Prevention of Pre-Diabetes
It’s always nice to see people in the medical community backing your beliefs. I found this quote recently by Dr. Michael Valentine, the President of American College of Cardiology (2018-2019) that said “While we are constantly finding innovative ways to treat existing heart disease, we must continue to focus our efforts on preventing heart disease. It will require efforts from more than just the medical community, but from communities and government as well.”
In this blog, we’ll be covering pre-diabetes, obesity and how to prevent both of these things from occurring in the first place. Many people have heard about diabetes, but what most people don’t know is how the sequence happens from pre-diabetes to full-on diabetes and the process that the body goes through during this time.
High blood pressure, diabetes, and obesity all go hand-in-hand.
When you have a meal that is rich in carbs, where do those carbs go? They are absorbed into the bloodstream and go knocking on the door of our working cells in our liver, muscles, and other arteries to tell them that blood sugar is available. The cells listen and use this to go about their routine and create the energy that we use daily. However, as blood sugar continues you to come around and tell us that blood sugar is available, not all doors open. Now, the pancreas already secretes insulin into our bodies, and when that blood sugar comes knocking, they say - “Knock louder, I can’t hear you.” The blood sugar or insulin must be louder and work harder to get through those doors, hence the creation of insulin becomes higher. Insulin continues to come back with more and more insulin in order to open those doors, but after it accumulates such high levels over and over, it eventually says, “What do you expect of me? I can’t keep up with these levels anymore” Hence insulin resistance starts its journey.
The main reason this occurs is when our bodies are not getting the proper treatment tactics - a healthy diet, exercise, and of course, too many carbohydrates. As we know, everything is okay in moderation, but when your body starts to become unresponsive, it’s because of unwanted belly fat and lack of care for our bodies. Our bodies try to help us maintain healthy weights, even from the inside, hence the resistance to insulin production trying to help keep us healthy and fit. For people that have diabetes and other health-related issues, this fight can be challenging. Your blood test will be where you see the difference in your body.
Your number should look something like this:
Pre-Diabetes: between 100-126
Diabetes: 126 or higher
1 out of 3 people in the United States test positive for pre-diabetes, and had no idea that they were even in a categorical place for pre-diabetes or diabetes in general. This is where we wrap everything back to our previous lessons: stay on top of your health and make your primary care physician your best friend. Get your checkups, monitor your own health at home, and do the things that you know are good for your bodies in the long run. Your physicians will tell you how to take care of your bodies before diabetes can kick in, or how to prevent your body from getting to a diabetic level.
To your health,
Dr. Anthony
Shared Decision Making
In an era where there are so many options in the medical field, having the opportunity for shared decision making is more important than ever. Shared decision making is when a doctor and patient decide together on what needs to be done next. This contrasts with the more traditional practice of medicine in the 19th and 20th centuries, where the health care providers had the knowledge and dictated to the patients and their families of what needed to be done. Shared decision making is important when more than one option is being presented and it’s not 100% clear on what needs to be done. In a more “clear cut” situation, the role of shared decision making is less pronounced. For example, a young person comes in with acute appendicitis. We know that if we don’t operate and remove the appendix quickly, it can burst, cause peritonitis and ultimately lead to death. We wouldn’t converse about it for an hour with the patient and his family; we would say that this is what needs to be done and this is what we are going to do. Another common case (that I have often experienced as a cardiologist) is when someone is having a heart attack. We know that it’s important to move quickly and take care of the situation, and giving a variety of options is not the best use of time.
In instances that have more than one option and are not as acute (or urgent), shared decision making is a very ethical option and practice with most physicians. Here’s an example of how this tends to play out: say we have a patient who comes in for an appointment. She feels fine, and has no symptoms of an impending heart attack or stroke, but is considered high risk. As a doctor, I offer the option of prescribing a statin (which lowers cholesterol). These medications have been widely used since the 1980s and have been credited for cutting the number of heart attacks in half. They have been very powerful and useful, but they need to be taken on a daily basis. While they are generally safe to use, it’s important to remember that there are no medications without side effects. Statins are not “muscle friendly”, and approximately 1 in 5 patients develops muscle aches while taking this medication. This is not life-threatening, but it can inhibit daily activities. It becomes a back and forth discussion that takes time and effort from both the patient and the doctor. Of course, it is much easier for a doctor to say “here is your prescription, take this daily and come back in two months so I can check your cholesterol levels”. But the approach where the physician invites the patient to make decisions together based on the patient’s comfort level can be extremely beneficial. On one hand, we want to educate the patient on what we think is best; but on the other hand, we want him to be able to follow through with that decision.
Shared decision making is a wonderful thing. It’s what patients deserve, but it takes time and a good attitude from both the patient and the physician. It takes the realization from the patient that there are no easy fixes in medicine and that prevention is the first line of defense. Does your doctor practice shared decision making? If you’re not sure, have a discussion with her and find what fits your needs the best.
To your health!
Dr. Anthony
New Year, New Diet? - Mediterranean (Part 3 of 3)
In my years of practicing medicine and prevention of cardiometabolic diseases, our diets and the way we eat make a very profound difference on our health. In my previous two blogs about the Paleo and Keto diets, I shared my professional opinion on their structure. But there is one more diet that I explain in my book which is a very healthy way of eating — the Mediterranean Diet.
The Mediterranean Diet is rich in whole, natural foods, including fresh vegetables, lean proteins and fish, and olive oil.
