New Year’s Reservations…I Mean, Resolutions

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New Year’s Reservations…I Mean, Resolutions

By MICHAEL SHAPIRO, PhD

January 2020

It occurred to me this week that I had not written a blog entry for the month of December, 2019. For the year 2020, I will resolve to pay better attention to deadlines…and then to not make any more resolutions!

Speaking of which…what is the deal with New Year’s resolutions? We’ve all made them; and we’ve all failed to keep them. When we fail, most of us feel guilty. We then resolve to stop beating ourselves up about it…which ends up being the only resolution we keep, at least until next year, when the cycle starts all over again!

Are we really so weak-willed? Do our best intentions always have to go bad? Is the custom of setting New Year’s resolutions just another yearly process to set ourselves up for humiliation and failure? Good questions! Let’s make a resolution to get to the bottom of this!

According to one of my most trusted scientific sources (the History Channel), the first New Year’s resolutions were probably made about 4,000 years ago in ancient Babylon. Each year, after spending 12 days crowning a new king (or pledging loyalty to the reigning king), these ancient partiers would make a promise to pay all debts and return all borrowed objects (like CDs, power tools, and stuff like that), in the hope that the gods would bless them with prosperity during the ensuing year. Later, the ancient Romans (who actually invented “January”) would begin each year by offering sacrifices and making a promise to behave themselves for the rest of the year. We all know how that turned out. At some point, making New Year’s resolutions became a secular (rather than religious) practice. Instead of resolving to improve ourselves as a community, we decided to look inward and make personal goals for self-improvement. Unfortunately, statistics show that although around 45 percent of Americans make New Year’s resolutions, only about 8 percent keep them. Where do you fall in that statistic? Yeah, I thought so.

So, should we throw the New Year’s baby (the cute one with the sash) out with the bathwater? I don’t think so. Setting goals is an admirable and commendable practice! Doing so prevents us from becoming stagnant. A resolution is a promise to ourselves to keep growing, improving, and changing for the better! As a psychologist who works with patients who suffer from medical disorders that are mediated by lifestyle (for example, obesity, diabetes, and hypertension), I’ve seen that goal-setting can be a lifesaver…as long as those goals are set properly! To this end, we health care professionals (or was it the ancient Babylonians?) have come up with an acronym for goal-setting that can easily be applied to New Year’s resolutions: SMART. Specifically, make resolutions that are Specific, Measurable, Attainable, Realistic, and Time-based. Let’s look at each of these individually:

A “specific” goal is one that is, well, specific rather than vague or overly general. For example, rather than resolving to “look better in 2020” or “lose this gut” (yeah, that’s one of my favorites); one might say, “I resolve to lose 10 pounds.” This places the goal in clear view, thereby making it more realistic and attainable (more on that in a minute).

A goal also has to be “measurable,” mainly to help you know when you’ve achieved it! After all, to “look better in 2020” is pretty subjective: my idea of “looking better” probably differs from yours (personally, if I leave home with my hair combed and my underwear on the inside of my pants, I’m looking pretty good!). Whether your goal involves weight loss, exercise, or something else; it’s helpful to have a numerical way to measure your progress, be it in pounds, inches, days, HbA1c levels (for you diabetics), calories, school grades, blood pressure values, or number of good deeds done.

An “attainable” goal is one that is not so far from where you are now, just a small “bump” up or down, thereby making it more easily reached. For example, a weight loss goal of one pound per week is much more manageable than 20 pounds per week…which brings us to the next part of the acronym: a “realistic” goal is one that is reasonable for your body type, your resources, and your circumstances.

I’ll confess that I’ve always held on to two important personal goals: to become an astronaut, and to invent teleportation (you know, like on Star Trek). Unfortunately, now that I’m in my 60’s and have established a fairly stable career path (oh, and don’t have a sufficiently high IQ or even a decent understanding of subatomic physics), I’m beginning to think that these goals may be slightly—and I mean just slightly—unrealistic. Similarly, if your goal is to become a millionaire this year; or to diet and exercise until you look like Natalie Portman or David Gandy (who, according to a study performed in the UK, are the most beautiful people in the world, based on what are considered to be the most universally attractive physical traits); you might want first want to take a look at your bank account, your investment portfolio, and your image in a full-length mirror.

