Archive for the ‘Excercise’ Category

You are What You Eat

In Excercise, Family Doctor, Food and Health, Junk Food, Mindful Eating, Mindless Eating on November 2, 2012 at 12:07 pm

I come back into the exam room, keeping my best poker face, sit down and turn to face her.  She’s on the edge of her seat, nervous and barely able to contain herself, maybe not even sure which answer she wants.


“Congratulations,” I say. She lets out her breath and smiles, huge.


Once the adrenaline settles down and she can hear me again, we start talking through the changes she can expect and the ones she needs to make.  I give her a very short ‘safe’ list of over-the-counter medicine she can take if needed.  She gets a prescription for pre-natal vitamins.  I remind her to avoid all alcohol and really put the screws on for her to quit smoking.

“Yes.”  “Ok,doc.”  “Mmm-hmm.”

Then I hold my fingers up about half an inch apart.  “This is how big your baby is right now.  It’s brain, bones, muscles, everything have to grow and the only food your baby gets it what you eat. Do you want your baby to be made from McDonald’s and soda pop or from healthy food, organic vegetables and fruits?  Now is the time to decide.”


The light that goes on, the Aha! moment I get to see is pretty cool, let me tell you.  This is often one of the conversations that feels like I’ve made a difference in someone’s life.

What I’ve realized over the years is this is true for all of us, all the time.  Every part of our bodies and brains is being constantly re-made, day by day.  The trillions of cells that make me are not the same ones that made me even a few years ago.  Some of our cells are not the same ones they were even yesterday!

Our bodies are constantly repairing and replacing cells by the billions and the only raw materials we have to work with is what we eat.  So, you are what you eat.  I am what I eat.  Everybody is the peculiar mix of Big Macs, broccoli, Guinness, apples, Twix, Doritos, salmon, and whatever else they eat – and nothing else!

Just take that in for a moment.  Think back to what you ate today or yesterday.  Cocoa Puffs?  It’s in there.  Chardonnay?  It’s there too.  Fast food, snacks, sodas?  Yes, yes, and yes.

One of the best ways I know to change your life is simply to become aware.  Mindless eating, mindless couch-sitting, and mindless sleep-skipping are pretty popular ways to feel like absolute crap.  Just being attentive to what I eat, what I drink, how active I am, and whether I get to bed early enough can help me actively choose to feel better.  If I go around on auto-pilot, I’m likely to grab chips for a snack, conveniently forget to run, sit at the computer way too late and feel like I deserve.

Be aware of your choices – you are making the you of tomorrow.  Choose Health!


Diet Arguments, Cheats and Shills

In Diet and Weight, Excercise, Family Doctor, Food and Health on February 16, 2012 at 12:07 pm

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I recently read a debate between a Ph.D. nutritionist and a physician about whether a person can be fit and fat.  This is an old argument that has lots of heat and emotion involved and not much logic or reason.  These experts argue about whether an overweight athlete is healthy but never really agree on how athletic or active this imaginary person is or even what they mean by healthy.

In the end both agreed that being normal weight was a good idea and exercise is good for you.  Amazing!   The MD said what I’ve always said: show me this person and we’ll talk.  After 15 years of examining thousands of patients a year, I don’t think I’ve met anyone in this category.

Debates aside, the fun links were at the bottom of this story.  A stomach-filling diet drink, a rejected diet pill, and a petition by Public Citizen to ban two more.  A lot to chew on, eh? (insert my wife’s dramatic groan here.)

Stomach-filling Diet Drink

The drink has a chemical called alginate that is liquid in a drink but changes to a gel once it hits stomach acid.  Interesting idea though it doesn’t sound that safe, really. Intestines blocked with gel-sludge could keep surgeons way too busy.

Seriously, this may have a future, since much of the trouble with eating less is the hunger people dread.  The recommendation I give is to eat apples and drink water to relieve the hunger pangs.  The pectin in apples actually does this same thing, thickening in the stomach and providing a full feeling.  My guess is the drink will cost a bit more than an apple.

