Posts tagged ‘healthy lifestyle’

WIAW On Call

There are a lot of things you learn during your third year of medical school that are completely unrelated to medicine. A few examples…

The traffic lights in Boston neighborhoods don’t wake up until 6am. On my bike ride or drive to the hospital, I can’t help but think, “If the traffic lights don’t have to do their job, why do I?”

Scrubs are comfortable, but likely the least flattering work uniform ever invented. However, the draw of getting to wear free (to me) pajamas to work daily is the biggest appeal of surgical specialties, in my opinion.

Being awake and alert for 24 hours straight requires a lot of food, and some planning. Too often, call nights are sustained by chips, greasy fast food options, and sugary drinks. With a little planning, though, call days can be managed with healthy food choices and some sanity by the end of it! So, here is What I Ate Wednesday on my 24-Hour Obstetrics Call.

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6:30-7:30am

Travel mug of coffee with my last homemade bagel, half with almond butter and half with blackberry jam. Nibbled throughout my drive to the hospital and between pre-rounding tasks.

11:45am

Lunch is usually the peak of a hospital cafeteria’s day, so I have found this is the best meal to purchase. The hospital I am at now has a GREAT salad bar that is not too expensive, so this tends to be my go-to option. That way, I make sure I get my veggies for the day! This salad had mixed greens, peas, chickpeas, carrots, sliced mushrooms, olives, feta, and noodle sticks with red wine vinegar and olive oil. With my student discount, it was only $4! Can’t beat that!

3pm

I never expect salads to hold me over all day, especially if things are busy and I am running around. For that reason, I always have a granola bar in my pocket for when afternoon hunger strikes! Having a healthy food option on hand helps prevent vending machine or nurse’s station munching. This Nature’s Valley Oats n’ Honey Crunch helped get me through the rest of a busy clinic session.

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5:30-9:30pm

When the evening hours hit and the staff downsizes into night shift proportions, things become a little more unpredictable. This is when the motto, “Eat when you can, sleep when you can” comes into play. I reheated some leftover Thai Curry with Rice and started half of my dinner. Things started to get crazy though, and 2 C-sections later, I finished my dinner around 9:30pm.

Meanwhile, I had a few snacks between surgeries. A few clementines I had brought, a Ghiradelli chocolate square, and some saltines and 8-oz diet Gingerale taken from the nurse’s station helped to tide me over through a busy early evening.

6am

My call night ended up being not busy after the early night rush, so my last granola bar served as “breakfast” to get me through morning rounds.

Some tips for new medical students planning for their first call:

Have lots of snacks. You don’t need to eat everything you have on you, but if things are busy, then you have lots of healthy food choices.

Have a few dollar bills on you. The only purchasable food options once the cafeteria closes down are from vending machines, and buying some trail mix is better than passing out in the OR from low blood sugar.

Have gum! And bring a tooth brush and toothpaste or mouthwash. You will probably want to freshen up your breath at some point…

You can try to bring all of your meals, but this can end up being a lot of food. If you do need to buy, buy lunch!

Eat when you can. Even if it is just a small snack, then you will have some energy when things get hectic.

Question: For any medical professionals reading, how do you handle planning for long hospital shifts?

February 27, 2013 at 7:00 am 1 comment

Goals

We are 5 weeks into the New Year… how are your New Years Resolutions coming? Did you make one? Did you write it down? The following infographic is from the Education Database Online and raises some great points about the benefits of goal setting!

Setting Goals Infographic

If you are in the majority of those who do make resolutions, it is likely that one of your goals is to lose weight or get healthier. While these are great goals, they are incredibly broad and difficult to measure success on a weekly basis. In my clinical training, I have learned to help people set more attainable goals within their main objective. For example, exercise 3 times a week could be a mini-goal for the month of February, which would be a step towards weight loss and better health. Weight loss can be influenced by other factors, but making a decision to add exercise is something that you can tangibly work towards. Besides providing compelling evidence for written goal setting, I love the emphasis at the end of this graphic on making step-wise, attainable changes! I hope that this helps to motivate you in whatever goals you are trying to accomplish in 2013.

Question: Did you make a New Years Resolution? Share below, and let us know how you are doing! Does anything in the above graphic help you with your goal?

February 7, 2013 at 7:00 am 2 comments

Snapshots from Life

Life has had more than a few new adventures for me in the last several months. I passed the first step of my board exams, started my third year clerkships (and completed the two hardest rotations!), and have begun to transition from being a book-based student to an apprentice. My days look dramatically different, and there has had to be some change to accommodate that. While I will never fully be able to settle into routine since my clerkships rotate on a close to monthly basis, I am starting to get the hang of “going to work” every day. I have never been happier to wake up each morning, excited to see what challenges face me and new things there are to learn. My days might be long and arduous, but even on the most difficult of days I know that I have made the right decision.

