Month: April 2016

“In addition to your prescription medicines, are you taking any over the counter vitamins or supplements?”  This is a question I ask every patient who comes to my office for a physical exam.  At least 50 percent of my patients respond that they are, which is consistent with the national estimates.  Of the 50 percent, multivitamins are by far the most common pill they take.  In fact, multivitamin use is so widespread that, according to the National Institute of Health, it accounts for almost 6 billion dollars in sales annually.  The main reasons I hear from patients as to why they take a multivitamin are that they don’t always eat enough fruits and vegetables so are making up the shortfall, and they heard a multivitamin daily will prevent disease.  Unfortunately, multivitamins don’t work for either of these reasons.

The scientific evidence against the benefits of multivitamins has been growing for twenty years.  More recently, The Physician’s Health Study II published in the Journal of the American Medical Association in 2012 found no health benefit in over 14,000 male physicians over the age of 50 after taking a multivitamin for more than a decade. Specifically, there was no difference in the number of heart attacks, strokes or death from vascular disease.  Similarly, the Women’s Health Study interim analysis published in the American Journal of Clinical Nutrition also found no benefit over 16 years of multivitamin use in reducing rates of heart attack, stroke or death from vascular disease.  Finally, in 2013 there were three articles published simultaneously in the journal Annals of Internal Medicine that found multivitamin use offers little or no benefit compared to placebo.  Keep in mind, these five articles I just referenced are only several out of many that have come to the same conclusion.

While studies are helpful in clarifying misconceptions, even without the evidence is it really surprising that our efforts to create a pill fall far short of nature’s ability to develop amazingly healthy fruits and vegetables? Think about it a moment.  Fruits and vegetables have hundreds, if not thousands, of vitamins, minerals and antioxidants that work together in concert to promote health in ways we don’t fully understand.  It is likely we still don’t even know all the components that are important.  If we agree this is true, then why would we believe a man-made multivitamin containing maybe twenty or so substances that were removed from their natural, organic form would be effective?  The short answer is it’s not.

While this scientific evidence and practical reasoning are terribly disappointing given the ease of taking a pill daily, it is better we know the facts so we can make choices that actually will promote our health now and in the future.  There is no substitute for nature.  So take the money you spend on multivitamins to the grocery store and stock up on delicious fresh fruits and vegetables!

Next week’s post:  Vitamins and Supplements, Part 2

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There’s nothing worse than gearing up to lose weight, setting the date to begin, finally initiating your plan, only to find your efforts fail.  Usually the failure is due to misinformation which is common nowadays given the endless articles, infomercials and word-of-mouth crazes we are bombarded with daily.  With this in mind, the following post will focus on debunking some common weight loss myths I hear frequently from patients in my practice.

Myth #1:  Skipping meals will help me lose weight.  It makes practical sense since skipping meals leads to less calories consumed.  Unfortunately, skipping meals also has the unintended consequence of slowing down your metabolism, making you less efficient at burning calories.  The net effect over time is that skipping meals makes it more difficult to lose weight and usually leads to having less energy in the day.

Myth #2:  Eating out frequently is okay as long as it involves healthy choices.  People often feel that a salad is a salad is a salad and it doesn’t matter if the salad is made at home or ordered in a restaurant.  While it would be nice and more convenient, this isn’t true.  To begin with, the portion size when eating out usually is twice the size of a salad made at home.  Twice the size means twice the calories.  Next, you have to consider restaurant salad toppings which almost always include unhealthy options such as croutons, crunchy Asian noodles or calorie-laden dressing.  Lastly, if you continue to rely on eating out, there will inevitably be stressful days when a salad won’t do and you will opt for food with more immediate gratification.

Myth #3:  Eating after 8pm will cause you to gain weight.  I am not sure where this concept began but the only place I know it applies is if you’re a Sumo wrestler!  Sumo wrestlers need to pack on pounds to be successful in their sport.  They tend to eat 20,000 calories a day with at least 10,000 of those calories late at night washed down with several pints of beer.  Unless you plan on moving to Japan and taking up this revered sport, it is safe to say that the problem with eating late has far more to do with the food choices you make at this hour than the hour itself.

Myth #4:  If I drink more water, I will lose weight.  Drinking water is healthy, and most people feel better when they are well hydrated.  They have less fatigue in the afternoon, less irritability, and are more likely to make positive food choices.  However, drinking more water will not help you lose weight unless the water replaces high calorie drinks such as soda, iced tea and fruit juices.  Next time you fill up your glass, remember that water has zero calories!

Myth #5:  If I exercise, I will lose weight.  Exercise may be the single best thing you can do for your health.  It will lower your risk of heart disease, high blood pressure and diabetes.  It will improve your mood, your balance and lower your risk of fractures.  Unfortunately, after the age of 35 or so exercise becomes an inefficient means of losing weight.  Consider if you take a three mile run.  You will burn approximately 350 calories, which may vary a little based on your size and speed.  Yet, there are 3,500 calories in a pound.  Your three-mile effort only burned 1/10th of a pound.  This doesn’t mean that exercise can’t assist in weight loss, as there are long term benefits regarding muscle development and metabolism.   However, the basic premise that beginning an exercise program such as walking or going to the gym by itself will help you lose weight successfully or quickly is not true.