Rejected Diet Pill

The diet pill Qnexa was getting some positive attention after news of the 10% weight loss people had in experiments.  Now it’s getting more attention but of the bad kind.  There were people with psychological problems and heart problems while taking the experimental drug.  Not many doctors would be surprised by the news since those are the problems the ingredients can cause too!

There is an enormous market and demand for weight-loss drugs, which means the drug companies will keep working at it.  The company that owns Qnexa says they will keep trying to convince the government of the drug’s safety.  My hope is that the FDA will do their job and protect patients.  Combining the ingredient in Adipex with a seizure drug and hoping its safe sounds like wishful thinking to me.

I’ve written elsewhere that I don’t prescribe Adipex.  I get at least one request a week from someone desperate for some kind of help.  I try to refuse gently and reasonably, but I still see the frustration and disappointment.

“Adipex isn’t safe,” I say.  “It isn’t safe, it doesn’t work and I have to carry extra malpractice insurance just to prescribe it.”


That’s the best answer I could hope for — it means someone just listened!  There is very little proof of phentermine (Adipex) working in the short-term and none at all that it works over the long-haul.  If it works, most people lose 10-15 pounds over 3-6 months.

Once it is stopped, my experience is that everyone goes right back to their old eating habits and gains all that weight right back.  Nothing really changed.  If a person won’t change their attitude and approach to food, if they keep eating like an American, they should expect every fad diet and diet pill to fail, Adipex too.

The safety part of phentermine is my biggest problem with it.  That whole “Do no harm” vow sure can slow a doctor down.  There may not be much proof that it works but I think there’s plenty of proof that phentermine can cause mental problems and permanent heart damage.  That’s why my first insurance company after graduation required me to pay for a policy rider if I prescribed medicine for diet and weight loss.  They were so sure I would be sued for prescribing these medicines they wanted me to pay more ahead of time!

That’s actually when I started looking in-depth at these drugs and came to my decision not to prescribe them.  The drugs in this family work by the same effect on the brain and all have the same risks to the brain and the heart.  Two of the drugs have already been taken off the market: Fen-phen and Meridia.  I think that phentermine should have been withdrawn too, but it is so old the FDA rules that apply to it are a little hazy about safety so it has stayed around.

Public Citizen wants them Banned

This ABC News article is about the other weight-loss drug type available, the fat-blockers Xenical and Alli.  There have been complaints about both drugs in the public since they came out.  Like the other diet pills, these don’t really work and don’t change the person, plus they offer the nifty side effect of “flatus with discharge” according to my epocrates app.  For those not in the know, this is also called “oily anal discharge” or “anal incontinence.”  However politely you say it, this is pretty gross.

The Public Citizen complaint to the FDA says they cause  worse problems too, like pre-cancer in the colon and vitamin deficiency.  Again, plenty of bad effects, underwhelming weight loss (10-15 pounds for all of them) and no permanent change in weight or health.  Not a very good deal, especially when you consider how much these pills cost and that insurance won’t pay for them.

There is one other diet pill on the near horizon.  Contrave is still working its way through the FDA, with a solid “Yes, maybe” from them in December 2010.  Whatever they decide about this medicine (other than high blood pressure and seizures it seems pretty ‘safe’) it’s still good for only about 10 pounds.  The company can sell it to us with a straight face, saying “If you take it for a year, you’ll probably lose 10 pounds.”  Seriously?

Expensive, bad side effects, crummy results — how about learning some new habits and finding joy in feeling well and eating healthy?  Come on, try it, you’ll like it!

Change Your Food, Change Your Life!

But Does It Work?

In Diet and Weight, Excercise on December 29, 2011 at 12:17 pm

doctorfoodtruth picture of blood pressure cuff and stethoscope

All day I badger and cajole my patients to take better care of their bodies:

“We really need to get some of this weight off, Mr. Jones.”