My personal life has also started to change as well. I have been dating my boyfriend for 5 months now and could not be happier. He has been a friend and constant source of encouragement for me as I face the shifting demands of third year of medical school. While we are best friends and have a lot in common, our thoughts on food are pretty opposite. He is a carnivore by nature and would be happy eating steak and eggs for the rest of his life if he could. He has been following the Paleo diet for the past few months, successfully losing 20+ pounds and gaining a substantial amount of muscle. This has forced me to do some reading and further research into healthy diets, and has left me with a softer and more moderate view towards food choices. My view on vegetables will never change: they are the cornerstone of a healthy diet, whether you are trying to lose or sustain your weight. However, there is good evidence to support that a sugar and carbohydrate heavy diet can be just as dangerous as a diet rich in red meat. I have also learned that diets lower in dairy consumption have also been shown to be healthier. My conclusion, not far off from where I started, is that life is all about balance. A healthy lifestyle is more than what we put in our body, it is also about gaining joy from what we eat and with whom we share our meals. Where does that leave me? I guess I am moving towards a more “flexitarian” lifestyle. I still cook and eat vegetarian/vegan meals at home. My diet is still based off of real foods. I have started using less dairy and wheat and have shifted to more whole grains like quinoa and farro. When I am in a giving mood, I will make my boyfriend a “side” of meat. When we go out, I will often choose the seafood option from the menu, since these tend to be healthier, less cheese-laden, and more creative. Living in New England means there is too much good, locally caught seafood to pass up. I am learning to let go of the rigid definitions of healthy eating that I have held, and to embrace enjoying food more fully as a cultural and creative outlet.

Outside of the hospital, I have still had time for a few fun adventures. To tie up a wordy post, I will leave you with a few pictures of the summer I squeezed in around rotations!

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Girls night out and reunion with a few of my college friends!

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Hiking in Western MA

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Spending time with my neighborhood family

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My birthday beach picnic!

September 21, 2012 at 12:00 pm 1 comment

Hidden Greens Frittata and a Give-away

Every once in a while, I get a bunch of unidentified green stuff in my Boston Organics box. I’d like to think I’m better than the average gal at green identification, but there are still occasions when I can’t quite distinguish certain species of kale from chard from random leafy greens. Last week was one of those weeks – I got a bunch of what looked like a mix between kale and Swiss chard in my box. Not sure exactly what the flavor of the greens would be, I decided to make a frittata out of them! I have posted several frittata recipes before and generally follow the same framework. For those of you who are new to this recipe, a frittata is essentially a fancy, fluffy baked omelette that is much simpler to make than its name implies. I use onions and garlic for a flavor base and 8 eggs with a splash of milk, salt and pepper for the fluffy egg center. To change the profile of the frittata, I simply switch up the veggies and cheese that I use. Goat cheese is my favorite because it is soft and melty in a freshly warmed frittata. To further switch things up, I splashed a bit of Balsamic vinegar over the greens as well. The result was a satisfying, fluffy egg dish bursting with green stuff. Who needs to know exactly what greens you are eating when it tastes this good?

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Ever find that most recipes with goat cheese call for an ounce measurement instead of a tablespoon or cup portion? You’d need a scale to do that… so here is your chance to win one!

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Sue from SlimKicker.com contacted me about hosting a give away so that one of you has a chance to win this amazing kitchen scale! SlimKicker.com is a calorie counter and healthy lifestyle app that turns your diet and fitness goals into a game-style challenge, complete with points and rewards. You simply track calories and your healthy food choices, as well as complete healthy challenges, to rack up points. Once you reach a certain point level, you are reminded to reward yourself with something like a “cheat food” or new fitness gear. The tracking system and supportive community are great motivation to stay on track with your fitness goals! I definitely found this type of support essential during my Game On challenge!

This is where you come in – SlimKicker.com is in need of some new ideas for healthy living challenges. To enter this give away, simply leave a 1-2 sentence comment with your idea for a fun and creative healthy living challenge. They can be anything from drinking 8×8 glasses of water a day, to getting 30 minutes of exercise per day, to learning to snack wisely between meals. The best idea will be chosen and featured as part of the SlimKicker challenges, and will receive the kitchen scale! The contest is open for one week, so leave your comment by Tuesday, August 7 at 9am to enter. One comment per reader, please, and prizes can only be shipped within the US. Looking forward to seeing the ideas that you come up with!

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Hidden Greens Frittata

serves 4-6

1 sweet Vidalia onion, chopped

1 bunch greens, roughly chopped

2 tbsp olive oil

dash garlic powder, parsley, salt

2 tbsp Balsamic vinegar

8 eggs

1/2 cup milk

2 oz goat cheese

Parmesan cheese

Preheat oven to 350F. Saute the onion in the olive oil until soft, about 5 minutes. Add chopped greens and saute until slightly wilted. Add Balsamic vinegar and allow liquid to reduce slightly. In a separate bowl, mix eggs, milk and spices. Pour over the greens and stir slightly to distribute. Allow to cook over medium heat for 4-5 minutes. Transfer heat-safe saute pan to the oven and continue to cook for about 15 minutes. Crumble goat cheese over the top and return to oven for 5 more minutes or until edges are browned and center is set. Immediately sprinkle with shaved Parmesan cheese, if desired. Cut into 4-6 wedges and serve warm.