The Mediterranean Diet gained popularity - as you can guess - near the Mediterranean Sea and has since expanded from its creation in the 1960s and 70s. It is a diet rich in fruits, vegetables, nuts (unsalted), fish, eggs, lean meat (mostly white meat), whole grains and olive oil — but red meat is rarely eaten. As with all healthy habits, processed foods, deep fried foods, and sugary beverages have no place in Mediterranean diet.
Key items to success with the Mediterranean diet (similar to Paleo) is that you consume healthy, whole foods made from scratch from fresh ingredients and that processed foods are thrown out of the window. It’s also important to note the lifestyle that goes along with this diet. The people who ate the Mediterranean diet would typically work out in the fields for 6-8 hours a day six days a week, which helped them keep up with their muscular physiques and flat bellies.
When comparing the Paleo and the Mediterranean diets, you can see many similarities with the biggest differences coming down to legumes, whole grains and dairy products (these are part of the Mediterranean Diet, but not the Paleo Diet) and the red meat and butter that are liberally allowed in the Paleo diet. The overall lifestyles that match these diets are similar to those who have daily physical work for several hours. There is good scientific evidence that people who eat the Mediterranean diet are prone to living longer, having less chance of contracting diabetes, and that the diet can protect against Alzheimer's and dementia.
Following a diet to live healthier should never be a “fad'“. Focusing on whole foods, while getting rid of sugars, processed and deep fried foods are probably the most important take home messages from both the Paleo and Mediterranean diets. Red meat (when eaten in moderate quantities, and provided that you check your cholesterol with your doctor) or “antinutrients” in legumes are not going to ruin your health. Always complement your diet with an active lifestyle and, of course, do not smoke.
To your health,
Dr. Anthony
New Year, New Diet? - Paleo (Part 2 of 3)
It’s hard to believe we’re almost through the month of January! Have you taken steps towards a healthier life?
In my last blog, I shared some information about the Keto Diet — and this time, I want to share one of the two diets that I have studied for many years and encourage my own patients to follow.
Let’s start with the Paleo Diet!
The Paleo Diet comes from the term “paleolithic”: meaning the era of early stone age and cavemen. Cavemen had no choice but to eat what they had access to, which for many, was heavy in protein — whereas, for others, it was predominantly plant-based. So, in the Paleo diet meat is in big time, including red meat.
What all is “ok’d” in the Paleo Diet? Grass-fed meat, poultry, fish, shellfish, eggs, vegetables, fruits, nuts, seeds and healthy oils are the favored foods.
Processed foods, sugars (including sugary beverages), dairy, legumes and grains are off the table.
Grass-fed meats and vegetables are always a win on the Paleo Diet.
A strong argument of the proponents of Paleo diet is that the human body was created for the challenges of the cavemen, so why shouldn’t we eat today what they ate then? A positive point of this diet is that, once you exclude sugars from your diet, you avoid insulin spikes and can lose weight without feeling hungry. I believe that cutting out legumes, whole grains and dairy is a rather weak point of Paleo diet as these foods contain fiber (legumes and whole grains), protein (legumes and milk), and antioxidants (all three). The concern that legumes contain anti-nutrients that block the absorption of other essential nutrients is more theoretical than real; one would have to eat extremely large quantities of the same legume to have a negative impact on their nutritional status.
Finally, a better way to approach Paleo diet is to consider it as a part of a “Paleo lifestyle”: cavemen used to walk for 2-4 hours a day and seven days a week, jump, lift weights and climb trees. This diet makes it ideal for those who are extremely active.
Overall, eating whole foods, cutting out the sugars and eliminating processed foods are strong, positive points of the Paleo diet — while cutting off legumes, dairy and whole grains is controversial.
Do you eat Paleo? Would this be a way of eating that you would consider trying?
To your health,
Dr. Anthony
Do you stint on your sleep?
So you’ve been making changes to your diet and lifestyle to become a happier and healthier individual… that’s great! But have you been catching enough zzz’s?
Today, I want to talk to you about sleep and how essential it is to our health. As we try to define what a healthy lifestyle is, we need to understand that, while exercise and a healthy diet are the pillars of getting on track with a healthy lifestyle, we must also factor in sleep, stress management, and other key factors that people too often push under the rug.
Scientific studies have concluded that we need 7-9 hours of sleep a night in order to function properly and let the body do its intended job of healing. Our ability to make decisions, to operate machinery, and other issues may be impaired when we are sleep deprived. Not only can sleep deprivation affect our day in terms of safety and productivity, but it affects our body internally as well. Some of the effects that sleep deprivation can have on the body are:
Appetite increases, which can lead to weight gain
Blood pressure rises, eventually causing high blood pressure
Blood sugar metabolism worsens which, in the long run can contribute to T. 2 diabetes.
If we sleep less than 7 hours a night, that can damage our body over the years. We are all pressured to work longer hours, stay up late, and not get to bed at a decent hour - which causes us to stint on sleep. The price we pay now and in the future regarding our health, can be detrimental. Do you have a job that forces you to stay up until midnight and wake up feeling fatigued, fuzzy, and irritable? If the answer is yes, take a second to assess how much sleep you are truly getting each night and if your health is paying the price. YOU are the only one that can make that choice for yourself. Choose health and try to schedule in 7-9 hours a night.
For extra advice visit the Sleep Foundation and read about how to get into a better routine and get your health, mind, and body back on track. A few of the tips and tricks that they provide are:
Avoid eating heavy meals or drinking caffeine and alcohol several hours before your set bedtime.
Make your room a pleasant and peaceful place that promotes sleep.
Avoid screen-time and harsh lighting a few hours before bed- try reading a book instead!
Healthy living requires high quality sleep. Get your sleep on track and your body will follow.
To your health!
Dr Anthony