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

AND THE WINNER IS... Balanced Eating vs. Detoxing & Diets

Healthy lifestyle, including healthy diet, is one of the main pillars of wellness and disease prevention and a key to a long- as disease-free as possible- and happy life. For healthy diet and healthy lifestyle to be effective, they must be practiced consistently with only occasional transgressions ( less than 10% of the time).

Given the importance of healthy diet, both the general public and scientists want to know which one is the best. The choice is not easy as so many diets are touted as the absolute best, while the scientific evidence supporting these claims may be lacking. The mere fact that celebrities follow and promote a diet should not be seen as evidence of its true superiority.

On this article we will examine a number of proposed short-term diets that belong to the “Detox” category. These are brief diets, running from as short as three days up to six weeks, and are supposed to “cleanse” our body from toxins and help us get a new, healthy beginning in life. They are also used as a jump-start for weight loss. Some diets work (in terms of losing weight) if you follow them to the letter. Are these diets a true winner or just fads, hype or a new trend? Is it realistic to think you will NEVER eat bread in any form again?

While some people may think that “cleansing” is a new concept, Pharaohs’ doctors in Ancient Egypt used to recommend enemas (colon cleansing or purging) as a way of removing toxins from the body. As an idea, it is appealing, but is it really working or necessary? Consider that our body has very sophisticated mechanisms in place, mostly through our liver, kidneys and immune system  to cleanse itself constantly from toxins and waste products. In 2011, researchers at Georgetown University conducted a comprehensive review of the medical literature and found absolutely no scientific support of the practice of detoxifying the colon.

It is true that several individuals feel better after a detox period but is this a “placebo effect”? Mayo Clinic reports that there is little scientific evidence that a detox diet actually eliminates toxins from your body.

While there is wide variation among detox diets, most of them eliminate highly processed foods. Some suggest fasting and allow only drinking natural juices. Others allow you to eat only raw vegetables and avoid sugar.  Certain diets require you to cut out carbohydrates, but in the same token other “fatty foods” are allowed.  One patient we have spoken to said she was in Las Vegas with a friend and at the breakfast buffet, the friend had bacon piled high on her plate, but you would not catch her dead with a piece of toast. Is that a good way to eat?

Here are some examples of foods prohibited by several detox diets:

• Processed, boxed or canned food
• Table sugar or foods or drinks with added sugar
• Refined vegetable oils
• Artificial sweeteners, preservatives, additives, or coloring
• Flour-based foods
• Grains (rice, oats, quinoa); some diets, though, allow non-gluten grains like rice and quinoa
• Beans and legumes (also allowed by many detox diets)
• Dairy
• Coffee and anything caffeinated
• Alcohol

Examples of recommended foods by several detox diets include:

• Fruits (excluded by some)
• Vegetables
• Non-gluten containing grains (rice, quinoa)
• Beans and legumes
• Nuts and seeds
• Oils (olive oil, hemp oil)
• Probiotic-rich organic yogurt and kefir
• Dairy substitutes
• Green tea
• Water

For “juicing”,  lemonade with spices and plant-based (for example with spinach or kale) drinks are recommended.

Some elements of detox diets are shared by traditional Western Medicine and Nutrient Science, like fruits and vegetables, whole grains, lots of water, avoiding sugary beverages, and opting for foods prepared from scratch with natural elements rather than packaged or processed food.

There are some important differences between Traditional Medicine and detox diets, however. Traditional Medicine and Nutrient Science do not advocate fasting; they recommend low-fat dairy products, accept up to five eggs per week and up to five cups of coffee per day. Healthy fats, as contained in fish, nuts, olive and canola oil, avocado and dark chocolate are also recommended by Traditional Medicine but prohibited by several detox diets.

While many of the detox diets are not dangerous (it is very possible that people who feel better after a detox cleansing period do so because they have avoided sugar and processed food), extreme fasting and drinking only juices for prolonged periods of time may harm your health.

Eating a balanced diet is better for you and easier! Whole grains won’t kill you; and lean meats/protein, whole unprocessed foods, and foods low in salt, fat and sugar are the way to go. Foods full of nutrients, vitamins, minerals, fiber and antioxidants work like medicine, supporting and preserving our health.

Think before diving into that new diet craze or a detox diet and talk to your doctor before embarking upon those diets. Keep in mind that, both for the purpose of weight loss and healthy metabolism, what is more important is consistency in the long run, not just extreme measures over a few days or weeks that allow you to go back to indiscriminate eating.

Eating healthy, exercising, getting restful sleep and making smart choices are the way to a healthy life. Making healthier choices and eating a balanced diet is the real reason for feeling good and healthy!

It is not always easy, but remember -you are in charge of YOUR health.

To your health!

Dr. Anthony

YOU CAN EAT A Healthy Diet ... with just a few easy steps

You want to eat a healthy diet, but you don’t know where to start. Don’t be discouraged, it’s not  that hard!

Cooking your own meals in your own kitchen is the best way to know you are getting a healthy and balanced diet. Start now by following these simple rules and you will begin your journey to a Healthy Lifestyle.

Healthy Food- 4 Simple Steps to remember:

Fruits and vegetables -either fresh or frozen- are important. Whole grains, which are the “good” carbs, are needed in a meal. Fats are necessary, but go for the good fats which include fish, unsalted nuts, olive oil, canola oil, avocado, and dark chocolate (who said eating healthy couldn’t be fun!). And you will need a lean protein to round it out. There are two ways to add a lean protein: non-animal protein like beans, peas, soy, tofu and certain seeds or lean animal protein found in skinless poultry and low-fat dairy.

Healthy Drinks:

Water or Club soda are the best options. Try to avoid soft drinks (regular or diet).

If you drink alcohol - remember to do so in moderation. This means one drink per day for a woman, two for a man (one alcoholic drink equals 15 grams of pure alcohol). Coffee and tea are fine choices also, just keep the coffee to no more than 5 cups a day. Green tea is rich in antioxidants and can be served hot or cold.

In your journey to eat healthy, there are also a few things to be aware of or to avoid when you choose your food.

Eggs are fine - up to 5 a week is generally accepted. Some experts say we can eat 2-3 a day (including the yolk). However, this is somewhat controversial.

Beef or red meat should be limited to once a week. Red meat contributes to colon cancer as well as artery and heart disease.

Fast food and deep fried food should be AVOIDED. They are high in calories, have a high salt content, and a high amount of unhealthy (saturated and trans-) fats.

Eating out is also acceptable, but don’t make a habit of it. You should not go out to eat more than once a week and be aware of what you order. Even a salad at a restaurant could be loaded with salt and bad (saturated) fat in the dressing. Also, the salad is usually accompanied with bread sticks which contain too much salt and bad carbs. Plus, you’ll be more tempted to order that high-fat dessert in a restaurant!

Energy drinks and sugary beverages may be unhealthy and should be used in moderation, if at all. The science behind diet drinks is unclear and their long term effects may be harmful. Even though they have zero or near zero calories, they cannot be recommended as a healthy choice.  

If you couple your healthy diet with near-daily exercise you are on your way to a healthy lifestyle. When you practice both, you feel proud about your achievements. That gives you the necessary strength to resist temptations when eating (which lead to long-term health problems, not to mention an unflattering figure).

“Enjoy a wonderful healthy meal surrounded by people you love!” - Dr. Anthony Pothoulakis

Your healthy meals should be your own free choices and should not be imposed on you. They must give you pleasure and make you happy, not miserable. Once you learn to enjoy them, you will be living a healthy lifestyle (healthy diet and exercise) and not even think twice about it!