I get this question or variations of it in my office all the time.  “I’m a vegetarian, I don’t understand why I’m not healthy/ losing weight and my cholesterol is high.”  I often reply, “french fries and chocolate are vegetarian and they cause a lot of people to be obese and have high cholesterol.”  Many people have very outdated ideas of what is healthy and unhealthy.  I believe part of this is due to our upbringing and the influence of TV and other media growing up.  I discuss more of this in my blogs on juice and breakfast.

To eat healthier, here are some tips:

1. Read the nutrition labels, you should look for low saturated fat, cholesterol, and carbohydrates.  For snacks, try to stay 100 calories or below per serving.
2. Avoid fried foods, meat that is high in fat (dark meat, pork belly, chicken skin, and red meat), deep fried foods, and thickened sauces.  Oftentimes, the thickening agent is flour or starch, which can raise blood sugar levels and cause weight gain.
3. If you are not sure about a food, save a portion of it and put it in the refrigerator.  If it comes out the next day with a layer of whitish-yellow thick fat, it is not healthy.  Saturated fats will congeal whereas “healthy” fats such as olive oil will not.  Try this with your next bowl of chicken soup.  Sure, it’s delicious and great when you’re sick, but it’s also laden with fat.
4. Google your food.  The internet has a wealth of resources that can tell you exactly how many calories, fat content, and ingredients for many foods.  All you need to do is enter the name of the food and the word “calories”.   You are likely not the first person to look it up!
5. Plan ahead before you eat.  If you are going to a restaurant, check out the menu online.  It’s very difficult to make healthy decisions when you have a waiter tapping his foot to take your order.  Focus on vegetable dishes, fish, and lean cuts of meat such as chicken breast.  Avoid cheese, thick sauces, fried foods, and excessive amounts of carbohydrates “carbs” such as pasta or rice.  In general, these should make up no more than 1/4 of our plates (half should be vegetables, and 1/4 should be lean protein).
6. Food that you prepare yourself will almost always be healthier than store bought or eaten in a restaurant.  When you make it yourself, you have more control over what goes into your food and will be less likely to put massive amounts of butter or sugar into them.  I always make it a rule to use 1/4 less sugar, butter, or salt than the recipe calls.  You can also try substituting healthier oils such as canola or safflower oil instead of butter, or honey instead of white sugar.  Try it, you probably won’t notice a big difference!
7. Count your calories and keep a food journal.  I know it may seem tedious to do this, but I recommend it for anyone who is finding it difficult to lose weight.  We often eat “unconsciously” and forget about what we have eaten.  By keeping a food journal, you can be accountable for every item you’ve eaten and perhaps realize that the “snacks” you are eating may have as many calories as meals.  Coffee drinks, especially the expensive ones from a store with a green mermaid as a logo, are notorious for packing on the calories, with some as high as 800 calories per serving!

You just had your physical exam with your primary care provider.  He/she says you need to raise your “good” cholesterol.  But wait, isn’t all cholesterol “bad”?  HDL or high density lipoprotein is actually a beneficial form of cholesterol.  Higher than average levels can neutralize LDL or low density lipoprotein, which is the main culprit in atherosclerosis (hardening of arteries) which in turn lead to heart attacks and strokes.

Here are some effective tips to raise your HDL and keep your blood vessels healthy:

1. If you still smoke, stop smoking!  There are MANY reasons to stop smoking.  This is probably one of the most important. Smoking lowers HDL significantly.  Even one cigarette or cigar a week has a negative impact.
2. Exercise at least 30 minutes per day, 5 days a week.  I recommend doing “Cardio” (ever wonder why we call it cardio?  because it’s good for the heart!).  Typically, you should get close to your target heart rate during any exercise you do, roughly (220- your age= target heart rate).  So that slow walk to the grocery store may not count towards your 30 minutes per day!
3. Eat fish 3 times per week.  I recommend eating oily fish such as salmon, sea bass, trout, sardines, and tuna.  You do want to make sure that the fish you eat are also low in mercury.  Tuna should be eaten sparingly.
4. Add flax or chia seeds to your oatmeal, yogurt, or salads.  They add a nutty taste similar to poppy seeds or sesame seeds, but will boost your HDL.  I recommend a tablespoon of each per day.
5. If you drink alcohol, drink one glass of red wine per day.
6. Lose weight.  If you are overweight or obese, try to get to your BMI (Body Mass Index) goal.
7. Use olive oil or canola oil in your foods.  The Mediterranean diet recommends 4 tablespoons of extra virgin olive oil per day.  Add some olive oil to your salads.
8. Increase your fruit and vegetable intake.  The type of fiber that is found in these foods acts like a sponge in your digestive tract and can help remove any cholesterol that you may have eaten.  The recommendation is a minimum of 5 servings total of fruits or vegetables each day.  One serving is about the size of your closed fist.  I would recommend minimizing the fruits that are highest in sugars such as mangoes, bananas, grapes, and figs.  Of course if you are choosing between eating a juicy ripe mango vs. eating a cupcake, I would say the mango would be a delicious and healthier choice!

In a recent New York Times article titled “Stress May Counteract Effects of a Healthful Diet”, the author cites a recent study showing that eating a healthy, low fat meal may not be enough.  Stress can create inflammation mimicking a high fat diet.  More and more, we are learning that inflammation in the body leads to early atherosclerosis (hardening of the arteries which could lead to a heart attack), diabetes, and high blood pressure.  I make it a routine to screen for stress on my annual physical exams.  I ask my patients, “How well do you feel like you are dealing with stress?”  If their answer is “not very well”, I give them tips on how to relieve stress.  Here is a list:

• Meditate.  It’s no surprise that the word “meditation” differs from “medication” by changing one letter.  Meditation can help with stress.  Don’t think you have enough time?  Even 5 minutes a day can be helpful.  Here’s a list of ways to meditate.
• Exercise can be a great stress reliever.  I prefer aerobic exercise, but punching a punching bag now and then can be quite cathartic too!
• Take a walk in the park.  Many studies have shown that seeing greenery such as trees and plants can lessen anxiety.  Add some plants to your home or office to bring a sense of calm where you need it most.
• Sleep on it.  Getting a good night’s sleep restores our bodies and allows our mind to sort through problems experienced throughout the day.
• Talk to someone.  When you talk about problems with friends, co-workers, family or a therapist, you will feel better and can possibly get useful advice or help with difficult situations.
• Take a vacation.  Statistically, most of us are way overdue for taking vacations.  Oddly enough, a good portion of the working population does not use up all their allotted vacation time each year!  Even a simple weekend getaway to a bed and breakfast nearby can be enough to recharge your batteries.
• Get a massage.  For millennia, the human touch has been an effective way of de-stressing.  It’s not surprising that stress often leads to neck and back pain.  Perhaps combine a massage session with a 30 minute meditation afterwards.

I get this question a lot in my practice.  Why are we confused about what to eat for this morning meal?  I believe most of us were brainwashed by watching TV commercials as children and sit-coms with images of smiling kids in front of giant bowls of cereal, tall glasses of orange juice, and plates of buttered toast.  In recent years, we are learning that all of those items are contributing to obesity and diabetes.  The cereal and bread are “carbs” and the juice is nothing more than sugar water, butter is a saturated fat.  So what is left to eat?

I think the question also brings up the idea, who determined what considered “normal” to have for breakfast or any meal.  Most of the world does not eat cereal for breakfast.  In China and Japan, it is common to eat a rice porridge called congee with pickled vegetables, fish, meat, and eggs.  In Southern India, they may eat a crepe called a dosa with fillings such as potatoes and side of cooked lentils.  In terms of quantity, some of these meals can be almost as much as dinner.

I believe “one size does not fit all”, see how your body responds to what you eat.  Ask yourself, how do you feel after eating breakfast, are you energetic or tired?  hungry or satisfied?  Change the breakfast to suit your needs and not base it on what the media thinks your breakfast should be.  Want to have a chicken salad for breakfast?  Why not?

Here are some tips I recommend to help you plan the most important meal of the day.