July 31, 2012 at 9:00 am 7 comments

Abs are Made in the Grocery Store

There is a popular saying that goes, “Abs are made in the kitchen, not the gym,” referring to the fact that our body composition depends as much if not more on our food choices than the amount of exercise we do. However, I think that phrase needs some revising. I truly believe that the choice happens at the grocery store, not the kitchen. If you buy healthy foods, you will eat healthy foods! Keeping tempting snack foods and indulgences out of the kitchens makes it much easier to make healthy choices when it is late, you are tired, or the stress of the day makes you want to eat everything in sight! But how do you conquer the grocery store and leave with only healthy purchases? This is what my best friend asked of me, so we took a field trip to Trader Joe’s to learn some healthy grocery shopping basics. This is the advice we came up with for filling your grocery cart with healthy food on a budget.

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1. Shop the perimeter of the grocery store. This is the oldest advice in the book when it comes to healthy grocery shopping tips, but it really works! The real food – like fruits, veggies, dairy, and meat – tends to be located towards the periphery of the store. The tempting snack foods, desserts, and prepared frozen meals tend to be located in the center aisles. While necessary ingredients are located in the center as well, the bulk of time should be spent perusing the outskirts. The 80-20 rule applies here. 80% of your time and grocery budget should come from the perimeter, while the other 20% is dedicated to the shelf stable centrally located necessities.

2. Stock up with fruits and veggies, and try at least one new produce item each week. The most common comment I hear from friends is that they don’t buy fresh produce because they are afraid of not being able to use it and wasting food. I have found that the more produce I have in my house, the more I am forced to make healthy choices for that exact reason. It is easier to choose an apple for a snack when you know you have to eat the fruit before it goes bad! It may take a few weeks and a little playing around with how much you can realistically eat within a week, which may mean a few up front weeks of spoiled veggies or sad fruits. However, it is worth the experiment in the long run! If this really is an issue, then frozen fruits and veggies are still an excellent option. Simply look for things that are flash frozen, have no added salt or sugar, and will maintain texture and flavor after being frozen.

Trying new things is also crucial here – you may find new favorites and will never know unless you begin to expand your horizons! This will also break you out of boring produce ruts and help to ensure that you get the full range of nutrients in your diet.

3. Focus on whole grains. Make sure that your bread is made with 100% whole wheat flour, choose whole wheat crackers and wraps, and look for items like quinoa, brown rice, old-fashioned oatmeal, and other unprocessed grains. White grains turn more quickly into sugar and are only for a treat, but often hide in products marketed as whole wheat or healthy. Be a label sleuth and a grain snob – it is for your health.

4. Read the labels! And don’t just stop at calories and fat. While counting calories is important for weight loss, there are other important items to consider. Serving size is key – my friend picked up a package of chicken taquitos and exclaimed, “Oh, only 110 calories!” That may sound ok until we looked at the serving size and realized that it is per tiny taquito, which would not make for the most filling lunch.

Ingredient lists are also good to peruse – anything with a laundry list of ingredients or with lots of hard to pronounce chemical names is probably something to steer clear from. Another important line to read is sodium. Anything with more than 10% of the RDV of sodium is probably not worth it – you can add salt if your taste buds need it, but you can’t take out the hidden salt. High sodium foods are not heart healthy, and also lead to water retention, which can be discouraging for dieters. The last place to look on a food label is the carbohydrates section. You want high fiber foods, since they help with satiety and help, well…. ya know. You also want to avoid added sugars, which I learned during my challenge, are everywhere!

Now take the reading labels example as a whole: my friend was choosing between 2 different types of bread. Both were 100% whole wheat, no weird preservatives, and similar in calories (110 vs. 80 per slice). Many dieters would stop there and choose the lower calorie bread. However, we looked down and noticed the 110 calorie option had 3x the amount of both fiber and protein, making it more nutritious per calorie and therefore the better option. Reading food labels is important!

5. Keep a well stocked pantry. Having staple ingredients on hand when the fridge seems empty will help you avoid the take-out temptation. Bulk grains, pastas, beans, low-sodium canned tomato sauce, and frozen veggies are helpful and can be thrown into a quick meal, like rice and beans or pasta with vegetables. Vinegars and herbs are also helpful for adding flavor and interest to a simple meal, without high cost, calories, or sodium. Having healthier quick-fix meal options, like low sodium soups or healthy frozen entrees instead of boxed mac and cheese and high sodium options, is also important for nights when things are too busy to cook.

6. Never shop hungry. If you are hungry, you will fall victim to end cap sale items, junk food treats, and impulse buys. Shopping on a full stomach will help you focus and make the best choices at the store.

