Creating A Healthy Relationship With Food

Imagine this relationship.

You spend all day thinking about it.  You plan your time around it, and when you’re going to be able to spend time with it.

Your friends and family don’t like it.  They think it’s not good for you.  They think you can do a whole lot better, and they’re not shy about letting you know how much they disapprove.

You feel anxious and empty when you don’t have it, and happy and fulfilled when you do have it.

You know too much of your energy goes towards it.  You know too much of your happiness depends on it.  You beat yourself up about how dependent you are on it and feel ashamed.  You might even be isolating yourself from friends and family so they won’t guess how you feel about it.

Finally you decide you’re done with it.  You take control of your relationship with it, and for a little while you feel so proud.  You have given up something that is so unhealthy for you!  You’re in charge, you’re strong and successful and moving in the right direction.  Your family and friends are proud of you and that approval feels so good.

Then you start to feel lonely, stressed, anxious and sad.  You think maybe you overreacted, maybe it wasn’t really so bad.  You really were happier with it than you are now, right?

Now the cycle has started over again.  You’re thinking about it all day, isolating and becoming secretive again, and battling shame and anxiety.

What is IT?

Many of you may be recovering addicts or have a loved one who is an addict.  This is how addiction has been described by many who suffer with it.

“IT” may also be an abusive spouse or lover.

Today I want to talk about how “IT” can represent food.  Many of us struggle with our weight and have an unhealthy relationship with food, particularly sugary, salty and fatty foods.

We use food to soothe ourselves when we’re unhappy or feeling anxious.  Eating sugary, salty, fatty foods stimulates receptors in the brain the way heroin does.  Our relationship with food can become just as unhealthy as an addiction or abusive marriage.

This is the reason why good bariatric surgery programs include intensive mental health evaluations and counseling, as well as nutrition counseling, before surgery.

Bariatric surgery changes your relationship with food.  If you’re not ready for the change you will go through a grieving process.  It is almost as if an abusive spouse died suddenly.  There is grief and guilt and relief (and then guilt over feeling relieved) and nostalgia because really, that relationship wasn’t so bad, right?

People who are obese can benefit from mental health counseling even if they don’t plan to have bariatric surgery.  It is very difficult to change your relationship with food without trained help.  For instance, you wouldn’t expect a heroin addict to just wake up one morning clean and sober without help, would you?

If you love someone who struggles with their weight, please share this post with them.  If YOU struggle with your weight, I want you to know 3 things:

  1. YOU are worthy of having a healthy, fit body that feels good every day.
  2. YOU are not weak or stupid or bad because you have trouble managing your weight.
  3. Just like addicts can get clean and stay sober, YOU can learn to create a healthy relationship with food so that food nourishes and supports your body instead of making it sicker.

QUESTION: What is the hardest thing about eating healthy for you?


Dietary Acid and Osteoporosis

There has been a lot of talk lately about how “acidic” the Western diet is.  Meat is acidic, dairy is acidic, soda is acidic, it goes on and on!

I’ve been doing some research lately about foods that increase acid production in the body.  This doesn’t mean the foods themselves are acidic, but the processing of the nutrients in the food causes more acid to build up in the body.

Why do we care about acid in the body?  There are a lot of reasons today I’m focused on the fact that having to get rid of too much acid puts a strain on the kidneys and promotes the loss of bone matrix (leading to osteoporosis) and the formation of kidney stones.

If you have kidney problems, osteoporosis (or a family history of osteoporosis) or kidney stones, you should definitely pay close attention to how many acid-forming foods you’re eating per day.

In this post I’m going to focus on osteoporosis.  I expect I will write in the future about kidney stones as well.

It is estimated that the Western diet we eat today produces a LOT of acid, the equivalent of 4.9 grams of hydrochloric acid every day.  Our lungs and kidneys get rid of most of it, but not all of it.  Our bodies use calcium from bone to neutralize anything that is left.  Over years, this leaches the minerals from our bones and leads to osteoporosis and fractures.

Where does the acid come from?  The most acid-forming foods in the Western diet are sulfur-containing amino acids (found in large amounts in animal protein), cereal grains like wheat, phosphoric acid in soda, and salt.  Yes, I know, salt is salt and doesn’t contain acid, but it interferes with the kidneys’ ability to process acid.  Eating too much salt will cause acid to build up in the body.