• Eat breakfast every day.  Your body is like a car and needs fuel regularly to keep going.  By not eating breakfast, you are essentially running on an empty tank of gas.  Certainly not good for your engine (your body)
• Minimize or avoid carbs such as breads, pastries, donuts, and bagels.  Complex carbohydrates are broken up into sugars in our body.  This can give you a surge in energy but then lead to a fast “crash” and fluctuation in insulin levels which ultimately lead to weight gain.  Whole grains such as oatmeal are the exception (see below).
• Eat protein.  Protein keeps hunger away and is your body’s preferred fuel for endurance.  I recommend eggs, Greek yogurt, lean meats (chicken breast), beans, and tofu.  Concerned about the cholesterol in eggs?  Read this post.
• Eat vegetables or fruit (make sure they are low in sugar).  This is an easy way to get toward your goal of 5 fruits or vegetables per day as recommended in the Mediterranean diet.  Fruit also is a great source of fiber to keep you feeling full the whole morning.
• If you want to eat oatmeal, make sure you are eating reasonable portions. My recommendation is to eat an amount (after it is cooked) no larger than the size of your fist.  Make sure that you are eating oatmeal that is not instant (not the kind where you just add hot water).  I recommend the old fashioned oats that you cook on the stove (10 minutes) and make sure you don’t cook it until it turns to a complete mush.
• Coffee or tea are both great as they contain antioxidants.  Avoid adding milk containing fats or cream as that can raise your cholesterol significantly.  Sugar is also a no-no.  I add powdered cinnamon to my coffee to give it more depth of flavor.  You may also add stevia (which is a no-calorie spice which tastes sweet)
• Non-fat dairy or vegan milk.  Milk has been vilified in recent years.  Milk or non-fat yogurt is still a very important source of calcium.  Over the years, we are learning that the best sources of calcium can not be replaced with supplements.  If you are vegan or lactose intolerant, you can drink almond milk, soy milk, or eat soy yogurt.
• Incorporate chia, flax seeds, or nuts into your breakfast.  These “Superfoods” are versatile and can be added to your yogurt or oatmeal. Be creative!

Summer is a great time to catch up on books.  Whether you read them on your patio or on the beach, I recommend these 6 books to improve your mind and your health.  Here are a selection of my favorites on my bookshelf.

1. The Sleep Revolution by Ariana Huffington.  This book examines how most of us have lowered the priority of sleep in our lives, the consequences of inadequate sleep, and how we can be happier through improved sleep practices.
2. The Miracle of Mindfulness: An Introduction to the Practice of Meditation
   by Thich Nhat Hanh. This is a wonderful book about how to incorporate meditation into your life and reduce stress. Though the author is a Buddhist monk from Vietnam, his technique is universal. One of the tips I learned from this book is to stop multitasking. No one truly “multitasks” (try telling that to your boss someday!). Instead, we “toggle” between tasks, shifting our attention from one focus to another. Accordingly, we should focus on our attention on the people directly around us, and not be distracted by out electronic devices. We all know it’s dangerous to drive and text, but it’s just as wise to put the phone away when you want to spend quality time with your loved ones. Live in the moment.
3. Grain Brain by Dr. David Perlmutter.  Wonder why you don’t feel so great after eating a giant bowl of pasta?  There is a scientific basis for this.  You may not realize that “carbs” and sugars may also be affecting the way you think.
4. Forks Over Knives by Gene Stone. This is the book that started an eating revolution and has many celebrity followers such as former President Bill Clinton. While I have not moved over to a completely plant-based diet, I have seen many patients with cholesterol issues improve their numbers with this lifestyle.
5. Dropping Acid: The Reflux Diet Cookbook by Dr. Jamie Kaufman and Jordan Stern. A MUST for anyone with gastroesophageal reflux disease [aka GERD, heartburn, reflux, LPR (laryngopharyngeal reflux), gastritis, indigestion]. Learn what foods can cause your problems and avoid them. I was surprised to learn that not apples are created equal! Granny smith apples are very acidic and can make your heartburn unbearable but Fuji apples do not.
6. Being Mortal: Medicine and What Matters in the End by Atul Gawande. We will all grow old and die. But does that mean we must suffer? This is a must-read if you have aging parents. It depicts the current crisis of the US healthcare system as it relates to end-of-life care.