7. Use a list. Some people go to the extreme with meal planning and lists, but I take a looser approach. In order to shop the sales, I make a bare bones shopping list: 3 types of fruit, 5 types of veggies (2 leafy green, 1 starch, peppers, mushrooms), bulk grain, bread, yogurt, eggs, etc. This allows me to choose what looks best that week or what is on sale, while still allowing me to have the essentials for meals throughout the week.

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With these guidelines in hand, my friend was able to conquer Trader Joe’s and emerge with bags of healthy food! Together, we brainstormed healthy lunches, picked up fruit for healthy snacks, and compared a lot of labels to pick the best products. We both learned a lot and had fun in the process, but who wouldn’t have fun with this little guy smiling back at you the whole time?!

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Question: Do you have anything to add to this list? What is your grocery shopping style?

Sources: WebMD and RD.com

May 25, 2012 at 12:00 pm 2 comments

Game On

A new month, a new challenge! My competitive nature has been brought out once again, this time for the Game On Challenge. My friends read the book and were inspired, so they got a group of us together to participate in this healthy living challenge. Although most of us already lead pretty healthy lifestyles, we all have our different motivations for participating. We are a week into the month-long challenge, and the competition is pretty fierce! All in a friendly way, of course. There are two teams of six, and the losing team rewards the winning team with gift certificates for a massage.

So what are the rules to this game? Well, there are a few basic categories: diet, exercise, sleep, hydration, habits, and communication. Every time you follow the rules within the category, you earn points. Every time you don’t follow the rules, you don’t gain points, and for a few circumstances, you lose points. You are allowed to take one day off per item per week with no penalty, or can cluster these days off if you specify ahead of time that you have a vacation or extenuating circumstances. To keep track of this, we have an epic spreadsheet, shared through GoogleDoc. A competitor, much more tech savvy than I, set it up so that the columns auto-fill and tally every time you record your day’s habits.

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A few of the categories have pretty basic rules: you have to sleep at least 7 hours a night (sleep), you have to drink 3 L of water (hydration), and you have to communicate in some way with at least one teammate and one opponent every day. For exercise, you have to log 20 minutes of intentional exercise each day. This can be running, body resistance exercises, yoga, or a brisk walk. It cannot be biking or walking to class, or running to catch the bus you are late for!

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From Pinterest

The most complicated sections are diet and habits. For diet, you must eat 3 solid meals each day. Breakfast must contain 1 fruit or vegetable, and lunch and dinner should have at least 2 vegetables that comprise at least half of your plate. One meal a day has to be vegan. None of your meals, snacks or ingredients can contain added sugar, with the exception of agave to sweeten morning coffee. You also lose points for any unhealthy snacks that break the above rules.

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Following the rules doesn't mean deprivation! This decadent breakfast I made the other day still fit the rules! Click the picture to get to the original post.

The habits section is individualized for each competitor. The goal is to choose one healthy habit to implement, and one unhealthy habit to break. My healthy habit: taking my vitamin every day. My unhealthy habit: getting off my computer a half hour before going to bed. This means stopping work for the day, getting ready for sleep, and giving myself a chance to read a book for fun or reflect on my day before passing out.

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From Pinterest

So at first glance, there are a lot of rules. Why would I subject myself to this if I already live a pretty healthy lifestyle anyway? Well, a massage is a pretty good enticement! All kidding aside, I still think it is important to evaluate your habits and be more mindful of your routines every once in a while. Sure, the rules surrounding diet and exercise fit pretty well into how I already live. However, I am terrible at drinking water and getting sleep! Turning my computer off and forcing myself to relax is helping me to get more sleep at night, but I am still struggling with the water challenge! I find that I am drinking so much that I cannot snack between meals. My meals tend to be smaller with snacks fit in between, so losing this snack has meant that I am not always taking in as many calories as I need. I didn’t recognize this until I was running on Saturday with my roommate and was having weird pains and dizzy spells. My body is starting to get used to having more water in my stomach, so my appetite is slowly starting to return. I am also bulking up my meals slightly since I still have less desire to snack than usual. I am learning to balance this new habit, but do not think I could continue to drink quite as large a volume forever! I am hoping to get used to drinking more each day though, and intend to be continually mindful of drinking at least my 8 glasses a day.

We have three weeks left of the challenge! Do you want to join us? You can choose one transformation areas and commit to those goals for the next three weeks! Whether it be hydration, exercise, sleep or a healthy habit, it is good to be mindful of every aspect of your health and well-being.

Question: What area would be hardest for you to make a change in? Do you want to join us in any aspect of this challenge?

