Weight Matters - Kim Sims, MD

December 12, 2020December 12, 2020

Healthcare as Selfcare: A Bold Plan for 2021

I have never been a fan of New Year’s Resolutions. Why? Because people tend to come up with these grand plans that they only stick to for 1-2 months and then gloriously fall off the wagon. However, what I do tend to notice is that at the end of each year, I naturally tend to reflect on the year, seeing if I’ve grown as person. Have I improved on the human I was the previous year. How do I want to improve in the next year? I think it’s a natural closing of a chapter.

This year has been like no other in most of our lifetimes–it has brought about a different kind of stress, a different kind of reset. And so, at the end of this year, it does bring about a different kind of reflection.

My friend has given me the honor of being a part of her wellness retreats and speaking on physical health. We began just trying to pick up the pieces that COVID had shattered. Next was a REFOCUS, as we shifted our vision back to those things that could keep us healthy in mind, body and spirit (I, of course, focus on body in my sessions, but fully agree in the whole approach). This time, we REBUILD, as we plan for how we will enter 2021, in a new head space.

I want to caution everyone from thinking that 2021 will be perfect–because we all entered 2020 thinking it had to get better than 2019, and look what we got…lol! So I think the first lesson is to be prepared for ANYTHING, and GRATEFUL in EVERYTHING!

As we prepare to rebuild in whatever 2021 has to offer I want to remind us that healthcare IS selfcare, and if we’re going to achieve it, we must plan for it. Here’s the first steps.

Get Your Mind Right

A few important principles:

Be realistic about your preferences and your lifestyle. If you don’t, you are setting yourself up for failure. If you already wake up at 4:30 for work, you likely aren’t going to get up earlier to do anything. If you don’t eat green foods, you likely aren’t jumping straight into plant-based. Don’t set yourself up for failure. Set small, realistic goals, and celebrate every small win.

You want a schedule, and not a to do list. A to do list tends to make you feel a little like you have a never-ending list of things you didn’t get done, and reinforces a failure mind set.

We have to start by believing that it can happen. “Fake it til you make it.” “Speak it into existance.” “Believe it and you can achieve it.” For me, it all came together when I read the book Psycho-cybernetics and was confronted with science and real world examples of the self-fulfilling prophecies and self-limiting beliefs that everything came together. It made the practice of affirmations make sense. So part of what I want everyone to do is assign an affirmation to each piece of what you plan to accomplish as you move through your plan of self improvement, because whether you believe you will or you won’t, you’re right!

Remember, imperfection is okay, giving up is not. Plan for imperfection. Know that you will not be perfect, and there will be moments you’re going to have to pick yourself up from falling off the proverbial wagon or horse or whatever. Plan to fall AND GET UP EVERY TIME.

Rest

I always start here because if you aren’t resting well, nothing else in your life will go well. You must get enough sleep (7-9 hours nightly for adults) in order for good mental clarity. However, it also regulates weight, blood pressure, blood sugar, appetite, cardiovascular health….you get it, it regulates a great deal. You need sleep. Additionally, you need other types of rest: meditation, mindfulness, and play. Don’t forget that we are not designed to be on all the times. Studies show that we are more productive and healthier when we incorporate the right types of rest into our lifestyle.

Rest Plan

Example: Set your reminder on your phone for when your evening ritual should begin. Commit to having this relaxing time and going to bed at a relatively regular time.

Exercise

Exercise is beneficial for so many things. It helps control weight, improve cardiovascular health, decrease joint pains, strengthen muscles, improve cognitive function, control depression and anxiety, strengthen our immune system–again, I can go on and on. I like to think of exercise as the fountain of youth. If you don’t have an exercise plan, this should be high on your priority list. Jogging as little as 7 minutes daily can make a difference in cardiovascular health, and 150 minutes of moderate intensity cardiovascular exercise weekly is what is considered an active lifestyle (75 minutes of high intensity)–that’s just 30 minutes daily. Truly, being sedentary is one of the greatest risk factors for an early death, and we are all doing much more sitting with working from home, zoom meetings, etc.

Exercise Plan

Examples: 1. Commit to walking 30 minutes daily during a meeting that can be off camera. 2. Commit to waking 30 minutes earlier to zoom a zumba class. 3. Commit to walking 10 minutes on breaks three times a day. *Hint* You can multitask and watch videos for a class, watch taped shows, or be in a meeting while being on a treadmill, bike or elliptical

Feeding our Bodies Well

The old adage says “You are what you eat” and it’s proving more and more to be true. I like to say, “You get out what you put in,” and I think of food as the ultimate medicine. It’s so important to choose foods well, because our diet plays an important role in our over all health. Your choice of diet should really depend on your personal risk factors and natural tendencies, but generally sticking to a healthy plate won’t steer you wrong, and I like to teach this often. When you are picking which diet you’d like to go with, please remember that it’s important to consider your preferences, your lifestyle–be realistic, because consistence is key. The important think is that plants are your friend, whole foods are your friend, and it’s important to watch your portions. To learn more about the individual diets, select the links: Plant-based, Keto, Intermittent fasting, Mediterranean

Food Plan

Examples: 1. Have a grocery day and a cooking day *Hint* It only takes about 30 extra minutes to cook several sides and prep proteins for the week. 2. Commit and budget to purchase meal prep. 3. Consider grocery delivery if not already participating.

stay One Step Ahead

We have to stay one step ahead of our health by being on top of our screenings preventative health. This means going to our doctor’s visits, knowing what our numbers (cholesterol, blood sugars, blood pressures, BMIs) look like, and having a long term plan for our health. We need to make sure we are on top of screenings such as colon cancer screening, cervical cancer screening, breast cancer screening, osteoporosis screening, and cardiovascular screening, lung cancer screening and prostate cancer screening (age, gender, and risk specific). We also need to get our eye and dental exams. Don’t let these things fall to the back burner–prevention is care–I have saved lives through early detection.