“This blood sugar level means diabetes is right around the corner – it’s time to get serious about changing your diet, Ms. Smith.”

“This blood pressure reading tells me that you’re not getting enough exercise, Bill.”

I’ve got pills for everything, it seems.  I just wish I didn’t have to use them!  So when I get a great success story like I had recently, I want to share it.

Gary came in several months ago because the nurse at work had found a very high blood pressure reading.  I looked him over and did a few tests on his heart and immediately started him on the blood pressure medicine I thought would work best for him.

When I start a new medicine like this for a long-term problem, I always make sure to tell my patient if I think they have any way of fixing the issue and stopping the medicine.  In Gary’s case, I thought it was pretty clear that he had neglected his health and was starting to have consequences from that.  The good news, I told him, was that he could turn back the clock and fix his blood pressure and other health issues.

Since we had just met, I wasn’t sure how seriously he was taking his health or whether he really meant it when he said “I’ll fix this.”  As I got to know Gary over the next few months and see his blood pressure come down to the safe range, I found out that he had truly taken my challenge.  Just yesterday, we both realized that he beat it – we stopped one of his blood pressure medicines and made plans to come off everything in a few more months!

“I’m eating healthy and walking at least once a day,” he says.  “Nothing fancy, just stuff I knew I should have done but never did until now.  And I feel great!”

He ought to feel proud too.  In five months, he’s lost over 30 pounds.  The diet and exercise he’s done, while nothing crazy or difficult, has been made up of good choices day after day.  Gary’s good choices have made his heart stronger, his sugar normal, and cut his cholesterol by almost 40%.  All this in 5 months, while still enjoying life and working full-time.  And the best part?  Now I know Gary well enough to recognize that glint in his eye when he told me, “This is permanent.”  I have no doubt.

Eat Healthfully, Live Fully Healthy!

Write it Down

In Diet and Weight, Excercise, Food Truths, Food Lies on December 16, 2011 at 12:46 pm

running on doctorfoodtruth

I was right!!

My wife Dr. Mary likes to keep track of those other times, of course.

But this time, I was right.

Just today a study hit the news that telling teens how many calories a soda had was useless. Telling them how many calories that soda was as a percent of their total for the day wasn’t much better.

But telling them how many minutes of running it would take to get rid of the calories? That worked!

In Food Truths, Food Lies I write about why exercise alone usually won’t lead to weight loss:

“Most people take 30 minutes of fast, sweaty walking to burn off one can of Coke…. Want to burn off a pound worth of calories? Better pack a lunch (which just puts you further behind) because that will take 10 hours on the treadmill!”

The moral of this story? Think about it before it gets swallowed. Once it’s down the hatch, it can take a very long time to get burned off again.

Change Your Food, Change Your Life!

I Can See the Future (recycled post)

In Diet and Weight, Excercise, Family Doctor, Food and Health on November 21, 2011 at 12:05 pm

A family Tree on doctorfoodtruth

One of the unique perspectives I get as a small-town family doctor comes from truly taking care of families.  My little town is a place people tend to stay to raise kids and their kids stay, too.  The stability of the community is one of its big attractions to new families as well.

For a Family Doc, this means I often know three or even four generations in a family.  What better way to know about someone’s medical family history than taking care of both their mother and son?  The great part for me is how quickly I start to feel like one of the family.  As I walk through illnesses, births, deaths, and other milestones with people, we learn a lot about each other and often become friends.

The hard part is watching health problems trickle down the generations.  Grandma’s diabetes is connected to mom’s insulin resistance (pre-diabetes) and her son’s obesity and acanthosis (a sign of coming insulin resistance.)  Sometimes it can feel like trying to move a mountain to get everyone to change.

What I know is that the eight-year-old is on the wrong path and heading straight for early health problems like the rest of the family.  What I also know is that it doesn’t have to be this way.

I have seen whole families choose differently and re-vamp their health together, I know it’s possible.  I also know it’s hard.

