist – that’s extension of the wrist) attach at the lateral epicondyle in the elbow.  Conversely, all the muscles that close the hand and flex the wrist (opposite of extension) attach at the MEDIAL epicondyle.  These two places are very vulnerable to overuse and strain.

Overuse and strain of the lateral epicondyle is called tennis elbow.  It is called that because it is very common in competitive tennis players.  They tend to overwork the backhand (the weaker stroke) and extend the wrist over and over against the tension of the racket hitting the ball, creating an overuse injury of the lateral epicondyle.  (Interestingly, the corresponding overuse injury of the medial epicondyle is called golfer’s elbow, and it’s generally caused by the tension of the golf club head hitting the golf ball, and also by digging divots.)

So do you have to play tennis or golf to have one of these problems?  Absolutely not.  Anything that causes an injury of these two areas is notoriously difficult to heal.  Why?  When was the last day you didn’t use BOTH of your hands all day long?  Never.  It’s nearly impossible to rest the hands in any kind of meaningful way, and that’s what you need to do to heal one of these problems.

What symptoms do you get if you have tennis elbow or golfer’s elbow?  Pain and weakness, generally.  Both problems cause pain when you pick up objects.  I have seen them so severe that the sufferer can’t pick up a coffee cup, let alone the pot!  The weakness is initially due to self-limiting from pain (i.e. it hurts so bad I can’t do it) but can progress over time to true muscular weakness from disuse.

What do you do for tennis elbow?  Ice, rest and anti-inflammatory meds for the most part.  Have you ever seen those straps baseball players wear around their forearms?  Those are tennis elbow straps and are very effective.  You put one around the forearm muscles on the sore side, with the top edge about two fingers below the elbow crease.  Tighten it down and feel near-instant improvement in symptoms!  (The tightness is a little bit of a work in progress.  Tight enough that you feel the muscles pulling against the strap, not the sore elbow, but not so tight your fingers turn blue, LOL!)  It’s always very satisfying to put one of those straps on a patient, cinch it up and watch their face.  They open and close their hand a few times and break into a huge smile.  Makes me feel like a magician 🙂

If the strap isn’t effective, I will usually give a cortisone shot which generally gives good relief.  If that doesn’t work then I refer to orthopedics.  Sometimes the common attachment point is so badly damaged that it requires enforced rest (i.e. a long-arm cast) and if that doesn’t fix it it may need surgery.

Luckily not many patients with tennis (or golfer’s) elbow have cases extreme enough to require surgery.  Please say a prayer for Mrs. T that she recovers quickly and well!

I’d like to wish everybody a happy and safe St. Patrick’s Day!

Lucky stars above you, Sunshine on your way,
Many friends to love you, Joy in work and play
Laughter to outweigh each care, In your heart a song
And gladness waiting everywhere All your whole life long.
Gaelic blessing
 

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So You Want To Look Like A Sumo Wrestler?

Hey everybody!   To kick off National Nutrition month, this week I did a poll on my Facebook page asking if my readers eat breakfast every day.  An encouraging number of people DO eat breakfast every day, but some don’t.  So I started looking into information about why breakfast is so important.

In my search, I found a number of websites that talk about the training that young sumo wrestlers go through.  I don’t know about you, but I definitely DON’T want to look like a sumo wrestler!  In fact, I pretty much want to be the opposite of a sumo wrestler.  So I thought maybe by learning what they do and doing the opposite, we’ll learn some interesting lessons about weight loss and weight maintenance.

The first thing sumo wrestler trainees do is NOT eat breakfast.  They exercise all morning while fasting, to slow their metabolisms.  Then for lunch they eat an enormous starchy carb-filled lunch with bowls of a meat-and-vegetable stew and large amounts of rice.  Then they go to bed and take a 3-4 hour nap.

After their nap they get up and exercise all afternoon, very intensely, to build muscle, then have another huge starchy meal for dinner, and go straight to bed afterward.  Sleeping with a stomach full of starch helps them put on the layers of fat they have to accumulate to compete in sumo (which has no weight classes, so the bigger the better).  They also drink a lot of beer (i.e. more starch) with their meals which helps direct the fat to be deposited in their abdomens.  Estimates are that sumo wrestlers eat up to 20,000 calories per day!

What does this information teach us?  If you want to look like a sumo wrestler, skip breakfast, eat lots of starches and high-calorie meals, eat right before bedtime, and drink lots of beer.  After all, there’s an old adage that tells us that if you want what another man has, find out how he got it and do exactly the same thing.  If you already DO look like a sumo wrestler, maybe take a look at your habits and decide whether there might be a reason to change.