Lastly, a “time-based” goal has a specific expiration date. This will ensure that you stay motivated, which is more likely when you set a definite time limit. When your timeframe is vague or non-existent (“I need to lose weight this year,” “I gotta get around to fixing the house,” “I’m finally going to clean out the basement”), it only give you an excuse to put it off. Besides, time limits provide a “checkpoint” for you to assess your progress. If you haven’t lost that one pound by the end of the week, you can stop and re-assess whether or not that goal was realistic and attainable. If you did meet your goal, you can pat yourself on the back, and then set a new goal that’s even more challenging (“Now that I know I can handle walking one mile a day, I’ll set a new goal for a mile-and-a-half!”).

So, if you’re looking back on all the resolutions you didn’t keep in 2019 but are not yet ready to completely give up on the grand old tradition of making New Year’s resolutions; try making some using the SMART goal paradigm. However, as of the day of this writing, it’s already January 3…so you’d better hurry up and get started. Personally, I think I’m actually only a few days away from finally nailing the whole teleportation thing…

Guidance to Good Health Blogs

Now is the Time: Catch-up to Get Ahead on Childhood Immunizations

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Now is the Time: Catch-up to Get Ahead on Childhood Immunizations

By Adm. Brett P. Giroir, M.D.,Assistant Secretary for Health

August 2020

During National Immunization Awareness Month, the U.S. Department of Health and Human Services (HHS) is urging healthcare providers and parents to “catch-up to get ahead” on childhood immunizations.

The COVID-19 pandemic has led to worrisome declines in well-child visits and routine immunization rates. Although we have made progress to reverse this trend, without high vaccination rates there is a risk for outbreaks and further strain on our nation’s healthcare system.

As a pediatric critical care physician, I know all too well the devastating consequences that diseases, like whooping cough and measles, can have on children and their families. It is tragic to see a child become sick, or even die, from a disease that we can prevent with safe and effective vaccines. In our fight against the COVID-19 pandemic, we cannot let down our guard against preventable childhood diseases. Now is the time to get every child back on track with recommended vaccines.

To increase childhood immunization rates and reduce potential outbreaks of vaccine-preventable diseases before flu season, HHS is coordinating the “Catch-up to Get Ahead” effort. Together a number of government and private sector partners will enhance access to essential immunization services by:

  • Increasing immunization opportunities by encouraging extended office and clinic hours for the administration of catch-up vaccines;
  • Informing parents about COVID-19 safety precautions and practices in place in healthcare settings and encouraging them to take their children to get vaccinated; and
  • Catching children up on their immunizations to mitigate pressures on our healthcare system when the influenza and SARS-CoV-2 viruses begin co-circulating in the coming months.
  • Promoting the importance of childhood immunizations.

It’s imperative to make sure our children are vaccinated on time throughout their childhood before they are exposed to potentially life-threatening diseases. Vaccines are a safe and effective way to guard our children against 16 serious diseases, such as rubella, polio, and cancers caused by HPV.

Getting children back on track with recommended vaccines is safe, but there may be delays, as many children need to catch-up during this time. Additional precautions are in place in healthcare settings to prevent the spread of SARS-CoV-2, the virus that causes COVID-19. Most vaccines are also available at no or low cost to the parent. Parents should talk to their healthcare provider if they feel that cost is a barrier to getting their children vaccinated.

To learn more about vaccines and vaccine-preventable diseases, visit vaccines.gov.

Why Do Some People Develop Diabetes and Others Don’t?

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Why Do Some People Develop Diabetes and Others Don’t?

By Lenny Salzberg, M.D.

May 2020

Risk factors for type 2 diabetes

Why do some people develop diabetes, and others don’t? Lifestyle and environmental factors account for the majority of the diabetes epidemic. We know that an energy-dense Western-style diet (food trucks, anyone?) and a sedentary lifestyle (thanks, COVID-19 L) are responsible for the epidemic of obesity, and that obesity often leads to diabetes. But not everyone who is obese gets diabetes, and not everyone with diabetes is obese! Why???

Genetics! Scientists have already identified 500 genes that are associated with type 2 diabetes, which together account for 20% of the predisposition to type 2 diabetes. But genes don’t explain everything. In addition to genetic factors, there are “epigenetic” factors, which are influences outside the DNA. These include things like aging, the environment, and exposure to substances during gestation. For example, prenatal exposure to famine has been associated with a higher risk of developing type 2 diabetes. Also, the children of women who have gestational diabetes are eight times more likely to develop diabetes themselves! So, if you don’t want your baby to grow up to have diabetes, don’t get pregnant during a famine, but if you must, don’t get diabetes while you are pregnant!

