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Lessons in Suffering

Soulful Sundays: Once a week I will have an installment that speaks to my spirituality, because, as I’ve said, to me, spiritual wellness, is essential to complete wellness. Because I am Christian, my spirituality is heavily based on my relationship with the Trinity and the Christian Bible. If reading about God, Jesus, or the Spirit will offend your sensibilities, these posts aren’t for you–be advised

Anyone who has spoken to me in depth, in person, about these migraines I’ve been experiencing since May of this year has heard this: this is a very spiritual journey. It may make some uncomfortable to know just how much I hear God’s voice and feel His Spirit guiding my every move these days. This is a transformative process, and so when people ask me how I’ve remained sane through some of my darkest days, or how I’m smiling when I’ve been in some form of pain daily for around 5 months, I say, “The Lord and I have become really, really close.” When there are weeks you spent where 70-80% of your day is alone in a dark room, you either go into the darkness, or you get VERY spiritual, start to really ask some questions about some things, and stop asking questions about others, and just—do what He’s telling you to do. It’s what started this blog.

Today, I want to talk about suffering again, because mine isn’t over, and it does my spirit some good to remind myself of purpose. We suffer for a few reasons.

Sometimes, we’ve made some choices, and there are consequences. For instance, Adam and Eve chose to disobey the command not to eat from the specific tree in the Garden, and all of humanity has suffered the separation from God since. Jesus came to restore, but God does allow free will, and he does allow the natural consequences to those choices that are outside His will in our lives. I’ll tell y’all, I had some growing to do here. You know, things like: take responsibility for eating on time, drink enough water, get enough sleep, draw some appropriate boundaries. Basically, make sure you are taking care of your body. I said to myself, “God isn’t going to heal you if you aren’t doing the things that you need to do to take care of your own body, sweetie.”  My preacher spent 5 minutes on the phone specifically trying to convince me to give up caffeine. I don’t take that lightly. So, I reduced it significantly, to amounts that I knew as a physician were much more in line with what was recommended for my condition (a major feat for me). And I saw major improvements. Consequences. I continue to pray for him to show me how to change the things I can change in my condition, as it is said, faith without works is dead.

Sometimes, the Lord is allowing a test, like in Job. And as 1 Peter 1:6-7 says, you may “suffer grief in all kinds of trials” but they have come to “prove the genuineness of your faith” that it “may result in the praise, glory, and honor when Jesus Christ is revealed.” Sometimes, your praise through the storm is simply to perfect your faith so that God can be glorified. And since Christians know Romans 8:28 well, we know there is no reason to get down about these trials. We know Job was restored, above and beyond his previous status. We know God’s will for us is above and beyond our wildest imagination for ourselves, as long as we align ourselves with His will. I’m no where near as tested as Job was, but I do lean on this story, as I encounter each new challenge, each new hurdle. A positive spirit goes a long way amid a storm.

Sometimes, as I discussed in my previous blog, the Lord is preparing you for a great blessing, but he’s got to use what appears to be a stumbling block to get you on the path that he has cleared for you.

But the scripture that has carried me, and I have meditated on: 2 Corinthians 12: 7-10

“So to keep me from becoming conceited because of the surpassing greatness of the revelations, a thorn was given me in the flesh, a messenger of Satan to harass me, to keep me from becoming conceited. Three times I pleaded with the Lord about this, that it should leave me. But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly in of my weakness, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with the weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong.”

–King James Version Bible

The timing of the headaches was right at a time in my life when all God’s blessings were falling into place, my career seemed to be coming together, my family is picture perfect, and I am finally beginning to own the gifts and talents He has blessed me with. Then BAM! Now mind you, I have never been an arrogant person—this is not really my struggle. In fact, I would say my struggle is the opposite—downplaying and not fully utilizing my gifts and talents. But I would say that I’m a bit of a control freak. I tend to like to take the wheel. I tend to like to make the plan. And at a time where I was beginning to see the gifts, I truly believe God has slowed me down enough so that I can learn to lean on Him for guidance with exactly how I am to use them, and who is supposed to be in my space when I do. I’m still learning, and clearly, the migraines are still here, so He still has some things to show me.