March 8, 2012 at 10:00 am 7 comments

What to do When You Don’t Eat Turkey on Turkey Day

Thanksgiving is the ultimate American tradition. Friends and family gather around a feast, often featuring traditional American dishes like mashed potatoes and green beans, but often also incorporating elements from their own heritage. Since my cultural background is rooted in American farm life, our Thanksgivings have always looked pretty typical. My mom and I do like to experiment with new twists on beloved recipes, however, to make them healthier or more flavorful than before. (You have never tasted anything like my mom’s stuffing, trust me!) The mainstay of this beloved meal, of course, is turkey. This leaves us veggie-lovers with a dilemma: how do I enjoy a meal that is centered around meat? I am the only vegetarian in my family, though, so many of our traditional dishes also contain meat or chicken stock. What is one to do? Here are some of my thoughts and strategies for vegetarians and vegans on Thanksgiving:

1. If you are not doing the primary cooking, bring a dish that you know will be friendly to your dietary preferences. Some great examples from other bloggers include an amazing looking vegan gravy from Daily Garnish. Also, don’t be tied to tradition if you want to bring a main course that will satisfy your needs, and can be enjoyed by others. This Mushroom and Asparagus Quinoa Risotto, also from Daily Garnish, or my Cranberry Quinoa, are great examples of something that could easily blend into a Thanksgiving spread.

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Mushroom and Asparagus Quinoa Risotto from Daily Garnish

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Cranberry Quinoa with Kale and Delicata Squash

2. If you are doing the primary cooking, it is easy to make most of your sides vegan/vegetarian. The biggest problem will lie in the turkey: just ask someone else to cook and bring it! If you are not okay with cooking a big bird and your friends and families are not okay with going without, compromise and ask someone to help contribute to the meal.

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Cornbread Stuffing from Rufus' Guide

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Spiced Sweet Potatoes with Pecans from Rufus' Guide

3. It is quite easy to get your fill of sides, even without the turkey! All of the other mainstays of traditional Thanksgiving, like sweet potatoes and roasted root veggies, are enough to fill me up, even without a plate centerpiece like turkey. If you are looking to freshen up some of your classics, here are some great ideas! The cornbread stuffing from Rufus’ Guide can be made with vegetable stock to make it vegetarian, and the spiced sweet potatoes with pecans look amazing.

4. Bring a vegan dessert to share! Vegan baking is often the hardest for others to accommodate, so take the burden off them and offer to bring a treat to share. Check out this recipe for a Pumpkin Brownie Pie from Oh She Glows, or this Vegan Apple Cranberry Crumble from the Smart Kitchen.

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Vegan Pumpkin Brownie Pie from Oh She Glows

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Vegan Cranberry Apple Crumble from the Smart Kitchen

5. Be flexible. For me, it is more important to enjoy the company of my friends and family than to worry if my mom made the stuffing with chicken or vegetable stock. If you do need to know if something has any animal products, ask the cook in a respectful way, and use it as an opportunity to inform them of all the things you can eat as a vegan/vegetarian.

Because it is a holiday that centers around rich food, it is a challenge to maintain your healthy eating habits, veg or not. In my opinion, it is okay to relax slightly and enjoy a few indulgences on this decadent holiday. However, going too far can lead to stomach aches, the “too-full feeling”, and tight waist bands. Did you know that the average American consumes 4500 calories in one sitting on Thanksgiving? This statistic is not meant to steal your holiday joy, but just to make you an informed eater. If you are looking to avoid the post-prandial food coma, here are some strategies to for the day:

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Holiday Salad with Apple, Pear and Walnuts from Oh She Glows

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Butternut Squash and Apple Soup

1. Preface your meal with a salad and/or soup. This fall themed salad from Oh She Glows has fruits, veggies, nuts and amazing dressing to kick off your meal. My Butternut Squash and Apple soup is low fat and calories, and is a tasty preface to the meal. By filling your stomach slightly with these, you are less likely to overindulge in the other holiday treats.

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Mashed Potatoes with Celery Root and Turnips from What Would Cathy Eat

2. Lighten up your mashed potatoes with less butter and cream, using skim milk and plain yogurt as substitutes, but fill up the flavor with unsuspected additions like turnips or parsnips. Leeks also add great flavor to mashed potatoes, and cauliflower can be used for added creaminess without too much flavor alteration. Check out this great mashed potato recipe featuring celery root and parsnips from What Would Cathy Eat.

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Sauteed Green Beans

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Roasted Brussels Sprouts with Sherry Mustard Sauce from What Would Cathy Eat

3. Don’t forget the green stuff! Fill up half or more of your plate, with salad and any other veggie that might make a Thanksgiving appearance. There are so many wonderful fall veggies, so don’t forget to make use of them in your Thanksgiving spread. These green beans are simple but delicious, and give Brussels sprouts a chance with this amazing recipe, another from What Would Cathy Eat.

4. Enjoy a bite of everything, but keep your portions small. There are so many things to sample, and of course you don’t want to leave anything out! Use the non-veggie filled side of your plate for small spoonfuls of the other, more calorie-dense sides. Getting a taste will satisfy your craving so that you won’t feel deprived by skipping a favorite.

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5. Watch for sneaky sugar! It often creeps into casseroles, sweet potatoes, cranberry sauce and dessert. Cut the sugar in your baked goods in half, and look for lower sugar recipes. My cranberry sauce is lower sugar than most store-bought versions, and the sugar can be reduced and still give sweet results!

