How can I avoid getting sick when eating out at restaurants?

November 1st, 2014

Eating out at restaurants is a pleasurable experience for most people.  You don’t have to worry about cooking, cleaning up afterward, and you have people waiting on you while you enjoy the company of family or friends.  However, you should be aware that your next meal out could get you sick with diarrhea or other food borne illnesses.  Here are some tips to protect yourself and your loved ones.

  • Scope out the restaurant.  When you walk into a restaurant, it should look and smell clean.  In some cities such as New York, eating establishments are required to post a grade on the outside window.  “A” means it has the least safety violations, “B” means pending which means there are a few violations, and “C” has the most.  If you are still unsure, check out the bathroom. If there is no soap or towels, you can be certain the food preparers and servers are not properly cleaning their hands.
  • Beware of the menu.  Menus are rarely cleaned and the pages can contain many germs.  It is important to wash your hands or at least use hand sanitizer after ordering your meal.
  • Beware of “Dinner Specials”!  Oftentimes, when a chef is faced with expensive produce that will spoil soon, he/she will often create a special dish to try and unload this produce, often with a strongly flavored sauce to cover up any taste issues.  If the waiter tells you about the wonderful “lobster in blue cheese sauce” special, avoid it and you will save yourself a night on the toilet.
  • Smell your food.  If the food does not smell right, do not hesitate to send it back and order something else.  Food poisoning is often mildly disruptive but can be deadly.  If you already took a bite of food, immediately purchase some Pepto Bismol and take 2 tablets.  Pepto Bismol has a mild antibiotic effect and can sometimes neutralize bacteria before it reaches your intestines.  I often recommend people to take them to prevent traveller’s diarrhea.
  • If you frequently eat raw shellfish, ask your healthcare provider for a vaccine against Hepatitis A.  This is a serious diarrheal and liver disease that results from shellfish harvested from contaminated water.  Fortunately, the vaccine is highly effective.  I also recommend the vaccine for people who plan to travel internationally.
  • If you have food allergies, be sure to always carry an epinephrine pen (Epi-pen).  Also, make sure you inform your server of any food allergies so they can take extra precautions when preparing your food.  If you have doubts about the contents of your food, do not eat it.  People with severe food allergies should avoid buffet-style eating establishments at all costs.  The utensils are often reused and mistakenly replaced in different dishes leading to contamination.
  • Skip the raw meat (beef, pork, chicken) and raw egg dishes.  Items such as steak tartare (raw beef chopped with seasoning) can contain parasites such as tapeworms.  On the other hand, most sushi-grade fish/seafood in the US is required to be flash frozen which kills most parasites.
  • If you develop fever with diarrhea, severe abdominal pain, or have bloody diarrhea, make sure you see a healthcare provider immediately.  These are signs that you may have a serious infection.

Are Eggs Healthy For Me?

September 30th, 2014

Eggs, or more specifically egg yolks, and their relation to cholesterol have been constantly debated in the scientific and nutrition worlds for over 20 years now.  The most recent studies show there is no added cardiovascular risk when eating eggs in moderation.  Current thinking is that eggs do contain cholesterol and some of it is in a form that could raise the LDL or “Bad” cholesterol.  However, for some unknown reason, we cannot absorb all the cholesterol in eggs when they pass through our digestive tract.  In fact, in a few studies, eggs were shown to raise the HDL “Good” cholesterol.

There are many essential vitamins and minerals (including vitamin D, B12, Folate) found in eggs that can actually protect against heart disease.  I definitely think eggs provide a rich source of nutrients in a form that is easy to digest.  At this time, I would recommend limiting the intake of egg yolks to no more than 2 in a day if you have no medical problems, and no more than 1 yolk per day if you have diabetes or high cholesterol.  Obviously if you eat eggs with bacon or cheese, the added cholesterol from those ingredients would negate the health benefits of the eggs.  Bottom line:  Enjoy your eggs in moderation!

Cardio Before Weights or Weights Before Cardio?

September 27th, 2014

I often hear a lot of “gym myths” at the gym and in my practice.  One of the most common is a belief (usually among men) that doing cardiovascular exercise (“Cardio”) diminishes the size of muscle produced from weight lifting.  I was very pleased to see that this question was answered in The New York Times Article, titled “Weights before Cardio?”  The article reviewed a few studies which showed both weights and cardio can increase muscle size.  The order of the two activities also does not matter.

There is no doubt that cardiovascular exercise is beneficial for your overall health.  Current recommendations say we should all be doing 30 minutes of cardio at least 5 days a week.  Does walking around count?  Walking would be considered cardio if you were walking at a brisk pace such that you are barely able to speak a full sentence.  I encourage everyone to try to pick up the pace.  Don’t have time to do cardio?  Can you find 15 minutes in the morning and 15 minutes in the evening?  Here are some tips to do cardio at home, without any fancy equipment.