Hopefully this can serve as an encouragement for someone else who’s going through a tough time or will go through a tough time. Truthfully, as I’ve stated before, this piece, this is about me, my growth, and my peace. Be blessed.

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Date Night

So interesting. Click on the mom tab and you see quite a few posts about the children. Sooo many healthcare posts. This is my first one about marriage.

It makes me a little sad.

A little sad because I promised myself this would be more of a priority.

A little sad because I LOVE dressing up for my husband and getting to reconnect, and it’s been since July, our 10th anniversary, since we really got to sit down and look each other in the eyes and just…kick it.

It’s a date!!

But the migraines, and the kids, and the dog, and then work, and suddenly, here our relationship is again, on the back burner. How does that happen?

Well, finally, it’s date night! And it’s amazing how a simple dinner can do a couple so much good. I got to talk to him, look at him, look at the Houston skyline with him, and remember why we’re doing this craziness together.

H-Town from a rooftop…

It’s so easy to get bogged down in the craziness of life. To become business partners, co-parents, roommates, and forget to nurture that loving friendship that brought you together in the first place. But it’s so important to do. Because it makes communicating through the craziness so much easier…remembering who your friend is, remembering you were friends before it all and through it all.

These were my sentiments, my thoughts, and I wanted to encourage all my fellow married couples, especially the parent married couples, to make the romance a priority. And the doctor in me kicked in. Is there any evidence for this? Turns out there is. I’ll be honest, it’s late, and it has taken me a week to be able to sit down and do this post, so I didn’t dig into the quality of the data, but it looks like there may be some supporting evidence to this date night thing. Communication was one of the factors, but also keeping the novelty, eros, and commitment in the relationship, and having a place to de-stress were all reasons to commit to a weekly date night in this study.

Turns out that making prioritizing your relationship can be really good for the health of your relationship. Go figure .

And parents, let’s talk. Prioritizing our relationships mean our children live in households with healthier, happier, more well-adjusted marriages. Maybe we spent 2 hours less with them. If that means we were able to parent better as a team, to model what a healthy marriage looks like for them in the future, to love them better as a unit–wasn’t it worth it?

I’ll admit, weekly seems a bit ambitious to this parent, but I do hope to make monthly more of a commitment. I love our us time. And it’s the us that built this thang, and will keep it afloat.

Cheers to us!

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Flu Season is Coming…

Protect yourself!!

Okay! So I’m here to talk about vaccines again. Why. Because vaccines save lives, VACCINES SAVE LIVES! And I always say, I chose adults because I want to be able to sleep at night knowing an adult made a decision for themselves, but it’s my job to EDUCATE! So that’s what I’m here to do folks. Do with the info what you will. But do understand, that your decisions do impact others—it is definitely a public health issue.

So here goes…

(First, if needed, to review the basics of general vaccination click here)

Why should you be vaccinated against the flu? Although it’s quite common, and it comes in different versions every year, this is not the cold, folks. This is the BIG BAD. This thing kills and maims. In fact, most years it’s responsible for 30,000 deaths, and in really bad years, like 2017, it can be responsible for up to 80,000 deaths. You know why those numbers are getting so high? BECAUSE PEOPLE WON’T GET THEIR VACCINES. Because it spreads like wildfire.

I previously didn’t spend a lot of time trying to convince relatively young healthy adults to try to get the flu vaccination. Then something started happening while I was in residency. I started noticing that people my age were dying of the flu. That wasn’t something that we were used to seeing. And then it was happening every year. So I felt like it was something I really needed to start talking about.

Why does it spread so quickly?

People are contagious before they know they are sick. So they are walking around shopping, going to school, work, thinking it might be allergies, and all the while spreading a highly contagious, airborne virus. Once they are sick, they’ve likely been making others sick for 48-72 hours.

Why is it so deadly?

Influenza is VERY fast. It replicates quickly and overwhelms our immune system. It continues to replicate quickly and starts to overwhelm our organs as well. When we have the vaccine, our immune system is prepared to fight, and even if we get sick, it can keep our organ systems from being overwhelmed.