Lastly, make sure you get some exercise, even if you are in a tryptophan-induced coma. My family always takes a long walk after holiday meals, taking the time to enjoy each other’s company and let our food digest before dessert. Even a simple half hour walk can burn 150 calories. If you are of my dad’s mindset, that means you get to enjoy an extra few spoonfuls of stuffing! ;)

Regardless of the food that you have at your Thanksgiving feast, I love some of the ideas behind this day: gathering together with people who you love, celebrating the blessings you have in your life, and taking time to be thankful. I hope you are excitedly preparing to share good food with people you love, and maybe you can find a new recipe or two from this post as you put together your shopping list! I haven’t made any of these yet, but am excited to incorporate a few of them into our holiday meal!

Questions: How do you maintain your healthy lifestyle as you approach the holidays? Do you allow yourself indulgences, or stay strictly to your normal eating habits? What is the one dish you are most looking forward to at Thanksgiving this year?

November 20, 2011 at 1:11 am 8 comments

The Healthy Lifestyle Rx

As I mentioned last Friday, we have been learning a lot about obesity epidemic and the related health problems in my cardiovascular class the past two weeks. I shared some alarming stats that really made my jaw drop. To recap, more than half of all Americans are overweight, which predisposes them to high blood pressure, high cholesterol, coronary artery disease, diabetes, heart attack and heart failure, just to begin to name a few. In our lectures, we are taught to “counsel on lifestyle changes” as a first step in the treatment of many of these diseases, especially high blood pressure and cholesterol. However, few doctors seem to do this, and few of the ones who do seem to be effective. As a future physician interested in preventative medicine and primary care, I reached out to you for thoughts on why. I have loved reading the insightful feedback and have begun to formulate some deeper thoughts and opinions on the matter. I would to love to further the conversation on this subject and hear even more thoughts at the end of this post!

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So why don’t doctors address the issue of weight loss in a patient who is overweight and at risk for these chronic conditions?

  • Fear of sounding judgmental. It is true that no one wants to hear that they are fat, and our culture has become very sensitized to weight issues. However, doctors must breach many other sensitive subjects (sexual health, substance use, mental illness, etc.) without judgment and seem to do a better job managing to ask these questions. Why not use the principles of sensitivity and normalization learned from our training in these areas to address weight issues with patients?
  • Fear of not knowing the answer. We do not receive proper nutrition training in medical school. We learn that you have to take in fewer calories, follow a lower fat diet, and increase exercise, yet the details rarely move past this point. Many of my friends would be unable to talk to you about portion sizes, nutrition benefits of certain foods, relative amounts of food groups needed, and strategies for healthy weight gain/maintenance/loss. It is difficult to counsel someone on something that you have a poor understanding of yourself.
  • Fear of being hypocritical. Physicians themselves struggle with weight and leading a healthy lifestyle. We excuse ourselves for being busy, stressed, and overworked for not fitting in time to cook homemade, healthy meals or get the recommended amount of exercise. How is an unhealthy physician supposed to effectively counsel their patient on lifestyle changes?

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Many physicians do talk to their patients about weight loss, but yet are ineffective. It would be easy at this point to blame the patient, frustrated with the fact that they are doing nothing in the face of crushing medical problems. But perhaps there is something in the counseling approach that went wrong. My mom pointed out to me that her physician does advise her to lose weight, but simply moves on after addressing it. It is like writing a simple prescription for a problem that is not so simple, and then never checking the efficacy of that prescription. In an ideal world, a physician would not only inform the patient about the link between chronic health conditions and excess body weight, but would also help them brainstorm ways to modify their lifestyle. However, this leads back into many of the same points I mentioned before, specifically the lack of nutritional changes and the problems many health professionals have with their own lifestyle. The biggest problem in improving this “quick fix” approach is time. Patient appointments continue to get shorter, and counseling on any issue takes up a lot of the scheduled time. When you already have so many other factors to address within a 15-20 minute appointment, how do you make time for one more thing?

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My last hypothesis is from the patient perspective. Because so many Americans are currently on medication for high blood pressure, cholesterol, and diabetes, these problems are becoming normalized. It is easy to assume that taking daily pills as part of routine medical management removes all risk factors for more serious sequelae of the disease, when this is in fact untrue. Treatment for high blood pressure is still counted as a risk factor for heart disease, just as uncontrolled blood pressure is its own risk factor. We have become complacent with how good our medical interventions are, and as patients are therefore less likely to make major changes in light of something we don’t always view as a serious problem.
The more I study it, the more in awe I am of the human body, but especially of the heart. It is incredibly complex and is able to compensate for some major stressors that we place on it daily. It is a machine, and it holds up pretty well for the beating we put on it. I am more dedicated now than ever to taking care of my heart through a healthy diet and regular exercise – I want this pump to work for many more years to come!
Question: Do you have any more thoughts on this issue? Do you agree or disagree with any of my above statements?
Note: All pictures are Google stock photos, not my own work.