Prevention Plan

Example: 1. Look at your schedule now to begin booking your healthcare appointments and scheduling that time. 2. Budget for the money you may have to spend on additional tests. Healthcare unfortunately does cost money in the United States.

Chronic Illness Control

This year has really thrown us for a loop, and it may be time to refocus on getting some chronic illnesses under control. The things above are important factors in controlling chronic illness, but if you have hypertension (high blood pressure), it’s also important that you be monitoring those numbers. If you have diabetes (high blood sugars), you need to be checking these numbers as well. It’s important that you have the supplies needed and that you make the time to monitor your health status. It’s also important that you take the time to make sure you are taking any prescribed medications that help keep your chronic illness in check. With my migraines, I have a few pharmaceuticals that help me manage my headaches–one is daily, one is monthly, and one I have to go in for quarterly to for injections. I will confess, I struggled for while with that daily medication–but I had to come up with some schedule to help me remember to get it in. I also have to make sure I make my quarterly appointments–and not just that–my weekly to biweekly physical therapy appointments, and as much as I hate working that into my schedule, it must be done. Make sure you are planning ahead and making the time to take care of your health.

Chronic Illness Control Plan

Example: 1. Attach taking your medications to an action that you do daily. Don’t do it until you’ve taken your medication. 2. Commit to taking your health measurements whatever prescribed frequency. Come up with a similar adherence plan.

US

Remember: this whole thing has been about us being on the schedule–us being a priority on our list. Don’t let the excuse for not accomplishing the above be because you were too busy doing something for the other people (husband, kids, employer) on your list. You are important. You matter. You are first on the list. Make it happen.

So remember, you need to book you me time. Sit with a work calendar and pick some days or afternoons off in advance–plan for those preventative care visits. Plan for your rest time. Plan for your exercise. You deserve it.

Example Affirmations

My body is a temple and deserves proper maintenance and care.
I prioritize rest and my health because I am important.
I have presence of mind and choose my response to stress. I eat when I’m hungry–not emotional, and stop when I’m satisfied.

I invite you to share some of yours that you will use to help you on your journey to better health in the coming year!

October 23, 2019

I HEART My Exercise

One of my fave shots of me and bestie1 getting it in.

But I’ve been exercising every day for the past X months, and I still haven’t lost weight…

I can’t tell you how many times I’ve heard that line in my office.

Or the response to the question “What are you doing for exercise?” that for some reason is immediately answered with their weight loss efforts, or how they know they should lose weight.

PEOPLE!! Exercise has lots of benefits—some of them have to do with weight, BUT that’s not all of it.

First, let’s talk about what exercise does for weight. Weight loss is 80% diet, 20% exercise. So, you can expect a small amount of weight loss from exercise if you have been completely sedentary, but don’t expect a great deal. What you can expect is weight stabilization. What we find in patients who have been successful in weight loss and kept that weight off for a substantial amount of time (years) is that they are exercising regularly. In addition, I tell my patients, the exercise is COSMETIC. It’s what’s going to help your body look like you want it to look, regardless of whether the scale changes. But for me, these are all extremely superficial to why I am asking people to exercise. Below are just some of the many reasons I like to encourage my patients to GET MOVING!!

In fact, this infographic highlights many of the benefits, from improving bone health to improving sexual health, including some of the things mentioned above.

My active and youthful octogenarians swear by exercise, and swear it helps keep them youthful, active, and they have less achyness when they are exercising regularly.

I encourage exercise at every age. I prescribe it first for almost every chronic ailment. You will hear me mention it often. And it doesn’t have to be much depending on what benefit you are going for.

I actually recently read this article that cited a study that showed that only 7 minutes of jogging daily can cut your risk of heart attack and stroke nearly in half, and adds to your life. I’m huge on circuit training and HIIT training to maximize your time when it comes to burning fat and building muscle—and these workout generally can provide major results in minimal time. But honestly, I encourage people to move in ways they enjoy, swimming, dancing, biking—whatever makes you happy, and is something you will sustain, is something you should do. If you hate walking on a treadmill—don’t buy one. Stop using the heat of the Houston summer as the reason you don’t work out—it’s hot EVERY SUMMER! Come up with a work around.

MOVE! Not to lose weight either. Just because it’s good for you.

October 6, 2019January 5, 2020

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.)

September 23, 2019

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.

September 22, 2019January 5, 2020

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

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

Category: Weight Matters

Healthcare as Selfcare: A Bold Plan for 2021

Get Your Mind Right