Who is most at risk?

Really young people (children under 5), our more seasoned citizens (our immune system gets weaker as we have more and more birthdays), people who have certain health issues (ie. Asthma, diabetes, cancer, COPD, heart disease, kidney disease, liver disease—to name a few—see a full list here. Why do those of us not in these categories get vaccinated? To protect ourselves, but also, to protect our loved ones who fall into these high risk categories.

What are the benefits of the flu vaccine?

There is long list here, but to highlight a few, it has been shown to reduce risk of death in children, ICU days from the illness, risk of cardiac events, and pregnancy related lung disease. It also reduces doctors visits related to flu illness, and overall severity of the illness.

What are some of the risks of the vaccine?

The risks are very low. Injection site reactions are the most common side effect. Feeling a bit run down 1-2 days after the injection can happen, but is generally a mild reaction. I normally explain this  as an immune system flair, but on review of the evidence, it actually occurred at the same frequency in people injected with the actual vaccine and salt water (placebo), which means this is likely NOT a reaction to being injected with virus. Please see below links to see the CDC discussions on the almost non-existent risk of Guillain-Barre Syndrome and the reasons you shouldn’t be worried about the amount of thimerosal.

The flu shot is so important, but this article reports that only half of adults plan to get it and only 40% of adults got it in 2017-18 flu season. People—this is why more and more young adults are dying of flu. And it’s PREVENTABLE. I don’t want it to be my patient or my friend, my family member, or my church member. Remember, I don’t get paid to do this—I just spent the past hour or so writing this blog post simply to try to spread awareness on this important topic. Not for a bonus. But because it’s my calling. Because I believe in it. Because it’s science, and it’s public health, and it’s people’s lives. You only get one.

Below I have linked some great reference pages from the CDC page. Also, maybe take some time to click through the side links, it’s really great information for anyone truly interested.

Key Facts

Who Needs and When

Misconceptions about the Flu Vaccine

For those worried about Guillain-Barre Syndrome

For those worried about thimerosal

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My Responsibility

https://jm-aq.com/wp-content/uploads/2013/10/stop-domestic-violence-logo.png?fbclid=IwAR1Y6SH03oI5U4QIpjKFIJtZZmdPYjJXe-kZhqMkgdo1E1tlGxuZhyAZQPc

October is Domestic Violence Awareness Month. I have a church member-friend-inspiration who has a non-profit organization that is all about Domestic Violence, and last year I had the opportunity to attend the organization’s annual brunch for the first time.

Her Voice is a mentorship program that supports victims of domestic violence in the first 2 years after they leave their abuser, since this is when they are most vulnerable to return to the situation.

My eyes were truly opened, and I realized that as a physician, I felt unprepared to handle this incredibly important topic. Sure, I knew I was supposed to be asking if my patients felt safe in their homes, but what was I supposed to do if they said no? So I’m sad to say hadn’t been doing my part.

I promised myself I was going to do better, in part because Dr. Shana made is very aware that ending Domestic Violence was each of our personal responsibilities. But I’m ashamed to say after a few failed attempts at trying to put a tool kit of resources together, and a few struggles of my own, I let this important topic fall to the back burner.

Well, here we are again, a year later, and I am at this fantastic event again. The transparency was unparalleled as the emcee shared that she, too was a victim of domestic violence and was having to work through some of her feeling surrounding being central in the event.

Dr. Shana defined domestic violence as “a systematic way of destroying a [person] from the inside out.” She also hit us with some very troubling statistics. Every 9 seconds a woman is abused. One out of every 3 women (and one out of every 4 men) will experience domestic violence in their lifetime. And Harris county, the county in which we reside, leads Texas in domestic violence homicides. I actually had to look this up , guys. And what I found troubling is that this has been a pattern since at least 2015—and as she said, this is NOT where you want to be #1.

