I have truly enjoyed working with each and every one of you. I feel like each of you has helped me to grow and become the person I am. That being said, it is time for me to move on to the next chapter of my life. I have accepted a position with Flagler Hospitals’ Intensive Outpatient Program and will be beginning that position early December.
Diana Brummer, MSW, will remain here in our office and is available to see you after I am gone. Although she does not accept insurance at this time, she has generously agreed to see all of my former clients for $25 per session.
I am still seeing clients through the remainder of November and although I know I won’t be able to accommodate everyone, I will do my best to get you in, if you desire a formal closeout session. I will also be able to send any case notes you wish to your next therapist.
You have all done amazing self-work and come a long way! I will be excited to see how much further you can go as you continue your journey.
The best way to know if you are accomplishing your goals is to start with a baseline and measure. As part of both our wellness program and the patients in my personalized health program with MDVIP, we measure weight, body composition and metabolic rate. Blood work is another way to measure your success if you are using your diet to treat diseases like blood pressure, cholesterol, and diabetes. Let’s review some common ways you can assess your improvement.
First is the scale, which is a great tool over to use over time but can be terribly inaccurate when used on a day to day basis. In the past, I have personally had weight swings as much as 5-6 pounds in 2-3 days, based on what I ate, when I measured and the time of day. However, weekly measurements over months can be helpful to gauge progress.
Although I have people joke with me that their clothes fit looser, this is not a bad way to gauge success either. In fact, studies show that waist circumference is better at predicting weight induced health problems than body mass index (BMI).
In our office we can measure body composition with a DEXA scanner, which measures fat and muscle mass and where it’s distributed. Using this tool, we can tell if you are losing fat in the right place and adding or maintaining your muscle along with weight loss. These changes occur slowly over time, so we do not check more frequently than every 3 months, but usually every 6 months. We can also retest your metabolic rate. Weight loss is often associated with a change in metabolism, and we will recheck this the same time we do your body composition to we are making positive changes to your metabolism.
Lastly, if we are using your nutrition to treat a disease, we will recheck your blood work at different intervals. Studies have shown a reduction in cholesterol, improvement in good to bad cholesterol ratios, and lowering of blood sugars and hemoglobin A1c with a reduction in weight. In the past, studies have also shown regression of plaques within the walls of arteries, reversal of fatty liver disease and reduction of pain from arthritis with improvements in diet.
So let’s go back to the process of measuring and understanding what we eat. In order to start, we have to set a foundation. In order to find out the nutritional information for food, there are a few good websites you can go to, in addition to apps you can download onto your phone to get the information on the go. Nutrition.gov has good information on the nutritive values of food. Apps like Lose It!, MyFitnessPal, or Fooducate are good for tracking calories. It is imperative to read and understand nutrition labels on food.
Reading Nutrition Labels
Let’s start with nutrition labels. There are the labels that come on the packing of most food you buy at the store. They list the nutritional facts of the food you are about to eat. The first thing a food label tells you is what is an average serving size and how many calories a serving size has. This is the first-place people go wrong with their diet. Either they pay attention to the serving size or measure it incorrectly. Remember a ‘handful’ is not a serving size.
The second part of the label is the breakdown of fats, cholesterol, sodium, carbohydrates and proteins. There are also sub-categories for fat that tell us the amount of saturated fat, trans fat, polyunsaturated fat and monounsaturated fat. Carbohydrates also have a subcategory of dietary fiber and total sugars.
The last section on the label lists the vitamins and minerals, as well as the ingredients.
So now that we know what’s on the label, we can measure what we eat to ensure we are meeting our nutritional goals. The applications you can download onto your phone have two different ways to look up the food you are eating. The first and easiest is to scan the barcode. This automatically populates the nutritional information into the app, so all you have to do is adjust for serving size. The second is to look the food up by typing it in the search. This will even look up restaurant meals, but you still have to input the amount you are eating.
How do you know the amount to enter? Well you measure of course. If you are eating something that comes from a single serve container (i.e. a cup of yogurt), the serving size is 1 and the amount doesn’t need to be adjusted. Otherwise, you need to measure things out with a scale and with measuring cups. You can purchase these from any supermarket and should plan on making this a regular part of your day. If you are preparing a recipe that you cook often, the applications allow you to create recipes, so that you only have to enter the recipe the next time you eat that particular food.
Fooducate in particular has a particularly useful feature of comparing foods. When you are shopping at the store, you can scan the barcode on a particular food item, and it will give you an idea of the nutritional value of that food, and some healthier alternatives. This becomes important when it comes to meal planning….
Plan for the day
One of the primary things all successfully healthy people to is meal plan. Meal planning is the
Idea that we prepare for what we are going to eat each and every day. This helps to know ahead of time what we are eating how to stay on track with our nutrition prescription.
The first thing you need to do when meal planning is generating a list of foods and recipes you like to eat. You should make sure your list includes a variety of each food type, so you don’t get burnt out of a food you like by eating it all the time. I would look to have 4-5 different fruits, vegetables, and protein sources in order to create this variety.