One day turns into the next, the TV is on, healthy food is harder to make and more expensive to buy — all these things and more can make change hard for families.

But I keep hoping, keep nudging, keep encouraging people to change.  Grandma can feel better and younger, mom can avoid diabetes altogether, and Junior can be a healthy kid without his weight and tiredness slowing him down.  I know it! Now if only I could show the future instead of just seeing it…

Change Your Family’s Food, Change Your Lives!


In Diet and Weight, Excercise, Family Doctor, Food and Health on November 14, 2011 at 12:05 pm

crossroads on doctorfoodtruth

I saw my patient Mary last week.  We’ve known each other four or five years now.  The appointment went pretty normally, us talking about her lab tests, her blood pressure, her weight.

She mentioned some minor road bumps that work had caused her and we chuckled at the difficulties that life can throw our way.  She admitted that her weight loss efforts we talked about at our last visit hadn’t gone very well.

After I did what I needed to do and she asked what she wanted to ask, I was about to tell her I’d see her in a few months when I was suddenly gripped by the need to add something else.

Mary and I are almost exactly the same age.  While I’m not quite 40, I definitely feel the hands of the clock moving faster and faster.  I know that when it comes to health, habit changes and exercise regimens that might be easy when you’re young are not when you get older.

So I said, “Mary, I need to tell you something else and I’m just going to be really honest with you.  I think that you are at a crossroads.  I think if you look this direction, the one prescription medicine that you need now will multiply to five or even ten prescriptions within a few short years.  You can see knee replacement surgeries and a slower, much more painful old age.

“But if you look the other way, you can see what would happen if you choose differently now.  You could have a completely different future.  You can fix you knee pain and avoid early arthritis by losing the weight that needs to come off.  You can heal your system and be able to stop your diabetes medicine within six months if you put your mind to it.  You can avoid the blood pressure and cholesterol pills we talked about today.

“In short, you get to decide how your life goes from here.  But you have to decide now.  Pretty soon, your body will have been damaged by your lifestyle and changing won’t be so healing.  It will be kind of too late.  Please don’t let that happen to you, please don’t wait to make the changes your body needs.  Please take advantage of the opportunity you have and choose to do something different.”

“Yes, Dr. Marcotte, I hear you.  I think you’re right.”

And you know what?  I think I may have actually gotten through to her with that.

We’ll see, I sure hope so.

Change Your Food, Change Your Life!

“Budget” Tips, Part 2 (recycled)

In Diet and Weight, Excercise, Family Doctor, Mindful Eating on October 6, 2011 at 12:02 pm
budget pie chart on doctorfoodtruth

Continuation of a two-part post translating money budgeting tips to healthy food choice/diet advice. The original article from The San Francisco Chronicle has 6 tips and #4, 5, and 6 are right here!

4) Increase your income rather than simply decreasing your spending. This was the one bit my ‘money man’ @PeteThePlanner objected to, since it can just send people back to the work-spend-work treadmill that is such a soul-killer. Ms. Mueller suggests taking on a part-time job to help ease the budget. Will the resulting overwork just make me feel even more deprived and deserving of the splurges and lifestyle that ruin a budget in the first place!

Interestingly, this is a piece of advice I am reluctant to teach in the food and diet realm too. Despite what Richard Simmons and Tony Little would tell you, I do not think exercise is the path to weight loss. I go into detail about this in my book, Food Truths, Food Lies, but in brief: It takes moments to eat or drink hundreds of calories and hours to burn them off.

The math is pretty simple and not knowing this leads to great frustration for millions. “Why isn’t the Ab-Roller making me skinny?!?” My painful but true answer: “Because it can’t.” Getting a part-time job to make ends meet is equal to planning to hit the treadmill to make up for a banana split. Who is really going to spend the 3 hours it takes to burn those 1,200 calories? And if I do put in that much sweat and effort, don’t I deserve a reward? More ice cream! Oops.