We later heard from one of Her Voice’s mentors, a domestic violence survivor, who shared her story of survival. Truly touching she shares how she “wanted and needed to be loved.” How she “thought she’d found Mr. Perfect”, and he had a broken past, and “she wanted to help him” but he flipped the script on her. His mom was even in on it, and tried to tell her how she could be have to try to avoid the abuse. It finally ended, but she almost lost her life. As she says, she finally realized that “Love does not hurt you, degrade you, mistreat you, or isolate you.” She is now in a loving relationship, and her husband was there to support her, beaming with pride as she shared her story, a perfect example of the theme of the the event: Shattered, but silent no more.

So the beginnings of a tool kit:

What is Domestic Violence?

Houston Hotlines

713-528-2121—Domestic Violence

Houston Area Women’s Center Shelter

Houston Area Women’s Center Counseling

List of Houston Area Resources

Also, I don’t want to forget to tell my Houston area people that there is a concert hosted by Men Against Domestic Violence later this month. For more information click here.

 Domestic Violence is a silent killer. 1 in 3 women, guys. That means if you don’t know anyone, it’s just because she hasn’t told you. So if you’re worried about your friend, ask some questions, without judgment. Let her know you’re there for her. Share some resources.

Whose responsibility is it to stop domestic violence?

MINE!!

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Intermittent Fasting

A patient may have made my 2019! She came to see me for the first time in April. She was already doing a great job with weight loss on her own but looking to optimize. She had been diagnosed with diabetes, so she has what we call “metabolic disease” and she was seeing an endocrinologist.

We got into a discussion about a theory on weight loss that I’m very excited about, but truthfully, has little evidentiary support: Intermittent fasting. I read The Obesity Code in 2 days while I was nursing my second while on maternity leave. I had recently certified in obesity medicine, in what was something of a whirlwind. I went to an introductory class and literally saw the science of my lifelong struggle with trying to maintain a healthy weight being researched and used to treat what had become an epidemic in our country. I began studying immediately and became certified. What we knew, is that the age-old “wisdom” of calories in-calories out just wasn’t effective, because our bodies are very smart and learn to adapt. We had been blaming and stigmatizing people for something that wasn’t their fault—something that was behaving as much like an independent disease as diabetes or hypertension and is modulated by hormones and brain functions and instincts. However, where I remained frustrated was that when it came to the practical portion of a medical weight loss plan, calories were still the mainstay.

NOT SO WITH THIS BOOK! This book utilized the hormone theory that we had to learn to certify in obesity medicine—the hormone theory that is becoming so important for the new medications that we are using to treat obesity. When I tried to get my patients to understand their diet plans from a calorie perspective, there would ALWAYS be a loophole, but there doesn’t seem to be a loophole with this theory. REMEMBER THOUGH, it IS a theory, and what we must remember with moving forward with this type of diet is that much like the calorie theory of calories in-calories out, theory doesn’t always translate into practice. The more we learn, this too, may prove to have its own pitfalls. For now, it’s very promising. And my patient’s FIFTY, that’s right FIVE ZERO, pound weight loss since April, is one example of how this can be effective if you use the understanding of the theory to help you make healthier choices all the way around.

It is important to note that she DID not stick to his SUPER LOW CARB diet, nor does she fast for entire days.  She uses the more common-sense approach of a 16:8 fast and remembers what she learned about how her hormones respond to certain foods and uses this to make healthful choices on a regular basis, and she has seen her body respond beautifully.

Not is her blood sugar average in normal range, but I had to stop her blood pressure medication because her blood pressure has been dropping too low. Can I tell y’all how much joy it gives me to STOP MEDICATIONS?! So, what are we talking about here?

Insulin Resistance

So the basics of the theory rest on this: insulin is a storage hormone, that in excess, causes the majority of our problems with metabolic syndrome, and helps make obesity a chronic health problem. Much of our counseling in recent years to combat obesity has been the opposite of common sense in say, the 1950s which was 3 square meals, early dinner, no snacking. We became a society that snacked all the time on refined foods, much of which contained very refined carbohydrates which caused our bodies constant exposure to insulin. This led to insulin resistance.

