As the New Year is approaching, many of us are thinking about resolutions to change ourselves for the better.  Many people vow to lose weight or exercise more.  But how many of us actually keep those resolutions for even a month into the new year?

A better way to make a life change is to create a S.M.A.R.T. (Specific, Measureable, Achievable, Realistic, Timely) goal.  Humans are creatures of habit, when something in our routine changes drastically we find it difficult to adapt and often give up.  Imagine someone whose been eating a donut everyday for breakfast for the past 10 years, and now because he/she wants to lose weight switches to oatmeal and fruit every morning.  How long will that change last?  How can they monitor their progress?  I can tell you for most people it will not be long!  By making a series of small changes, you create small steps instead of giant leaps toward your goal.  If we apply the S.M.A.R.T. goals to this situation, maybe the goal would be to add a piece of fruit to the usual breakfast donut for a month.  The next goal could be to cut the donut in half the following month.  Eventually, the person will be able to change their diet, but in a gradual, sustainable way.

In my own life, I have found making S.M.A.R.T. goals to be highly effective at making lifelong changes.  One year ago, I gave up all carbonated beverages.  I used to drink lots of diet sodas, but I realized the acid can cause dental enamel to erode and your blood to become acidic leading to a whole host of diseases.  At first, I just started brewing my own unsweetened ice tea at home and keeping a pitcher of it at all times in the fridge.  I still drank diet soda for the first month or so, but eventually I replaced them completely.  I started feeling much healthier, and realized I could make other changes.  Shortly thereafter, I decided to reduce and eventually eliminate red meat from my diet.  Again, I felt much healthier and my exercise stamina improved greatly.  In turn, this has allowed me to exercise more and has prevented me from gaining weight.  S.M.A.R.T. goals are stepping stones to major changes in your life.

This New Year’s Eve, find out what your first S.M.A.R.T. goal will be, write it down, post it on your fridge, share it with a friend.  Make that change happen!

The flu is here!  Currently many states are experiencing rising numbers of flu cases.  Much of this is likely due to family gatherings during the holidays.  There are many strains of the flu virus and before each flu season, a panel of experts predict what are the main strains to add to the flu vaccine.  During years when they are correct, the incidence of flu decreases.  When they are not, many people can become sick.  Currently, it appears that the flu strains going around now (mainly H1N1) are the ones which have been included in the flu vaccine.  However, you will not have protection if you do not get the flu vaccine.

It’s not too late to be vaccinated.  The flu season is just starting and unlike last year the vaccine is still plentiful.  Just be aware that it will take up to 2 weeks to become effective.  I generally recommend that people get adequate sleep, exercise, and drink plenty of water after getting any vaccine.  Your body’s immune system needs to be at it’s peak performance to create adequate antibodies.

If you have any close friends or relatives currently sick with the flu you should keep a distance.  Flu is spread by respiratory droplets.  Avoid being in contact (kissing, hugging, sharing food, etc.) with anyone with the flu.  Also, avoid touching your face or nose as viruses on your hands can enter your respiratory tract easily that way.

Recently, in my office I have seen a few cases of flu in people who didn’t get the flu shot who have small children at home.  Remember that when you get the flu shot, you not only protect yourself, but you are also protecting your loved ones such as your children and your parents.  A flu may be nothing more than an annoyance for healthy people but for children, the elderly, or people with chronic diseases, the flu may lead to complications such as pneumonia, dehydration and death.  Be smart, get vaccinated!

After working with patients for many years in New York City, I have seen many cases of “City-itis”.  This is my own phrase for a condition that I see which occurs after people remain within the boundaries of the city for long periods of time.  My patients usually tell me they can’t sleep at night, they feel anxious all the time, they feel like time is moving very fast, and sometimes even depressed.  I usually ask them one simple question, “When was the last time you physically left the city?”  The answer is usually 6 months or more.  Some have even skipped out on their allotted vacation time and opt to continue working on their work projects!  It is no wonder they don’t feel well.

Your environment affects the way you feel.  The fast pace of the city, the crowds of people, and the constant stimulation of lights and sounds takes a toll on your body.  Studies have shown that when people are exposed to bright flashing lights or loud, fast-paced music, your brain becomes stimulated and your heart rate and blood pressure increase.  In many cities, the street lights and constant car traffic create a place which never gets completely dark and is noisy all the time.  Imagine the effect of living in a city 24/7 for 6 months!  It is no surprise this could have an effect on your overall wellness.