So what’s the opposite of a sumo wrestler’s training program?  What’s the program to become the opposite of a sumo wrestler?  I think a good start would be to make sure you eat breakfast every day, limit calorie intake to something sensible and spread it throughout the day, stop eating a few hours before bedtime (or have only a small snack before bed) and mix up your starches with protein and good fats.  Have a small meal or snack before you work out.  Also be careful about your alcohol intake.

So what do you want to be?  An enormous (but tremendously fast and strong) 250-300 pound sumo wrestler?  Nope, not me.  But I’m glad to know how to go about it if I ever change my mind!

PS – If you want a quick, easy breakfast that keeps you satisfied all morning AND helps with weight loss, check out the Shaklee 180 smoothees.  Chocolate shakes for breakfast?  Yes, please!

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American Heart Month, A Recap

Wow everybody!  I had a great time giving you 28 suggestions on my Facebook page for a healthier heart to celebrate February, American Heart Month.  I had a request to compile them all in one place, so here goes:

1:  DON’T SMOKE CIGARETTES!  If you smoke make a plan to quit. Talk to your doctor if you need help, there are meds that can help. Your heart will thank you 🙂

2:  Exercise!  Cardio is called cardio for a reason!  Sustained physical activity that raises your heart rate increases your heart’s efficiency, decreases your blood pressure and resting heart rate, and decreases your risk of heart trouble down the road.  Get moving!

3:  Add more fresh fruits and veggies to your plate every day!  Color it up, especially red, blue and purple fruits and red, orange, yellow and green veggies.  These pigments are antioxidants that help neutralize toxins.  They may be helpful in slowing down damage to the insides of blood vessels that promote the growth of plaque.  And they taste great!

4:  Eat soluble fiber.  This type of fiber binds cholesterol in the intestine and keeps it from being absorbed.  It also slows the movement of food in the digestive tract, can decrease appetite and helps blood sugar control in diabetics.  Good sources of soluble fiber, according to WebMD, include oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, and carrots.

5:  Get your blood pressure checked!  High blood pressure increases your risk of heart attack, stroke and kidney failure and is easily treated. It has NO symptoms so you can’t feel when it’s high. Adults should have their blood pressure checked at least once every 2 years.

6:  Get and stay married!  A study in Finland showed that unmarried men and women both had about a 60% higher risk of heart attack than married folks, and were also more likely to die of their heart attack within 4 weeks.

7:  Eat nuts like walnuts and almonds for omega-3 fatty acids, plant sterols and fiber.  Watch your portions though as nuts are also high in calories and fat.  A portion is 1 oz (a kitchen scale is very useful) and has about 170 calories.  They are great on salads!

8:  Get to and stay at a healthy weight!  I know, I know, but I have to include obvious stuff too, right?  Obese people have a much higher risk of heart attack and stroke than those at a healthy weight.

9:  Eat fatty fish at least twice a week, or take a fish oil supplement daily.  Omega-3 fatty acids help decrease heart risk and also relieve symptoms of asthma, depression, and arthritis.  Non-fish food sources of omega-3 fatty acids include walnuts, soy and flaxseed oil.  Click the link for more information about Shaklee’s OmegaGuard fish oil supplement.

10:  Manage your stress!  Stress increases the resistance of blood vessels by causing the release of adrenaline.  This increases blood pressure and makes you feel anxious and, well, stressed.  Over the long term high levels of adrenaline are hard on the heart, brain and kidneys.  For more info about stress and ways to manage it, check this page.

11:  Eat soy! Soy lowers triglycerides and has soluble fiber. The healthiest way to eat soy is as edamame (lightly steamed or boiled in the pod and eaten hot) but other options are as tofu, miso, and tempeh. Soy milk is popular too. DON’T eat them raw, and limit textured vegetable protein as this form of soy is cooked to the point of losing the beneficial isoflavones.

12:  Color up your starches!  Instead of white potatoes eat sweet potatoes (beta carotene), brown rice instead of white, brown bread instead of white.  More fiber and more nutrition.  Enjoy!

13:  Take a probiotic supplement!  New research suggests not only are they good for your digestion but they improve your mental health, lower cholesterol and help control blood sugar in diabetics.  Check out this article for more info!  Shaklee of course has a great probiotic supplement called OptiFlora.