Once you have a fairly good list, you can begin planning for the week. You should look to plan for breakfast, lunch, dinner and snacks in between. Once you have created a menu for the week, you can generate a shopping list. This can also be made easier by using an app on your phone, such as Paprika (although there are many others as well), to plan out the menu, and then have it automatically generate a shopping list.
Once at the store, use Fooducate to ensure the foods you are choosing are healthy options, and replace any food that land on the list, but may have healthier alternatives. Having a prepared list will also help you avoid spontaneous purchase of food, which often times gets us in trouble.
Now that you are back at home, begin following your menu for the week. I advocate preparing everything (except maybe dinner) the night before and storing it for on the go the next day. With your scale ready and your phone with the app of your choice ready to go, we can begin preparing our meals and snacks for the day. I use small Tupperware containers to store my food. Place it on the scale, zero it out and add your food until you have the serving size you have accounted for on your meal plan. Repeat this step for each of the foods on your meal plan and keep them altogether in a section of your refrigerator, or if going to work, store in an insulated food bag or box to keep cool during the day.
When you travel
Travelling can pose a challenge to staying on track with your diet. Time zones, airports, different hotels, and unusual schedules can play havoc with a routine unless you plan ahead. Although I don’t travel much, I am going to share with you a simple strategy to stay on track with eating healthy on the road.
First, before you leave, meal plan for the upcoming trip. If you know you are going to have to get up early or even operate on a different schedule than when you are at home, plan your meals accordingly. Remember, just because it’s different doesn’t mean it should be an excuse. Try to think of things that are dried (less problems storing and refrigerating), easily measurable (with a small measuring spoon or in single serve containers) and don’t need preparation beyond their purchase. Take some back up foods like protein bars and shakes with you. Once my meal plan is done, I pack small food containers, a shaker bottle, and a leak-proof cooler bag in my suitcase. With stackable containers, this can be done without occupying much space in your bag. I also pack one or two small measuring utensils, so I can make sure I stay measuring correctly.
I will plan ahead by making sure my hotel has a refrigerator before I make my reservation. This almost goes without saying in this day and age, but it’s always good to double check. Next, I will look at a map of the surrounding area and find a grocery store close to the hotel, so that when I land I can get an Uber or walk to the store. I will also get on the stores website ahead of time to make sure they have what I need, including a deli. Keep in mind the space in your refrigerator, and don’t buy beyond what you can fit in there. By the way, I also find this saves a ton of money on food expenses when traveling.
The last thing I do when I travel is back off on my daily calories a little, so that when eating out at night, I have some calories banked. When ordering from a restaurant, I will try to keep it a little healthier, and also look up the food I am eating in my calorie tracking app to get an idea of how many calories I am getting. Although not perfect, it helps you stay on track.
Lastly, if your travel is vacation, enjoy. The reason to stay good on a regular basis is so you can enjoy life’s better moments. I don’t track my calories on vacation and boy do I enjoy my food!
Before we discuss which diet is right for you, let’s revisit the basic building blocks. Carbohydrates are the primary source of energy utilization in the body. Carbohydrates come in different forms, and each cause a different physiologic response within the body. Many plant based carbohydrates also serve as a great source of dietary fiber. Fats are essential for us to build and rebuild cells that make up our tissues. Fats can also serve as a backbone for the formation of natural antibodies and hormones. Proteins can be used as a physiologic signal in the body, in addition to providing a building block for muscle. Vitamins and minerals serve to assist many of the physiologic processes in the body, like maintaining calcium in our bones and helping to build new blood cells.
When we apply this to trying to choose a diet, this often times can lead to a great deal of confusion. There seem to be a million different diets out there, and a million different opinions differing about which to follow. While a comprehensive review would take time well beyond what we have here, let’s review some of the more common diets out there.
Plant-based diet – This is not the same as a vegetarian diet, although the core of this diet is based on eating foods that comes from plant sources. Lots of fruits and vegetables. Many people who follow a diet like this continue to add a meat based protein source, such as chicken, fish, pork, or even lean cuts of red meat. However, the vast majority of calories come from fruits, nuts, vegetables and legumes. The Mediterranean diet is an example of a plant-based diet, and there is quite a bit of science that supports this type of diet to treat and prevent diseases such as diabetes and heart disease.
Vegetarian diets – a true vegetarian does not eat meat, but many still eat foods containing eggs and dairy (known as lacto-ovo vegetarians). The majority of the diet is plant-based, and some attention has to be taken to get good sources of protein. Vegan diets exclude any animal products, and therefore also have to add a source of vitamin B12 to their diet. For those of you in a mixed house, there are companies that make meat replacement products you can use in place of a meat when cooking.
Low Carb and Ketogenic diets – although not exactly the same, these diets are similar. They are limited the amount of carbohydrates in the diet and differ in the amount of proteins and fat. The idea here is these diets is by not having carbohydrates available, the physiology of your body shifts to using alternative energy sources. Without carbs the body can shift to making energy from proteins or to transform fats into ketones. While these diets have shown promise with weight loss, improvement in diabetes, and reduction in cholesterol, there is not much evidence for improvement in cardiovascular disease. Also, ‘restriction’ type diets can be hard to maintain long-term. ‘Paleo’ and ‘Atkins’ diets are derivatives of a low carb or ketogenic diets. With what we currently know, I would recommend working with a lifestyle physician or nutritionist if you want to follow a diet like this.