5) Spend money on maintenance. The SanFran article goes into the wisdom of keeping your stuff in good working order to prevent financially disastrous repair bills. You know, skipping the $30 oil change to “save money” then paying for the $2,000 engine overhaul. Not smart.

As a Family Physician, I believe this wholeheartedly. Fixing the diabetes or heart attack or cancer is so much harder than keeping our bodies healthy and whole in the first place. Avoiding obesity by being aware of food choices and calories is so much easier than struggling to lose those 50 deadly pounds. Please don’t neglect your amazing body! Doing that will always come back to haunt you.

6) Don’t panic about your non-existent savings account. In her last turn-it-all-on-it’s-head piece of advice, Ms. Mueller gives us permission to not panic about a lack of savings. Yes, it’s important, she says, but “If you take money away from paying off an interest-bearing debt in order to put it in a savings account, you’ll likely be losing money…” In other words, priorities matter. Some things are always more important than others. For her, paying off high-interest credit cards is numero uno.

For health, I think this means needing to accept where we are while working to change. If you have diabetes, please don’t stop your medicine so you can concentrate on weight loss. If my cholesterol is already dangerously high, quitting my medicine so I can use the money to buy organic at Whole Foods would be crazy.

Yes, health is always improvable. Yes, we should all want to be well. Yes, the effort is worth it. None of these truths mean I should stop doing the little things to pursue some grand health goal.

As a bonus tip, Mueller ends with the advice to stop being so secretive. She thinks using positive peer pressure is a great idea to help us stick to our budgets. If you’re going to make a change, tell someone you trust. Let them help you stick to it when it gets a little tough, as it certainly will.

For health and wellbeing, ditto. Join a group (Weight Watchers is great,) challenge a friend to join you, blog about it — make it known. We humans are social critters and having support is crucial in any worthwhile endeavor.

The last piece of advice that we always need? Get going!

Change Your Food, Change Your Life!

Becoming Choosy

In Diet and Weight, Don't Eat White!, Excercise, Family Doctor, Food and Health, Mindful Eating on September 26, 2011 at 11:55 am
Shelled almonds on doctorfoodtruth

I believe in keeping things simple.  When I challenge a patient to change their health habits, I usually pick one thing for them to change and give them a simple, easy-to-measure goal.  Once we agree on the goal, we arrange to check on their progress in the next few weeks or months and shake hands on it.  Of course, sometimes they’re just not ready for a challenge and we agree to wait instead.

Once they see success and get a taste of how health habits directly affect how they feel, I usually encourage them to a little bigger goal.  Instead of bringing their cholesterol down 30 points or losing 5 pounds, we might aim for a bigger weight loss goal or a shift to mostly vegetables in the diet.

Again, my hope is always for an achievable goal that they believe in as much as I do.  As I remind them, I’m not going to be following them around to slap their hand or drive them to the gym.  It really is always up to the patient.

The final step, the advanced study program at my office, is learning how to markedly improve your health with proper food choice.  Learning that they can succeed is always the first step – so many people have just about given up goal-setting for their health by the time we talk.

Next comes making a substantial commitment to their health and future with a real lifestyle change: exercising regularly, avoiding beef and pork, maybe cutting the “white” out of their diet.  By the time a person has succeeded with this step in affecting their health, they come to truly believe my little mantra “Change your food, change your life!

The final, advanced step is becoming choosy about what becomes part of you.  My friend over at Small Bites, Andy Bellatti, reminded me of this with a couple of his great Tweets today:  Monounsaturated fats (avocado, olives, almonds, pecans, etc.) highly anti-inflammatory. Proof that whole foods is way to go!  &  High intakes of monounsaturated fats decrease cardiac and diabetes risk much more than low-fat approaches.

Here is what I think of as the last and still-evolving step in becoming healthy – becoming choosy with what powers your body.  Choosy to the point that I choose almonds over peanuts for a snack due to the Omega-3 content.  Choosy to the point of picking the higher calorie guacamole over salsa because I know how beneficial avocado is.  Choosy in the eggs I buy, the restaurants I frequent, and the fruit I eat.