What are some surprising risk factors for diabetes? Many of us know about the risks incurred by lack of exercise and by drinking Mountain Dew and other sugar-sweetened beverages (e.g. sweet tea). But did you know that eating a low fiber diet, not sleeping enough, and even exposure to loud road noise are all independent risk factors for diabetes? Did you know that drinking 3 or more cups of coffee (either caffeinated or decaffeinated) is associated with a lower risk of diabetes?

The Microbiome

One of the frontiers in diabetes risk management involves our complex intestinal ecosystem: the “gut microbiome.” The gut is nearly sterile at birth. However, by age three, the gut has acquired most of the microbes that will be present through adulthood. These microscopic organisms (certain types of bacteria, fungi, and viruses) share a symbiotic relationship with the lining of the gut.

The two main types of bacteria in the gut are called Firmicutes and Bacteroidetes. Firmicutes are found predominantly in the small intestines, while Bacteroidetes reside mostly in the colon. These bacteria are involved in nutrient metabolism, drug metabolism, maintenance of the gut lining, and protection against pathogens. Dysbiosis (an imbalance of gut microbes) occurs as a result of an unhealthy diet, antibiotic treatment, or chronic infection. In one study, four days of a meat-based diet rapidly decreased the abundance of Firmicutes in the gut. Who would have thought that eating meat was bad for us? Also, it has been shown that the guts of patients with diabetes and prediabetes have fewer of the type of bacteria that change carbohydrates into short-chain fatty acids (SCFAs). SCFAs affect metabolism, energy balance, and the stability of the immune system.

Strategies to prevent and treat diabetes through manipulation of the gut microbiome are being developed. We know that you can help your own microbiome by consuming “prebiotics”, like vegetables and fruit. Probiotics, like kefir and yogurt, may also improve your gut microbiome! In the meantime, pick your parents well, eat a high fiber diet, avoid meat, drink a lot of coffee AND get enough sleep, and try not to live next to a highway! Good luck!

Corona, No Lime

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Corona, No Lime

By Ebaad Malick, M.D.

March 2020

For most of us, these past few weeks have been full of fear, news reports, memes on social media, and thoughts about finally getting that modern Japanese toilet installed (look it up). Of course, I am talking about Coronavirus, or, more specifically, COVID-19. At the end of this article I will include helpful links to some of the world’s top health organizations with easy-to-digest information about the virus and how to manage this developing pandemic. For now, I think we should all take a step back and think about a few things.

COVID-19 has engulfed all of the world on one key issue, thereby uniting us all against it. People are packing grocery stores to stock up on food and cleaning supplies. Around the globe, there have been cancellations of major sporting events and public gatherings. Even celebrities and politicians are being tested (or finally deciding to get tested), and there are a few instances of leading doctors and healthcare workers who have tragically passed away due to the disease.

At times like these, I hope we can at least feel more empathetic to those in our society who everyday can’t get the supplies they need, or who live in constant fear of opportunistic diseases due to their socioeconomic status. Hopefully, we can now better understand why so many people act out of fear and try everything they can to migrate to a safer area for their family.

All of a sudden, we are all injected with our own fears, and we begin to act out of that fear. Some of the pettier issues in our lives seem smaller. Our fragile humanity has been exposed. Viruses do not discriminate the same way we humans do. They don’t care if you are black or white. They don’t care if you’re rich or poor. They even don’t care if you’re one of those people that put pineapples on pizza (why, though?). A virus can infect almost anyone who is exposed to it; even with certain genetic factors and risk factors at play.

At this time, I would like to thank all physicians, nurses, and other healthcare workers who are putting themselves at risk by being the first to respond to people with symptoms of COVID-19. When a patient comes into the clinic coughing up a storm, it is the person working the front desk that is exposed first; even before the patient gets a mask or further precautions. Nurses are still taking vital signs and touching the patients more than anyone. In major sporting leagues, they have suspended the season to help control the spread of the virus and protect players, spectators, and their families. However, there is no suspending hospitals, clinics, and laboratory testing.