In the last several years, we are learning quite a bit about ‘food genomics’ or the idea that our genetics and the bacterial biome in our gut significantly impact the way our nutrition affects each of us. There are companies that can test the biome of the gut, the results of which have already led to advances in treating diseases like Crohn’s disease and ulcerative colitis. There has been research in ‘inflammatory diets’ and ongoing research in applying nutritional changes to treatment for dementia. We are learning that diet is becoming an individualized prescription, much like some of us respond to medications and some of us don’t. While advances in science and research in this area will aid us in one day individualizing this method of treatment, right now your unique nutrition prescription is best accomplished with a personalized program like MDVIP, where your intake can be tracked, and changes can be made according to the repeat results of blood work and body composition.
“Let food be thy medicine, let medicine be thy food.” – Hippocrates
For more than 60 years now we have known that what we eat can make a significant impact in our health for both good and bad. One of the earliest studies done on this showed a significant improvement in the survival rate of patients with known cardiovascular disease, with almost 40% surviving at 12 years after following a low fat diet. Consequently, the group who did not had a 0% survival rate during the same timeline. This study was published at a time where there were little medications to treat disease and interventional procedures and surgeries had not yet been discovered.
Many years later, in 1998, Dr. Dean Ornish published his lifestyle intervention trial, showing reduction in the amount of stenosis of the coronary arteries after following a low-fat, plant based diet. Conversely, the group who did not make any changes in diet demonstrated a 10% increase in the degree of blockage.
Dr. Caldwell Esselstyn showed similar reductions based on his switch to a plant-based diet. While there are many who feel this is a significant change in their lifestyle, Dr Esselstyn said it best, when he quoted, “Some people think plant-based, whole food diets’ are extreme. Half a million people a year will have their chests opened up and a vein taken from their leg and sewn into their coronary artery. Some people would call that extreme.”
We have clearly shown through evidence-based science that treating our diet like a prescription can make a significant impact in our health, by preventing as well as treating disease. On the other hand, many of the health issues facing patients today are a direct cause of following a poor diet and not paying attention to nutrition.
Understanding Food as a Prescription
In order to understand food as a prescription, we first need describe our nutrition in terms of a prescription. Whereas with medication, we use the terms milligrams and frequency, with nutrition we use the terms calories and meal times. When thinking of it in these terms, we would never take a medication we did not know the dosage or frequency. However, most of us eat without thinking about what or how much we are eating.
To think of it simply, all foods boil down to 5 basic components, which are carbohydrates, fats, proteins, vitamins and minerals. Everything we eat has a different amount of each of these, and a well-rounded diet will make sure we get all the nutrients we need to keep our bodies functioning well.
The dosage of food is measured in calories. There are several methods to determine how many calories each food has, and what proportion comes from fats, carbs and proteins. Using tools like apps on phones, or websites to track our intake, we can record our daily intake. Additionally, reading food labels and measuring food with a kitchen scale will make sure we are getting the correct ‘dosage’ when we eat. This is not something most people do, but when done correctly, we are most of the time successful in helping our patients attain their goals of reversing disease and losing weight.
Dear family, friends, and patients in the community,
We have received a lot of questions about meningitis in the last couple of days, because of the unfortunate news of a Bartram Trail alumni who passed away this week. Many of you have called with a lot of questions about testing, vaccinations and exposure risk. Based on this I will pass along the information and recommendations:
1. After contacting the health department, the cases in question are being investigated as suspected meningitis by the health department. Although concerning for meningitis, this has not been confirmed, and as such we do not know a strain.
2. Regardless of exposure, we recommend that all persons keep up with all recommended vaccinations, including meningitis A (or Menactra) and the newer meningitis B (Trumenba).
3. There are no good tests to screen for meningitis. If you or someone you know may have been exposed, you should contact a doctor for evaluation and prophylactic treatment if indicated.
4. Symptoms of meningitis include but are not limited to a rapid onset of symptoms, the most common of which are high fever, stiffness in the neck and changes in mental status. If you have any questions, especially if there has been a potential exposure, you should seek medical evaluation immediately.
5. The meningitis vaccine is up to 85% effective, but does not offer ‘herd’ immunity, meaning if you are relying on other people’s vaccination status to protect you or your children, it won’t. Bacterial meningitis has a very high fatality rate, even with intensive treatment. It is for this reason that we highly recommend vaccination.
Most physicians who treat pediatric and adolescent patients will review vaccination status and update if needed at your annual Well Child Exam. Most of us use the online Florida database, “Florida Shots”, to track and coordinate shot records for our patients regardless of where they were received. I would strongly encourage you to make sure this annual exam is kept up with, as this is the best place to review all preventative health issues, including vaccines.
Ross Osborn, MD, FAAFP
Scott Marberry, MD, CAQSM
Nathan Adams, PA-C
Melissa Sutton, PA-C
The Center for Health and Sports Medicine