So keep these thoughts in mind when planning your weight loss strategy.  Remember that, while not as exciting as the latest fad diet, focusing on a healthy lifestyle by preparing most of your meals and exercising moderately for health benefits is still the best and most successful means to a healthier and leaner you.

Next week’s post: The Truth About Taking Vitamins

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In 2013, the American Medical Association finally declared that obesity is a disease.  With that in mind, here are three facts I’d like you to consider:

1. Over 35 percent of adults in the United States are obese.
2. It is easier to gain weight than to lose weight.
3. Almost all of us think about our own weight at some point each day.

The poem below hopes to shift the misconceptions those with obesity confront daily in favor of the understanding and empathy their plight to battle this illness deserves.

TODAY MY DOCTOR SAID…

Morbid: a) characteristic of disease
b) characterized by gloomy or unwholesome feelings
c) grisly; gruesome

Today my doctor said
I am morbidly obese.

He said it with
a professorial tone
as I imagined
leather elbow patches
being sewn on his white coat.

He doesn’t know I was
a philosophy major
and I’m not certain
he remembers I’m a lawyer.
So he seemed surprised
when I responded:
“Doctor, I have read that
uncontrolled high blood pressure
is called severe,
and a person who ignores
their diabetes is
poorly controlled.
Even someone
with liver failure
is called cirrhotic.”
To which he nodded.
“So I have a weight problem
which may be severe, uncontrolled,
and even extremely unhealthy–
but I don’t think I’m morbid.”

Perhaps I was only arguing semantics
yet his shamed silence
did not give me the usual surge
I feel after winning a trial.
For these are the words
I did not share with him:

“I am reminded
of my fatness
when confronted
on the supermarket
checkout line
by beauty magazines
guaranteeing perfect abs
in six weeks.

I am reminded
of my fatness
when the person
boarding the plane
struggles a smile
when they realize
their seat is 16F
and mine is 16E.

I am reminded also
in the department store
when I tell the salesperson
who helped me find
a size 24 that
I’ll buy the dress now
but try it on at home.”

The world doesn’t see me
as a mother. They see
a fat mother.
They don’t see a wife
but a fat wife.
And a fat daughter,
fat lawyer and fat friend.

It’s a wonder
I am not gloomy,
unwholesome,
gruesome or grisly.

 

Next week’s post:  Debunking 5 myths about weight loss

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I recently decided to count the number of restaurants in a one-mile radius from where I work.  Specifically, I wanted to know the number of restaurants that I can place an order for lunch or dinner and receive it within fifteen minutes.  Having worked in the area for over twenty years, I guessed there are 25 restaurants or so within this distance.  To my surprise, there are actually 49 places to take-out food!

While this exercise could be used to check the accuracy of Siri or Google Maps, its real purpose is to highlight the ease of ordering dinner out. Unfortunately, over the last couple of decades our priorities as a nation of eaters have shifted, forgoing supermarkets and home cooking in favor of convenient, unhealthy and expensive take-out.  But is this a wise choice? Does this choice create habits that will lead to a lower risk of heart attacks, strokes or diabetes?  Does this choice help us lose weight?

Let’s look at the calorie content of some typical take-out options.  Jersey Mike’s is a popular sub shop in our city.  A standard turkey wrap with honey mustard has 539 calories.  If you add in a small bag of potato chips and sweet tea (I live in the South so this is a must), the total calorie count is over 900 calories.  Imagine if you were to make a turkey sandwich at home instead with whole wheat bread, tomato, lettuce and mustard.  With a piece of fruit and a bottle of water, the calorie count would be less than 300 calories.

Now on some days, a turkey sandwich simply won’t do and you need comfort food to combat the stressful day.  Chinese food would be that comfort food for me.  Well, according to PF Chang’s nutritional information, sesame chicken with fried rice would have 1,198 calories.  We won’t even discuss adding egg rolls or dumplings!

Here’s the fundamental point you will never hear recommended by the Department of Health and Human Services or the U.S. Department of Agriculture (USDA).  If you want to lose weight and be healthy, stop eating out frequently.

So what am I suggesting?  I recognize that stopping at the supermarket every night after a long day of work, then coming home to cook, is an unreasonable plan.  However, here’s an example of how to get from Sunday to Thursday eating dinners at home with minimal effort.  To begin with, on Sunday cook dinner with the purpose of having enough leftovers for Monday night.  Whatever you wish to cook is fine, as long as it includes a protein source such as chicken, fish or meat.  On Tuesday, stop at the supermarket on the way home from work and pick up a rotisserie chicken already cooked.  Don’t pick up the sides–only the chicken!  At home, microwave 90 second rice which all the main brands now have–whole grain or brown rice would be nice–while making a quick salad with lettuce and toppings such as tomatoes and cucumbers.  You will have leftover chicken for Wednesday to have a chicken sandwich with a side salad.  Finally, make Thursday a “breakfast for dinner” night with an omelet or different form of eggs, whole wheat toast and a piece of fruit for dessert.  The key to this plan is going to the supermarket on Sunday to buy everything ahead of time with the exception of the rotisserie chicken which you will get on Tuesday.  Try this for one week and I bet on Friday you will say:  “This week I ate delicious healthy food!  This week I saved money!  This week I lost weight!”

Next Week’s Post:  “Today My Doctor Said…”, a poem reflecting on living with obesity.

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