Are there foods that will decrease acid production in the body?  Yep.  Diets high in magnesium, potassium, and fruits and vegetables increase bone mineral density and decrease fracture risk. You can replace animal protein with plant protein like beans, soy and quinoa.  You can also replace cereal grains with non-grain plant foods like roots, tubers, leafy green vegetables, vegetable fruit (veggies with seeds like tomatoes and cucumbers) and fruits.  These foods decrease acid production in the body.

What about supplements?  Turns out that potassium citrate and magnesium supplementation decreases bone turnover, increases bone density and decreases the amount of acid excreted in the urine.  Magnesium and potassium citrate also decreased the formation of kidney stones and even dissolved calcium oxalate stones (the most common type).  A beneficial side effect was that potassium supplementation also decreased blood pressure significantly in those with hypertension.

One BIG word of caution about potassium supplements.  PLEASE check with your doctor to see if potassium supplements would be safe for you before you start taking them.  There are medications that increase potassium levels, and as we age our kidneys get less able to manage potassium properly.  High potassium levels in the blood are VERY dangerous.  Blood test monitoring is prudent in anyone at risk for elevated potassium.

How can you see whether you’re getting too much sodium or not enough potassium?  There is a free calorie tracker at that will give you nutrient information such as vitamin and mineral intake, calories, fat and protein grams in addition to calories.

I checked for recommendations about magnesium and potassium citrate.  I found that they gave good ratings to the potassium citrate supplement from Natural Factors, the potassium-magnesium citrate supplement from Thorne Research, and the magnesium citrate supplements from Solgar, Kirkland and Spring Valley.

If you have osteoporosis or a family history of osteoporosis, you should strongly consider changing your diet to include more fruits and vegetables, roots, tubers and green leafy vegetables.  Don’t drink soda, period.  You should limit your animal protein intake (meat, dairy, egg and fish) and substitute plant sources of protein.  You should carefully monitor your sodium intake.  You should also make sure you’re getting enough potassium, and if not (most of us don’t, including me) you should consider taking a potassium citrate supplement, with magnesium citrate if you have a personal or family history of kidney stones.

QUESTION: Do you have osteoporosis?  Did anything in this post surprise you?


3 Keys For Headache Treatment

I had a patient in the office this week with a severe headache.  Headache is a common problem that can be tough to treat.  My patient’s experience really made me think it’s time to write about headache treatment.

My family has a strong tendency towards migraine.  Both my parents, myself, and both my sons have migraine.  My personal experience with migraine has made me learn a lot about headache in general.  Also, headache is very common problem we see often in primary care.

In thinking about headaches and headache treatment, there are 3 keys to choosing the right therapy.

What type of headache is it?

Choosing the right headache treatment depends on knowing what kind of headache you have.

Tension headaches are by far the most common type of headache.  That’s the headache that’s felt in the temples and in a band around the head.  Sometimes it is felt in the back of the head and radiates around the head.  This type of headache is thought to be caused by muscle tension in the neck and in the muscles of the head and face.

Migraine is usually felt in one side of the head, often centered near the eye, is severe and pounding or throbbing in character, and has associated nausea and sensitivity to light and sound. Some patients have a vision problem called an aura that comes before the headache starts. We don’t really know what causes migraine.  Usually there is a family history.

Sinus headache is just what its name suggests, pain caused by sinus pressure.  It is felt in the forehead, cheeks or behind the ears and sometimes radiates to the top of the head. There is usually associated congestion and other sinus symptoms.

The last major and (thankfully) most uncommon type of recurrent headache is cluster headache.  These mostly affect men, are brief but sharp, stabbing, severe pains centered in one eye.  That eye usually gets red and watery and sometimes the nose runs on that side.

Other, more serious causes of headache are rare but do happen.  These include brain tumor, aneurysms and other vascular problems, meningitis, and other causes of increased pressure inside the head.

How often do you have them?

The more often you have headaches, the more difficult they are to treat. If you have headaches more than 8-10 times per month, you should definitely see your doctor.  If you have 15 or more headache days per month, that is considered chronic daily headache.