To understand Insulin resistance, I’ll compare it to alcohol tolerance. If you have one glass of wine, and you don’t drink, that glass of wine might really affect you. But what if you drink a glass nightly? Now you have to have two glasses to feel the same effects that one glass did. Now what if you have 2 regularly? Now you need 3-4 to feel the same effects that that one glass had at the beginning.

In insulin resistance, our bodies have been exposed to non-stop insulin, because we are always in a fed state—always snacking, always eating, and always causing an insulin release. So, our bodies don’t respond to the same amounts of insulin to move the sugar—it needs more. This (in theory) caused the type 2 diabetes epidemic. However, insulin is still telling our bodies to hold on to all those calories that it’s storing, it’s not letting the calories be used for anything—this (in theory) caused the obesity epidemic. It’s a storage hormone. But when you’re in a fasting state, insulin levels fall, and lets those calories, or sugar, in the cell, be burned, like they’re supposed to.

Thought behind it:

What Dr. Fung proposes in this book is that if you keep your body in a state with insulin removed for long enough, you develop sensitivity to insulin again, and you reverse the dysfunction that the resistance to insulin causes. You have smaller amounts of insulin around, so you’re storing fewer calories. You not only reverse obesity, but you reverse metabolic syndrome and constant hunger as well. Believe me, I have not done this topic justice AT ALL. I am far oversimplifying for the sake of space—the man wrote a book, and this is a blog. You should definitely buy the book if you want to understand the full theory behind this. But know this about intermittent fasting: IT will not work if you are drinking sweet drinks or artificially sweetened drinks in the fasting state. IT will not work if you snack between meals. This type of diet is all about resetting the hormones, and it will not work if you try to game the system. The more you know about WHY you are doing what you are doing, the more likely you are to get it right. *Please note, his theory is just one and the latest theory in intermittent fasting. For a great, short article on some interesting research on intermittent fasting, click here.

Warning:

If you have ANY chronic health issues, this is NOT something you should try without close follow up with your doctor. You may have to stop some of your medications. Your health problem may not allow for this type of lifestyle (for instance, right now, with my migraines, it’s not something I’m trying to do, though I don’t know I’d always be limited from something like a 16:8).

16:8

The schedule above suggests that you have an 8-hour window daily that you eat, and you do not eat for 16 hours daily. This tends to be what I most often suggest as a lifestyle as it makes the most practical sense to me. It’s probably just what our bodies are craving. It could look like eating from 5 am to 1pm (I wouldn’t suggest this) or 8 am to 4pm (more reasonable) or 1 pm to 9pm (again, a little extreme). Any of these work though, and you can pick a time that fits best with your lifestyle (i.e. family dinner for people with children, work schedule, evidence that eating earlier is better for LDL cholesterol).

24/30-hour fast

Some people participate in longer fasts. The important. A 24 hour fast would begin at the close of dinner one day and end with the start of dinner the following day (so you would skip breakfast and lunch of one day) while a 30 hour day is more what you would think of as a full day fast.

Fasting

The key to fasting, whether 16, 24, or 30 hours, is HYDRATION, HYDRATION, HYDRATION. You can have liquids including water, unsweetened tea or coffee, and broth including small amounts of bone broth. Up to 2 teaspoons of heavy whipping cream are acceptable additions to beverages, but no artificial sweeteners as these cause insulin spikes although they do not cause sugar spikes. This is all that you have during the fasting period and between the three square meals during fed periods.

So these are the basics. Honestly, you can combine this thought process with whatever healthful diet you would typically be eating otherwise, plant-based, low carb, ketogenic, or low fat. This is more about understanding the importance of timing when eating meals. As I’ve previously stated, I am no one-size-fits-all physician. I do not know that this is something that will work for everyone. I do know that with everything I know about obesity, and with the research that is being done on this topic, it is a very promising theory, that shouldn’t be ignored as we continue to understand the complexities of our health.

As always, I look forward to questions/comments on this topic! Discussion drives learning.

(Update 1/5/2020: More benefits discussed briefly here.)