This “everything matters” approach may be too much for some.  I don’t saddle my patients with everything I know about nutrition (which keeps growing daily thanks to friends like Andy!) but I do offer it to them.

The food choices I make absolutely make me.  There is no other way to look at it.

Your energy, sleep, mood, memory, digestion, and even personality are tied to your food picks.  Better be choosy!

Eat Healthfully, Live Fully Healthy!

Insult to Prevent Injury

In Diet and Weight, Excercise, Family Doctor, Mindful Eating, Self Image on August 25, 2011 at 12:10 pm

He was proud but still mad.

One of my favorite couples came in together to see me recently. One of the things that has struck me as a Family Doctor is how closely some couples’ health tracks with each other.

I usually get to see lab tests before I see the person for their follow-up visit. I often get a glimpse into how the past few months have gone for people by seeing how much their blood chemistries have changed. Liver tests look good or go wild in someone I know struggles with alcoholism, cholesterol levels may suddenly jump for a lady who had told me she feared for her job, that sort of thing.

A few years ago, I had a couple who had been very stable with their diabetes suddenly both have terrible blood sugars. I knew immediately something was wrong and when I asked, found out that the husband had been diagnosed with lung cancer a few weeks earlier. They had both completely stopped their medicines and diets out of stress and grief. Since then he has done great and both of them are back on track.

The couple last week was different. Once again I had seen a change in the blood tests but this change didn’t match: the husband was suddenly much improved but the wife right where she had been. Why?

Two months ago, I had sent the husband to see a cardiologist (heart specialist) for symptoms that concerned me for a coming heart attack. I was relieved to get the other doctor’s letter saying he didn’t believe the symptoms were heart-related and that he had recommended exercise and diet change.

I usually start family visits with the person who has the most issues or most pressing needs. I turned straight to Bart (pseudonym) and said, “What’s different?”

“Well, I lost some weight.” That much was obvious.

“Good, but why are you mad?”

“Cause that heart doctor you sent me to told me I was fat and lazy! He said the only thing wrong with me was that I needed to lose some weight, that my heart was fine.”

Oh. I pick my specialists carefully and I picked this one because he does more testing than his partners and I thought Bart needed a certain test. I hadn’t warned Bart that this doctor can be pretty blunt sometimes — oops.

“But, I’m glad he did, though I’m still mad at him. I haven’t felt this good and had this much energy in years!”

Sounds like I may need to add therapeutic insults to my medical bag of tricks!

I Can’t

In Excercise, Family Doctor, Food and Health on July 20, 2011 at 9:50 am

“I can’t”

I tell patients this every day because it’s true. I’m not a Superman kind of doctor who thinks he can cure everything. The list of things I can fix is pretty short, so I often have to tell my patients “I can’t fix this.”

Truthfully, there aren’t many things any doctor can fix — we’re just not very good at admitting it. Surgeons can cut out or bypass parts that malfunction, we have some poisons that can cure some cancers, and most infections are curable now. Other than that, all we do is tweak.

Diabetes, blood pressure, cholesterol – all my pills are tweaks. If you take them everyday and don’t overload your body with too much sugar or salt or cholesterol, my pills will do wonders to keep your body going longer. Start skipping pills or eat so badly you cancel their effects and those pills might as well be a placebo (sugar pill.)

No, the only real life-changing treatment I offer most of my patients is me. I will test and track and harass you as long as you keep coming back for the “treatment” of talking to me. See, even my one good treatment is completely based on you!

The person who can fix it? Again, you! Most high blood pressure and diabetes and cholesterol can be made much better or even cured by only one person: the patient.

Changing your diet works. Getting off the couch and exercising works. Changing your outlook and attitude works. At best, my pills can only help. The real power to heal is in YOUR hands!