Daily suppressive medication will decrease the frequency and intensity of chronic headaches.  Taking abortive treatment alone (medication to make the headache go away once you have it) will NOT work.

Taking over-the-counter medication for chronic daily headache will actually make the headache worse.  This is due to something called rebound, where the temporary relief of headache actually makes the headache come back stronger once the medicine wears off.

If your headaches are frequent please see your doctor.  The sooner you get started evaluating and treating your headaches the sooner you will feel better.

Are you doing anything that is making your headaches worse?

In addition to taking over-the-counter pain relievers too frequently, there are a number of things people do that can trigger or worsen headaches.  Not getting enough sleep, not drinking enough water, and eating too many sweets are examples of common mistakes that can make chronic headaches worse.  Chronic headaches are a common symptom of sleep apnea.

Do you have any nutritional deficiencies?  More than 50% of Americans don’t get enough magnesium in their diet.  Stress makes you need more B vitamins.  Magnesium and B vitamin deficiencies can cause headaches, and taking supplements can help keep them away.

Are you eating foods that may trigger headaches?  Some common headache triggers are chocolate, red wine, aged cheese and MSG.  I have patients who have chronic headaches whose headaches have gone away when they have identified and eliminated foods to which they are sensitive, like wheat gluten and dairy.

There are 3 keys to headache treatment.  Your doctor will help figure out what type of headache you have and what treatment is best, and will also explore whether you’re doing anything that is contributing to your headaches.  Successful headache treatment depends on it!

QUESTION:  Do you suffer with headaches?  What do you do about them?


Hepatitis C

This morning I attended University Hospitals Primary Care Institute’s second annual Wellness Symposium.  We had great talks on new guidelines for managing high blood pressure, diabetes, obesity, atrial fibrillation and quite a few other problems.  The one I want to talk about today though is the amazing advances in treating hepatitis C.

Hepatitis C is a viral infection that affects the liver.  It’s estimated that about 3.5 million people in the United States have chronic hepatitis C infection.  75% of patients with hepatitis C do not know they have it.  Hepatitis C kills more people per year than HIV, and has done since 2006, but there is not nearly the same urgency or awareness of testing for hepatitis C as there is for HIV.

This is curious, because hepatitis C is transmitted exactly the same way as HIV, but is much easier to catch than HIV.  Far and away the most common cause of hepatitis C infection is intravenous drug abuse, which is a huge concern with the current epidemic of heroin addiction.

Other ways to catch hepatitis C include blood transfusions and the medical use of blood products, from infected mother to baby, and through unprotected sex (although the risk is low particularly for monogamous heterosexual couples).  It also can be transmitted in the medical field through needle-stick injuries and other exposures to infected blood and bodily fluids.

About 10% of people with hepatitis C have no idea where they got it.  Scary.

Current recommendations are to offer screening to anyone who has one or more risk factors for infection, and to screen everyone who was born between 1945 and 1965.  This is because the baby boomers account for 70-80% of patients with hepatitis C.  (This may change with the IV drug abuse epidemic we’re currently having.)

Why do we care about hepatitis C?  Hepatitis C is the #1 cause of liver transplant in the United States.  It is also the leading cause of hepatocellular carcinoma (primary liver cancer).  And as I mentioned above, it now kills more people per year than HIV.

What happens if you have hepatitis C?  Everyone knows viral infections can’t be cured, right?  Actually, that isn’t true.  Hepatitis C is nearly 100% curable with current medications, and new medications expected to be released soon will push the cure rate even higher with fewer side effects.

What does this mean for you?  If you were born between 1945 and 1965, have EVER abused intravenous drugs, have ever traded sex for drugs or money, have a household contact with hepatitis C or are concerned about your personal risk, PLEASE talk to your doctor and get checked.  The screening test is covered by insurance plans.

Talk to friends and family members.  If you love someone who has risk factors or was born between 1945 and 1965, make sure they get screened.  Hepatitis C can kill them, and it’s curable if it’s diagnosed before permanent damage is done to the liver.

Hepatitis C is estimated to affect 3.5 million Americans.  It often has no symptoms until the liver begins to fail or cancer develops.  75% of Americans with hepatitis C don’t know they have it.  It is curable, if we find it.

Get tested.

QUESTION:  Has your doctor ever asked you about your risk factors for hepatitis C?