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BREAST CANCER AWARENESS

Two days into breast cancer awareness month, I diagnosed my first breast cancer of the month. It was recurrence in one of my long time, favorite patients. Your favorite patients—it’s funny, they’re not always the ones that do the right thing. They just generally have personality traits that remind you of yourself, or your family members or friends. This one—she never does what I say. In fact, she only got this screening done because I happened to realize I hadn’t seen her in a while and reached out to fuss at her. Thank God I did. We caught it early. She’ll beat it. That, my friends, is why we screen. For that feeling of knowing that we will be able to save a life because we caught something early.

Last year at Susan G Coleman Race For The Cure with a fave–no judgments!! I look a little rough.

Who should be screened?

Different groups feel differently*, but we should begin discussing it around 40 (this will depend on personal risk factors) and most people should be being screened by age 50.  By 75, or if someone is expected to live less than 10 years due to illness, there isn’t data to support that we are going to do more good than harm by continuing to screen.

How often?

American College of Physician recommends every 2 years if you are at average risk. At increased risk, or findings on mammography would change this recommendation.

With what?

Mammography. Clinical breast exams really aren’t quite as good as mammography and are prone to false positives and over testing. Home breast exams are similar, though I always encourage women to know their bodies well.

Truthfully, there are two sides to every coin. And there are both risks and benefits of every treatment, every screening. It’s why these recommendations are so confusing. Every group is trying to make sense of them.  And since you may or may not have had the opportunity to have this talk with your physician, I’ll share some basics here, from the information I learned from the American College of Physician Guidance Statement on Breast Cancer Screening in Average Risk Women released earlier this year.

Average risk patients are between the age of 40-74. Things that change your risk include:

  • history of breast cancer or high risk lesion
  • history of known genetic risk (meaning genetic testing, not remote family history) with testing showing you are a carrier of a known gene that increases your risk
  • radiation exposure to the chest in childhood
  • The thought is that increased breast density may increase risk a very small absolute amount that may or may not be clinically relevant.

Things that do not increase your risk

  • Early menarche (onset of menstrual period)
  • Late menopause (stopping of menstrual period)
  • Long term contraceptive (birth control) use
  • Menopausal hormone therapy

What are the benefits of screening by age?

The US Preventative Task Force Services conducted a study that states that mammography has reduced the number of deaths due to breast cancer by age group as below:

40s: 3 per 10,000 women screened in 10 years

50s: 8 per 10,000 women screened in 10 years

60s: 21 per 10,000 women screened in 10 years

70-74: May be 13 per 10,000 women screened in 10 years.

Of note, the only “statistically significant” values are in the 50-69 age group, which is why you see the recommendations focus so heavily on these women. Also, note the most lives saved are in the 60s age group.

So what are the risks?

About 20% of women diagnosed with breast cancer in a 10 year period will be “over-diagnosed and overtreated.” This means they would not have been harmed by or died from their breast cancer had it not been treated, and therefore will only experience harm by any therapies we add to their lives.

Other harms include:

  • False-positive (test is worrisome even though woman doesn’t have cancer
  • Psychological harms (worry and distress from tests and procedures)
  • Pain from tests and procedures
  • Some women believe lack of shown reduction in all-cause mortality (death from any cause) constitutes a harm
  • Mammography specific harms including radiation exposure, and the risks associated with this.

This is a real risk we must consider when we make recommendations for screening, and it’s why you see us beginning to relax the guidelines.

If you need screening and are uninsured, there may be an organization in your area that has a program. I know in the Houston area, The Rose is one. Feel free to look into it. An evidence-based screening regimen is an important part in a preventative lifestyle. If you are between 50-70, there is no doubt you should be screened. DO IT!

*See links to different guidelines below:

American College of Physicians

USPSTF

American College of Obstetrics and Gynecology

American College of Radiology

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Vaccines

I’m an internist…not a pediatrician…but am very much pro vaccine. Because I’m pro-science. And I’m pro-people-not-dying-of-preventable-stuff. It’s kinda why I became a doctor, ya know?