The solution?  I tell my patients to get out of the city.  For those with means, a flight down south to a sandy beach in Florida is a great solution and a way to get much needed vitamin D during the wintertime.  Another easy option is to drive 45 minutes outside of New York City where there are beautiful parks such as Harriman State Park, Bear Mountain State Park, Robert Moses Beach, Fire Island National Seashore, and the Palisades Park.  Hiking in the woods, walking along the beach, observing nature, and getting fresh air for a few hours provide a required respite from the city.  Even sitting in Central Park is enough to bring people back to a sense of calmness and feeling centered.  Most of my patients who follow my suggestion tell me they are amazed at how quiet it is for the first hour after leaving the city.  Some even tell me that their ears start ringing because they are not used to the silence.  Humans are in many ways no different from animals.  We have an inherent need to see nature.  It is the natural environment that make us feel safe and comfortable, not the concrete buildings and asphalt in which we currently live.  Ever wonder why you feel so much better just watching a nature program on TV?

Just as eating, drinking, and getting adequate sleep are important to your overall health, so is the need to allow the mind to relax.  This is better than any medication.  Feeling stressed in the city?  You may just need a “Prescription for a Nature Getaway”.

The American Heart Association and the American College of Cardiology recently announced new guidelines outlining who should be on cholesterol medications.  Essentially, they are saying more Americans need to be put on “statins”, a class of cholesterol-lowering drugs including brand names such as Crestor, Lipitor, and Zocor.  The revised guidelines suggest that health care providers in the US should into consideration the many risk factors that can lead someone to develop ASCVD (atherosclerotic cardiovascular disease) and not just their cholesterol numbers alone.  In fact, they suggest most people do not need to have their cholesterol levels rechecked after starting an appropriate dose of statin.  In my opinion, this is a tough pill to swallow.  Most people would like to see how low their cholesterol drops after starting a medication;  it provides them with feedback on how they are doing and encouragement to continue taking the medications.

Another big change is the reduction in the cutoff point where statins should be considered as treatment.  Previously, medical providers would calculate a cardiac risk assessment using guidelines outlined by the Framingham Risk Assessment Tool. This takes into consideration risk factors such as high blood pressure, smoking, total cholesterol, and HDL “good” cholesterol.  If this number came out with a number over 10% (indicating the patient has a 10% chance of developing ASCVD over the next 10 years), the person should be placed on cholesterol-lowering medications.  The recently released guideline suggests this should be lowered to 7.5%.  What does this mean for people in the US?  More people are going to meet the criteria to start statins sooner.

How will these changes affect medical care?  This is still hotly debated, but in my opinion medical providers will be “freed” from focusing on the numbers.  Instead they will be able to pay more attention on counseling and realizing that there are other risk factors aside from cholesterol that need to be addressed.  For example, if someone is a smoker with high cholesterol merely being on a statin does not reverse the greater damages of smoking.

How will this affect you?  No matter how old you are, you should ask your medical provider to do a cardiovascular risk assessment at every annual physical.  If you are overweight, smoker, or have high blood pressure, you need to have these under control.  These are the major risk factors for ASCVD that you can change with lifestyle modifications or medications.  Cholesterol medications should never be a replacement for healthy living.

The FDA recently revealed it is taking steps to eliminating trans fat from the grocery store aisles.  What is trans fat and what does this mean for our health?  Trans fat is a synthetic fat made from naturally occurring oils.  Essentially, manufacturers add hydrogen to oils made from corn, turning a liquid oil into a solid.  Eating foods high in trans fat is directly linked to a higher risk of heart disease and stroke.  This is obviously a good move on the part of the FDA.  Currently in New York City and many other cities in the US, there is a ban on restaurants using this unhealthy fat.  I have noticed among my patients that this ban is having other positive effects, such as making people more aware of the health dangers in overconsumption of fats in general.  It is also getting people to read food labels.  Speaking of which, you certainly want to know that many foods will rarely list “trans fat” on the list of ingredients.  Instead, they are hidden under other names such as:  partially hydrogenated (soybean, canola, vegetable, etc.) oil, mono and di-glycerides, trans fatty acids, and modified oils.  Unless you’re a chemist, you may never know you were eating something that could potentially kill you!  If you have the option of choosing a food item with the “trans fat free” label, certainly pick that one.

I generally recommend that people avoid prepackaged foods.  If you bake your own cookies and cakes, you control what you put in them.  You can choose healthy oils such as olive oil or canola oil and I’m sure you won’t be putting preservatives in them like their counterparts from the store.  If you must have your sweets (always in moderation!) but you don’t know how to bake, go to your local bakery.  They will also be less likely to add trans fats to your food.  In addition to eating a healthier product, you will also be supporting the local economy, reducing your carbon footprint (they didn’t need to use gas to drive the product halfway across the country and package it in petroleum-based plastic), and it will likely taste ten times better than that sad cookie sitting on the shelf for months.

I think the FDA is heading in the right direction.  They are creating awareness among the public that we do not need to accept the “toxins” in our food.  I often tell my patients to only eat foods that their grandparents would recognize.  I’m sure a synthetic fat that is created in a sterile chemistry lab would not be one of them.