September 30, 2011 at 7:30 am 5 comments

Nerd Alert

I try not to be a complainer about school on my blog. I’ll drop the occasional hint that I am stressed or that school is difficult, but let’s be real here: I am in medical school and that is to be expected. The last few weeks of school have been legitimately hard for me because I wasn’t enjoying the material. Every second of studying felt like work and by the end of the module, I was left questioning if medicine was something I was truly passionate about. It is so nice to be reminded that the answer to that question is yes! We have moved from studying infectious diseases to the cardiovascular system, and I am really enjoying. There is still a lot of work, I am still stressed and school is still difficult, but I am enjoying learning again!

The best part of this block is the practicality of it (many of my future patients will have heart disease, but I am unlikely to see a rare fungal disease that I just spent hours memorizing!). I am interested in primary care and preventative medicine, and there is no better example of the importance of lifestyle interventions than in the cardiovascular system. First some sobering statistics, then some good news, and then I have a question at the end that I would love your feedback on!

Some sobering stats:

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    • The newest reports show that 68% of American adults and 20% of American children are overweight (BMI > 25). The super obese (BMI > 50) is the fastest growing segment of the population. By 2025, 50% of the US will be obese (BMI > 30). This is some scary stuff! While it is commonly assumed that obesity is an American epidemic, that is not all true either. It is more prevalent here, but upward trends are beginning in many other countries as well.
    • Obesity is the 2nd leading cause of cardiovascular related deaths, second to cigarette smoking. This kills more than 400,00 people per year!
    • Cardiovascular disease is the leading cause of death in the US, and actually kills more women than men annually.
    • Cardiovascular disease and hypertension, when combined, cost more in health care dollars than cancer and trauma-related injury.
    • The estimated annual cost of cardiovascular disease, including productivity hours lost, is $287 billion dollars.

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I could continue. Each of our lectures begin with slides packed with graphs, charts, and statistics that make my mouth drop. We are a nation in a disease crisis, but it is insidious and difficult to confront. Unlike the flu pandemic or vaccination campaign to eradicate small pox, public health initiatives seem to be making little headway against disease. Something needs to change.
Time for some good news… it doesn’t take much! Too often, a healthy lifestyle is seen as an all or nothing approach. For some, jumping head first into a new lifestyle may be effective. But for many, it is overwhelming and prevents them from making any changes. Consider these facts:
  • The biggest gains in cardiovascular health come from just adding minimal physical activity. If the population is divided into five groups, 1 being sedentary and 5 being most active, a person reduces their risk of cardiovascular disease the most by moving from the first to second quintile. What does this mean? You don’t have to run a marathon to be healthy. You don’t even have to run! Just go for a walk at lunch time or before dinner a few times a week! Five 30-minute sessions of light aerobic activity is enough to cut your risk of heart disease in half. There are added gains of even more activity, but the biggest boost is the first step.

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  • One in seven new cases of type II diabetes can be prevented by a 7% weight loss and the addition of 150 minutes of physical activity per week. Lifestyle interventions have been proven more effective than medication therapy. 7% weight loss is pretty modest – 14lb for a 200lb person. A person can lose up to 20 lb in one year simply by cutting 125 calories (the equivalent of a can of soda or an extra slice of toast at breakfast). Again, not a major step for huge benefit.
  • Cardiovascular deaths can be cut in half by national and individual efforts to reduce major preventable  risk factors (smoking, obesity, high blood pressure, high cholesterol, etc.) If you are a nerd like me, check out the Million Hearts Initiative.
Enough data spewing, I think the point is pretty clear. Obesity is a real problem, and it has real health consequences. While obesity-related cardiac death kills almost as many people as cigarettes do, health professionals are half as likely to counsel patients on lifestyle changes as they are on smoking cessation. I have talked to my parents, who both have long struggled with their weight, about why this might be true. I have some ideas, but first I would like to hear yours!
Question: Why do you think doctors are reluctant to talk to their patients about weight reduction and lifestyle changes? If a doctor were to address these issues with you, how would you want them to do it? Have you been counseled by a physician before on lifestyle interventions, and what made this a good or a bad experience?

September 23, 2011 at 1:33 pm 10 comments

How to Win the Weight Loss Battle

Before leaving for the wedding weekend on Thursday, I got to attend a lunch talk by Joan Salge Blake, a registered dietitian and professor at the Sargent School of Health and Rehabilitation Sciences at BU. I have heard this same talk twice before, but she always has so many excellent points that I come away with at least one or two new ideas each time! Her talk was entitled, “How to Win the Weight Loss Battle” and focused on the obesity epidemic, potential reasons why weight is becoming such a problem, and strategies to help people make small changes. Here are some of my favorite tips from her lecture:

You have to move more! But don’t reward your hour-long walk with the dog or half hour at the gym with an extra serving of dessert! She has a client vignette that cracks me up every time: an older man had reached a plateau with his weight loss, so she recommended that he walk the dog for 45 minutes every night before dinner. He did, came back and only had lost 1 pound. Frustrated, he exclaimed, “I did exactly what you said, and only lost 1 pound. The dog, on the other hand, lost 11! What gives?!” She later got him to own up to his extra serving of dinner each night because he thought he burned it off walking. So be careful that you aren’t overcompensating for calories burned!