14:  Be happy!  There is evidence that optimism and a sunny disposition are protective of your heart and reduce your risk of heart attacks.  Have a great day today everybody, and Happy Valentine’s Day 🙂

15:  Eat flaxseeds!  They are full of omega-3 fatty acids (ALA, different from DHA and EPA which are in fish oil), high in fiber and have lignans which have antioxidant and estrogen-like effects.  It needs to be ground to be properly digested.  1-2 tablespoons in cereal or yogurt daily is the suggested daily dose.

16:  Drink coffee and tea!  Both coffee and tea have antioxidants and other substances in them that are protective of the heart and blood vessels.  Caffeine, of course, raises the blood pressure so you shouldn’t overdo it, but 1 or 2 cups daily is very heart-healthy!

17:  This tip seems to have disappeared from my Facebook timeline.  Oops!  Can’t remember now what it was but I’m sure it was great 😛

18:  Eat oatmeal!  It is great for your cholesterol (hint:  the oats in Cheerios are what makes THEM good for cholesterol), keeps you full for longer than cold cereal and helps, um, move the digestion along 😉  Putting honey and cinnamon on it also is good for you.  Cinnamon helps control blood sugar.  Honey, especially local honey, has lots of positive effects on the immune system and is low-glycemic!

19:  Get a pet!  Studies have shown repeatedly that pets reduce your blood pressure, reduce stress, and are protective against heart disease.  Larger pets like dogs and cats have better study data, but any pet that makes you happy will help your heart.  How many dog and cat parents are out there?

20:  Drink red wine!  Resveratrol is a powerful antioxidant in red wine that seems to decrease inflammation, hardening of the arteries and heart disease risk.  This is definitely NOT proven and scientists are furiously researching it.  Modest alcohol intake also raises good cholesterol (HDL).  Be sure to limit your alcohol intake to 7-10 drinks weekly for women and 10-14 drinks weekly for men.  Don’t like red wine?  Shaklee has the most powerful resveratrol supplement on the market.

21:  Know your numbers!  See your doctor and get your blood pressure, height/weight/BMI/percent body fat checked.  Ask for an order for cholesterol labwork.  Make sure they are all at goal and be open to your doctor’s suggestions for correcting them if they’re not.

22:  Lift weights!  No, you don’t need to look like Arnold, but lifting weights builds muscle mass which increases your metabolic rate.  This in turn makes it easier to lose and maintain your weight.  Which is good for your heart!  BTW if you’re not familiar with weight lifting PLEASE invest in a few sessions with a personal trainer.  Hurting something is NOT good for your heart 😉

23:  Have kids!  A study documented a 17% higher heart-attack risk in men who were childless compared to men raising kids.  Not sure why, nobody seems to know, but this one should stimulate some interesting conversations…

24:  Get some sun!  This is a very cool 13-minute video from the TED talks where a dermatologist outlines some reasons why sunlight is good for your heart and blood pressure.  And no, it’s not from vitamin D production 🙂

25:  Season your food with herbs instead of salt.  Decreasing sodium intake helps decrease total plasma volume (i.e. water component of the blood).  When you decrease the water content in elastic pipes, you decrease the pressure inside the pipes!  Normal blood pressure reduces your risk of heart attack and stroke.  There are lots of herb blends available to make your food tasty without adding salt.

26:  Eat plant sterols and stanols!  These are cholesterol-like substances found in plants that block the absorption of cholesterol in the digestive tract.  Ideally you should get 2000 mg of them every day.  They are foun…d in nuts, seeds, vegetables, fruits, and grains.  They also have been added to margarines and spreads.  There’s also a supplement form.  The experts agree that getting your nutrition from food is much better than getting it from a pill.  I agree wholeheartedly but getting it from a pill is better than not getting it at all.

27:  Drink water!  Most of your body is water, and it makes up the majority of the blood volume.  Drinking water also helps flush salt out through the kidneys, combats fatigue and helps you tolerate exercise better.

28:  Diagnose and treat sleep apnea! If you have sleep apnea you basically can’t sleep and breathe at the same time, so you constantly stop breathing, wake up, start breathing, fall asleep, and repeat. This puts a big strain on the heart, raises the blood pressure, and makes you feel tired and sleepy all day. If you snore and wake feeling unrested in the morning, see your doctor!

Thanks for reading along!  I know this was a long one (3 times longer than a typical blog post for me!) but it’s important info.  Here’s to your heart!  In March we’re celebrating National Nutrition Month so if you are on Facebook feel free to like my page and follow along.

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