Myths I would like to debunk: I do not get paid for vaccinating people. I do not get paid directly by any pharmaceutical company, period. PERIOD. When you hear that doctors get “paid” for vaccinations, what really happens is they may get value-based bonuses on whether or not they are able to vaccinate a certain percentage of their population. Because vaccinations save lives. And it’s a public health issue.

NEWS FLASH!! This does not come from the pharmaceutical company. It either comes from our EMPLOYER who ALREADY PAYS US, and who are actually paying FOR the vaccine or from your INSURANCE COMPANY, who AGAIN, is ALREADY PAYING US, and actually pays FOR the vaccine.

Second NEWS FLASH, very few offices make money on vaccines. Many offices actually LOSE money on providing the service of vaccinating their patients, but they still do so, because they find it so IMPORTANT.

My kids are being vaccinated on schedule. ON. SCHEDULE. Many of the things out against vaccines were debunked a while ago, but for some reason, continue to spread and cause fear in well-meaning parents. What we SHOULD be afraid of is the diseases that these vaccines protect against…most of which caused death and permanent harm to children when they were widespread.

So, how do they work? Why are we putting the illness, or something like the illness in you in order to prevent the illness? So glad you asked! This infographic explains it quite well, and you’ll find a link to the full blog post.

http://hcrc.missouri.edu/2015/08/05/im-kind-of-a-little-big-deal-public-health-ninjas/

So basically, it’s like training for a marathon. The first time you do it, you don’t have the muscles and your body isn’t fast enough. But once your body’s been introduced to it, it’s faster, and ready to go.

So what about boosters? These are vaccines where your body doesn’t mount a complete response the first time. It needs more practice.

Well why do some people still catch, say, the flu, even though they get the flu shot? You guys ask great questions!  Sometimes, the virus that causes the illness is faster than our bodies ability to fight it off, and we still get sick. This doesn’t mean the vaccines was useless. We still typically don’t get as sick as we would have if we were completely naïve to the virus.

And what do we mean when we say it’s a public health issue? Well, there’s the whole issue of herd immunity. There will always be people who can not be vaccinated for one reason or another, or simply won’t respond to the vaccine. Herd immunity, or the fact that most people are immune and won’t catch the illness, so won’t spread the illness, protects these people. See the image below.             

The below article is long, but if you are seriously wondering about why physicians would recommend we inoculate our bodies with a form of the illness to prevent the illness, below is why, and why the schedule may seem intense. If you are as concerned about your health and your child’s health as I know you are, it’s totally worth the read.

Cashing In On Fear: The Danger of Dr. Sears

Protect yourselves, your children, and our population, and get vaccinated!

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Ketogenic Diet

The ketogenic diet is essentially a very low carbohydrate diet. You cut your carbohydrates so low, that your body begins to burn fat for energy. NO, your body doesn’t NEED carbs. Our bodies are AMAZING and they have been designed such that they can adapt to the absence of carbohydrates by making the sugar our brain needs from fat or ketone bodies by a process called gluconeogenesis from lipolysis or ketolysis (please see figure below if you really want to get super scientific).

Ward, Colin. Metabolic pathways [internet]. 2016 Jan 19; Diapedia 5105765817 rev. no. 25. Available from: https://doi.org/10.14496/dia.5105765817.25

All that being said, as I tell my patients, I AM NOT a fan of the way it is marketed, as the diet where you can have all the bacon and butter you want. There are far too many studies that show us that these animal based saturated fats are unhealthy for us. Sure, if you have cut out all processed, refined carobohydrates and sugars, then you will tolerate more of these fats than the average individual. However, I tend to advise my patients who decide on this diet to choose healthier sources of fat as a go to.

The include: avocado and its oil, grapeseed oil, nuts and nut butters, salmon, olive oil.

Sure, it makes it less “fun,” but the goal is health, right?!

Keto has many benefits including immediate improvement in glucose control, because you are decreasing the very thing that increases sugars—carbs. However, if you are someone who is taking medications for your blood sugars, you should discuss how these medications should be adjusted before starting this type of diet. If you have a history of pancreatitis, liver disease, issues with fat metabolism, malabsorption—you should really consider another type of diet. Most people on this diet will need a multivitamin.