COVID-19 belongs to a class of viruses called Coronaviridae. So far, it has been shown to mainly affect people over 60 who have heart failure, diabetes, and immunosuppression (weakened immune system). Nevertheless, it is important to note that new information comes in every day, and there are still some cases showing up in all age groups. Leading scientists and medical professionals caution us to understand that everyone is still at risk, even if the first wave of reported deaths and hospitalizations are in older populations with comorbid medical conditions. So far, it appears that the virus is transferred via respiratory droplets, similar to the flu. This is why social distancing is important to reduce the amount of time you are within 6 feet of another person. We should also understand that touching our noses and mouths can transmit the virus if we touch an infected surface (like metals and fabrics). By washing our hands we can decrease the chance of transmitting the virus to ourselves or someone else.

For more information about the Coronavirus please use one of the following links:

Center for Disease Control (CDC)

World Health Organization (WHO)

The Best Diet? No Diet at All.

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The Best Diet? No Diet at All.

By Kristina Kurkimilis, DO

February 2020

My (not so formal) formal disclosure: the following represents the opinion of a second-year family practice resident, fitness enthusiast, and nutrition dabbler…namely, myself.

“Diet” is defined as, “…the kinds of food that a person, animal, or community habitually eats”; or “…to restrict oneself to small amounts or special kinds of food in order to lose weight.” Nowhere in this definition are you told how to eat; you’re only told that dieting involves restricting food. However, how do you know what you’re supposed to restrict? Also, how can the restriction of any kind of food be completely sustainable?

This brings me to my next definition, “fad diet.” This term refers to “…a popular diet used to lose as much weight as possible in a short amount of time.” For example, some fad diets (like the South Beach Diet, the Lemon Diet, and “juice cleanses”) call for the complete elimination of entire food groups. I have a lot of issues with these fad diets! For one, the goal should never be to lose as much weight as possible, but instead to lose weight in a healthy way. Second, losing weight in a short amount of time only leads to “yo-yoing” (sudden weight loss followed by sudden weight gain).

Why do I sound like such a diet hater? Because I believe that if you’ve decided to make a commitment to your health by losing weight and eating better, then you should do yourself the favor of creating sustainable new lifestyle habits that will last a lifetime, rather than dieting for just a few weeks so that you can fit into that dress or that pair of pants. Instead of crash diets or fad diets, I recommend small, sustainable changes that will eventually evolve into lifetimes habits.

When it comes to dieting, small changes will be much more productive than the drastic changes demanded by a fad diet. For example, let’s take a diet that promises that you will “…lose 15 pounds in a week if you eat zero carbohydrates.” You may be able to do this for a few days, or until you’re tempted by cake at your best friend’s birthday party. At that point, you might think, “I can cheat with one piece of cake today, and then jump right back to my diet tomorrow!”  Unfortunately, that one piece turns into a few pieces, or you add some pizza and fries! This is a common story that I hear pretty frequently in my office. The intent to eat better and lose weight always starts off strong, when the motivation is high and there is a “newness” to the whole process. But then you start to crave what you can’t have, you want to be able to enjoy a drink or a meal with your friends, or you have a tough day at work and just need that ONE thing you’ve sworn off of to feel better. This is no way to live your best life! Instead, you’ve created a life full of deprivation, guilt, and shame.

Instead, I think you should adopt an “80/20 lifestyle.” This means that instead of eliminating something completely, you try to abstain from it 80% of the time. Then, following the rules below, you can spend the remaining 20% enjoying live and giving yourself some grace!

More generally, try to follow the following rules, which I give to all patients who are seeking out a healthier diet:

  • Eat whole foods (foods as close as possible to the way nature made them). Try to avoid frozen, processed, or packages foods.
  • To make rule #1 easier, shop the perimeter of the grocery store, because the shelves in the middle of the store are usually reserved for less healthy items, like packaged and frozen foods.
  • Limit foods that have white grains, added sugar, and added salt. You can still eat foods with natural sugar in them (like fruit), but for a zero on the “added sugar” part of the label. Replace white bread and white pasta with their whole-grain counterparts, and don’t keep a salt shaker on your table at home!

So, if it’s your best friend’s birthday, go ahead and have a piece a cake. If you keep up with the “80/20 rule,” you won’t feel like it’s “cheating,” and you’ll avoid the temptation to binge later on. For some people, the word “diet” is enough to make them feel restricted. Instead, I challenge you to create new habits and change your lifestyle rather than trying a fad diet, failing, and regaining the weight you were trying to lose. You may feel like the tortoise in the race against the hare, but who wins the race? Slow and steady.