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Have family dinner! As a kid, we used to eat dinner together as a family at least 5-6 nights a week, but that is becoming a thing of the past in many households. Even with busy schedules, for both kids and adults, it is still important to slow down and share food together. This gives time to only eat as much as you are hungry for, and also increases the likelihood of it being healthier food.

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Find life outside of the kitchen pantry. This is the only point that I slightly disagreed with Joan about. I think more people need to find life inside the kitchen. Cooking can be fun and simple; it is not that hard to eat healthy, and even easy to make healthy food taste good! The problem is that so many people are kitchen-phobic. Cook dinner, sit down with friends and family around the dinner table as mentioned above, and enjoy real food. Find life outside the pantry, the snack closet, the cookie jar, or whatever other food force enslaves you, and replace the time spent mindlessly snacking in front of the TV with a new movement based hobby, but find life inside of the kitchen to find new favorite healthy dinners.

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Remove the myth around frozen veggies. Many people think that it is only good for you if it is fresh, but that isn’t always the case. Many vegetables are picked early and allowed to ripen so they are fresh in the grocery store. Frozen vegetables are picked at their peak and then flash frozen, making them just as good as fresh. Plus, they are often pre-chopped and really convenient for easy weekday meals. Watch out for mixes that contain any sort of dressing or added salt, and stay away from canned. But eating frozen veggies on weeknights for convenience is much better than eating frozen dinners or fast food!

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Eat pasta in a 1:1 ratio. Joan is a NJ Italian, so she understands the “mangia” mentality about some beloved Italian American foods. Even if you aren’t Italian, who doesn’t love pasta?! The only problem is that it can be calorie dense without nutrient dense. Instead of eating 2 cups of cooked pasta (400 calories), eat a cup of pasta with a cup of cooked vegetables mixed in (250 calories). Same amount of volume, equally satiating, and an easy way to cut 150 calories from your meal. Similar to this idea, take some of the meat and cheese of your sandwich and replace it with veggies, and load up your omelets with veggies. Your stomach’s hunger signals respond to volume faster than calories, so be sure to satiate yourself with low-calorie, high-nutrient foods like fruits and veggies! Joan’s famous catch phrase: “They fill you up before they fill you out.”

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Eat on smaller plates. Standard dinner plates used to be 8 inches. Now they are 12. Most of us are not gourmets and will not leave a large rim around the plate for decoration. Instead, we eat with our eyes and fill our plates. Then we clear them, remembering times at the dinner table when mom wouldn’t let us leave food behind. This can lead to up to a 500 calorie increase in dinner! If we use smaller plates, we eat less but feel equally as satisfied after clearing our plate. Even more, you should use the plate method, newly adopted to replace the outdated food pyramid. If you divided your plate down the center, half should be fruits and veggies. The other quarter should be lean protein, and the last quarter should be whole grains.

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You gotta eat! A hungry person is a cranky person, and cranky people are far less likely to make healthy decisions. You need to eat 3 meals a day, but they should be smaller. In between meals, snack on whole fruits and veggies or small servings of air-popped popcorn. Look for things that are full of fiber but low in calories for snacks. Don’t let your day be a triangle, with all of your calories consumed at night. Space your meals pretty evenly throughout the day, and have protein at every meal to help you stay full longer!

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Breakfast is always the hardest for me to incorporate protein into. It is pretty natural to add beans to my salad, have quinoa at dinner, and ensure that I get protein at other points of the day, but it is not always so easy first thing in the morning. Recently, I have been adding a tablespoonful of peanut butter to my oatmeal, and that really makes a difference in staying full until my lunch break. This breakfast burrito is another great way to stay full all morning. It kept me full for 5 hours while running around all morning setting up for my best friend’s rehearsal dinner (more on the wedding soon!) Eggs can get a bad rep with dieters because they are high in cholesterol. The bigger problem than eggs, however, is that with eggs usually comes gobs of cheese. To keep this breakfast full of flavor without all of the added cholesterol, I filled it up with veggies and spices! In this breakfast alone there is a full serving of veggies, whole grains and proteins, and you won’t miss the cheese at all.

Question: What is your favorite take-home point from Joan’s talk?

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High Protein Breakfast Burrito

serves 2

3 eggs

1 tbsp milk

3/4 cup black beans (half a can)

1/2 yellow squash

1/2 red pepper

2 whole wheat tortillas

2 tbsp salsa

1/4 tsp cumin

salt and pepper to taste

Dice the red pepper and yellow squash. Coat a frying pan with cooking spray and saute the vegetables over medium heat for about 4-5 minutes, until they are soft. Add the black beans and cumin. In a separate bowl, beat the eggs and milk together. Pour over the vegetables and scramble. When eggs are mostly cooked, add the salsa. Season to taste with salt and pepper. Spoon half into each tortilla, roll, and serve warm.

September 5, 2011 at 7:50 am 5 comments

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