With most diets, you will see an increase in the cholesterol transiently when you begin, but with this one, you REALLY see the numbers increase, but they typically go down after a few months of dedicated lifestyle change. Also, people tend to find that in the first few weeks, they get what’s known as the “keto flu.” The biggest problem with this diet? People actually sticking to it long enough for me to see the benefit. People are typically doing the unhealthy version of this, and they are cheating too often for me to see the benefits actually come through. It generally takes 6-12 months of dedication, but if you stick to it, I see the results, physically, and metabolically. Also, while the short term safety has been shown for most, sticking to this diet hasn’t been shown to be safe past 24 months, so it’s generally recommended that after 12 months, you begin to transition to a more long term plan.

I don’t have any links for you guys, because I have yet to find recipes that I have deemed appropriate for long term use—again too much butter and bacon. But as I find them, I’ll try to link them for your use.

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Plant-Based Diets

If we’re looking at diets that cut one particular type of food, plant-based diets may just have the most data to support its benefit to health. I do find that people, for some reason, are the most resistant to this thought, but it could have something to do with the fact that I’m located in the great and interesting state of TEXAS!

Truth is, Americans eat WAY more than their share of protein, and we really don’t need animal protein to meet this requirement if we eat a wide variety of plants to fill this need. You do have to do your research and make sure that you get all your essential amino acids daily, and generally will need to supplement with vitamin B12 since we do get the bulk of this from animal products.

Plant based diets tout benefits such as reducing risk of cardiovascular disease and cholesterol, reducing insulin resistance, and reducing body weight, in addition to other health benefits including reduction in some gastrointestinal cancers. I will likely go further into some of the benefits in later blogs, but we’ll stop here as an introduction.

Physicians Committee for Responsible Medicine is an organization that is passionate about plant based diets. Please find some of their excellent links below to get you started if you are interested in this lifestyle!

A 21 Day Quickstart Program

More guidance on Nutrition

A Vegan Starter Kit

Recipes

Vegan for Atheletes

Vegan in Pregnancy

Nutrition for Kids

(Update 1/5/2020: Houston Vegan Chef with Great Food)

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Getting to Know Me

So this was posted on Twitter, and because I’m not popular on Twitter and have no following, it wasn’t something that mattered when I replied, but I thought it’d be a fun thing to blog as a “Get To Know Me”…so here are a few of my responses:

“And then…I gave up coffee” Been drinking it since I was 10 or so. When I was in high school, my mom got me a coffee maker with an espresso maker as one of my gifts for Christmas.

“The movie was better than the book” Like—who in their right mind believes this? Also, books are BAE! I mean tied equally with coffee and great food. And after my human BAEs of course…yeah…lol.

“I’d love to go to that party full of people I never talk to!” Introvert 4 Life!

“Small talk is the best thing EVER!” See above

“I LOVE being pregnant!!” Yeah, not for me. Ever. Again. Assuming the Good Lord says the same (I’m definitely doing my part, I tell ya! Faith without works, chile…)

“Supersize it!” You should never. Unless you’re a 19 year old, 220lb male who runs track 5 days a week.

“I LOVE planning parties!” Shoot me.

“I would totally do residency again” See above

“I love pickles!” I’ve tried. I just..can’t. You guys make them look really good, though.

“Chocolate is GROSS!” Who are these people?

“Wine is GROSS!” Jesus didn’t say this…you can’t say this 😊

“I just love CHAOS!” Type A personality here—I crave order and I have a plan A, B, C. It drives me crazy that other people don’t have answers for my 5 million hypothetical questions. I’m working on this. Also, this blog is probably the most unplanned thing I’ve ever done…in life. So cheers to a bit of therapy!

“So, I’m going to have on flats at brunch” I never wear flats, y’all. I have to be hiking, or training a dog, exercising, or something where heels are really, really unsafe in order not to wear them. I wore them every day of my pregnancy. I wear them everywhere. If I’m not in heels, you should know there’s something wrong. Ask. I’m not okay.

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