How can I protect myself against cold viruses?

September 13th, 2014

Viruses which cause the common cold and flu, known as Coronaviruses, Adenoviruses, Influenza, and Enteroviruses are everywhere.  Here are some tips to protect yourself.

  • Wash your hands frequently and properly.  Use soap and warm water.  Make sure to get all surfaces of your hands especially on the fingertips.  Proper hand washing should be 20 seconds long (think about singing the “Happy Birthday” song twice).  Dry your hands completely with a clean towel.  There have been some anecdotal evidence that using “hand dryers” in public bathroom may actually introduce more germs onto your hands because the air blowing through may have droplets from the toilet.  It is especially important to wash your hands before eating a meal.  If you are at a restaurant, wash your hands after touching the menu.  Many menus are covered in viruses and bacteria.
  • Use hand sanitizer when you are unable to wash your hands.
  • Avoid touching your face or mouth.
  • Avoid being around people who are ill.  You’d be surprised how many people still go to work when they are sick.  Are they contagious?  Absolutely.
  • Maintain a good sleeping schedule.  Your body can fight off most viruses on its own.  You may not even recognize you’ve been infected with a virus.  It is important to make sure your immune system health is at it’s optimal performance.  Adequate sleep is one way your body strengthens its defenses.
  • Eat plenty of fruits and vegetables.  Antioxidants and minerals can support good immune system health.
  • Maintain good air quality.  This includes proper temperature and humidity in your surrounding.  Do your nasal passages feel dry?  Are you sitting in a drafty area?  Irritated nasal passages can make you touch your face more often and allow for easy transmission of viruses into your body.
  • Get your Flu shot!  I can’t overemphasize this point.  Flu shots are given starting in September/October each year  Make sure you get it EVERY year as the formula changes and three new strains of the flu are introduced.

What “numbers” do I need to know about myself?

September 13th, 2014

I often have patients who know the mileage of their cars or how much money they have in each bank account, but they don’t know the important numbers regarding their health.  The next time you have an annual physical with your healthcare provider, ask about these lab values and get a copy of your labs so you can keep them on file and can refer to them when needed.

  • Total Cholesterol– this should generally be below 200 for everyone.  If you have a history of heart disease or diabetes, your physician may want to see this number even lower.
  • LDL “Low Density Lipoprotein”, aka “Bad Cholesterol”– this should be lower than 160 for everyone, but should definitely be lower than 130 if you are over 50 years old.  If you have diabetes, heart disease, your goal should be even lower.
  • HDL “High Density Lipoprotein”, aka “Good Cholesterol”– this should be as high as possible.  If this number is above 59, it is considered a marker of reduced  chance of heart disease (as long as your other cholesterol numbers are normal)
  • Blood Pressure– Elevated blood pressure leads to heart disease and stroke.  Blood pressure consists of two numbers.  The top is called the “systolic” and should be no more than 150, and the bottom is called the “diastolic” which should be no more than 90.
  • Body Mass Index This is calculated from your body weight and height.  A body mass index of 25-29 means your are likely overweight and this increases your risk of diabetes and high blood pressure.  30 and above indicates you are obese.  In certain populations such as Asians and Latinos, body mass index may not be accurate (underestimates risk).  For example, an Asian woman with a BMI of 22 is likely at higher risk of cardiovascular disease than a Caucasian woman with the same numbers.
  • Fasting Blood Sugar– This is a test that you do after an 8 hour fast.  It tests for diabetes and pre-diabetes.  Numbers below 100 are considered normal.  100-125 are considered pre-diabetic state, and 126 and above can indicate diabetes.  In general, it takes years to develop type 2 diabetes, with a gradual progression.  It is important to recognize a rising trend in fasting blood glucose early and take steps to prevent the onset of diabetes.
  • Creatinine– This is a measure of kidney function and varies based on body mass.  A lower creatinine generally indicates improved kidney function.  People with diabetes and high blood pressure need to make sure that this number is as low as possible.  A rising creatinine can sometimes indicate poor blood pressure control or poor sugar control.
  • AST/ALT-  These are liver enzymes.  Again, they should be as low as possible.  Elevations of AST/ALT can indicate inflammation of the liver, known as hepatitis.  Common causes of liver enzyme elevation are fatty liver (occurs when your cholesterol/saturated fat intake is high), acetaminophen(Tylenol) use, alcohol ingestion, and viral hepatitis (Hepatitis A, B, and C).  If you drink any amount of alcohol, it is important to make sure these numbers are normal.  Current recommendations are no more than 2 alcoholic drinks in 24 hours for men and no more than 1 drink for women.
  • Hemoglobin-  This is a test for anemia.  A low number can indicate blood loss either from not being able to make enough blood (such as in iron-deficiency) or losing blood which may occur with colon cancer.  For this reason, any anemia that is found needs immediate and thorough work-up.