At the Academy Awards this year, the wrong movie was announced as the Best Picture which created a very awkward situation.  After a full investigation, the cause of the embarrassment was a distracted staff member who was using social media while he should have been fully focused on his job.

I was not surprised that social media and cell phone use caused this debacle.  Many major train crashes and derailments in recent years have been attributed to conductors who were not paying attention because they were looking at their phones.  Don’t get me wrong, I think phones and social media are not inherently “evil”.  Heck, you may be reading this article on your phone right now!

My concern is that we are no longer living in the moment and experiencing life now.  Humans can not “multitask”.  We are not designed to deal with more than one task at once.  Meanwhile, while I’m writing this blog, I am drinking my morning cup of coffee and listening to music.  Isn’t that multitasking?  Yes, an observer may think that I am doing three things at once but I’m actually not.  I’m typing for a few seconds, then my attention goes to reach for the coffee mug, then it goes back to typing on the keyboard.  I am actually “toggling” between activities, albeit at a very fast pace.  I am not truly doing these three things at once.

If a task requires more concentration or I am doing more tasks at once, the “toggling” becomes more cumbersome and reaction/response time will increase.  My chance for error will also increase.  Hence, this is the root of the Oscar incident and many accidents.

While it is not entirely feasible to “disconnect” from our phones entirely in this digital age, I would recommend that we try to avoid the temptation to be staring at screens all the time.

Here are some tips to learn how to “live in the moment”.

• Create a dedicated “time out” from electronic devices each day.  I recommend putting the phone away when you are eating and at least one hour before bedtime.  Why?  Distracted eating can cause you to overeat.  Think about the last time you went to the movies and how much popcorn or candy you ate.  Looking at the news (especially nowadays!) and social media before bedtime can also lead to disrupted sleep.  Oftentimes when we sleep, we replay events or thoughts in our mind particularly things that occupied our minds just before falling asleep.
• Remove or hide “addictive” apps from the phone/tablet.  Games and shopping are great distractions and are not all bad.  They can sometimes give your mind a mini “mental coffee break”.  However, if you are finding they are taking up too much of your time, they can negatively impact your health.  That 20 minutes playing a “Candy” game could be better spent getting some fresh air outdoors or calling a friend you haven’t spoken to in a long time.
• Talk to people.  It’s amazing how little we talk to people even with our closest friends.  We text, instant message, snapchat, tweet, but we don’t talk to real people in real time as much as we should.  Pick up the phone and call someone today.
• Practice mindful eating or any other activity.  We need to experience things more completely.  Try this little experiment.  The next time you start to eat something, take one small bite of the food and close your eyes.  Take 2 full minutes to eat that piece of food.  Allow your taste buds and your mouth to fully sense the full texture, taste, and even sound produced.  You would be surprised how wildly complex and exciting one bite of food can be, but we don’t often realize it because we are eating too quickly and eating with distractions.  This often leads to overeating.  You can adapt this to any life experience.  I love to do this when I’m enjoying a beautiful sunset.
• Try an “Electronic Device Fast”.  Just like people stop eating food for certain religious holidays, I recommend a period of time where we live as we did 15 years ago.  Put away your tablets and/or phones for just one day or two.  Right now, most of us continue to check our electronic devices even while on vacation!  I am just as guilty of this myself.  However, on a recent trip to Cuba, where internet access is difficult, I was forced to disconnect for 3 days and it felt great.  When you first try the “fast”, you will notice that smartphones are like drugs, you will notice a sense of withdrawal.  However, after a while you will be much more mindful and focused on “real life” experiences rather than “screen” life.
• Meditate.  I can’t overemphasize how meditation is the best solution to counter the negative effects of information overload.  I think meditation is like the “reset” button for our brains, similar to pushing and holding the power button on the smartphone when you’ve opened too many apps and the phone freezes.

Per my gastroenterologist friends, “you can tell a lot about a person’s health by how they poop”.  I couldn’t agree more, but I often find patients are reluctant to discuss their bathroom habits or even to bring up issues such as hemorrhoids (enlarged veins in the anal area that often bleed or cause itching).  Our bowel movements are dictated by many different factors:  how much fiber we eat, how much water we drink, how much we exercise, and how long we sit on the toilet.  Here are some tips on how to improve your visits to the bathroom.

• Eat fiber and lots of it!  Fiber acts like a scrubber and removes cholesterol along your intestinal walls and pushes food forward.  It also causes the stool to clump up and come out in one piece.  Your bowel movement should look like a banana-  tapered at the front and back.  I recommend shooting for a goal of 25-35 grams per day.  Here is how to get there.
• Take probiotics found in foods.  Billions of bacteria live in our colon.  They serve to help us digest properly.  Yes, they sometimes do contribute to embarrassing gas, but overall they are the “good guys” and keep us healthy.
• Drink water.  Hard stools which lead to constipation, are often caused by inadequate hydration.
• Do not sit more than 2 minutes on the toilet.  There should be no email writing, reading of magazines, newspapers, or even novels on the toilet.  You should be practically running to the toilet to have a bowel movement.  If you sit for more than 2 minutes and nothing is happening, go do something.  Drink some water, or exercise to get your bowels moving.  Don’t worry, you WILL move your bowels at some point.
• Try a new way of sitting on the toilet.  A new product called Squatty Potty (which debuted on the TV show, Shark Tank) has been shown to improve hemorrhoids, straining, and reduce time on the toilet.  I have one and I absolutely swear by it!
• Exercise.  Yes, yet another reason to exercise.  Each time your body bounces up and down on a treadmill, exercise bike, or jumping rope your intestines also move food along.  Ultimately, this leads to the need to eliminate.
• Avoid or reduce medications which can cause constipation.  Narcotics (such as oxycodone, Percocet, codeine), antihistamines, and even calcium supplements or TUMS are well known culprits for causing constipation.  If you do take one of these, you may even want to take a laxative or increase your dietary fiber to avoid the resulting constipation which can sometimes be severe enough to require hospitalization!
• Keep track of your bowel movements.  We should all ideally be going to the toilet at least once every day or every two days.  If it gets more than that or your habits change suddenly, it may be time to check in with your primary care provider.  Colon cancer can manifest with sudden constipation.

I recently changed my exercise routine from five days a week to seven days a week.  Why the change?  I had a realization that doing things intermittently have a higher chance of failure (not likely to complete the full course) than every day.

How did I reach this epiphany?  I learned it by observing patients in my practice.  Typhoid is a an illness that is often acquired when traveling to underdeveloped countries and eating food or water contaminated with sewage.  There are two types of Typhoid vaccine which are recommended for travelers.  One is an inactivated vaccine in a injection “shot” form that is a one time deal and provides two years protection.  The other way to get immunity is to take a series of four capsules separated by 1 day in between.  So a person would swallow a capsule on day one, skip day two, take a capsule on day the, skip day four, etc.  I generally prefer the capsules since they provide five years of immunity and most people would prefer one less needle in the arm anyways!  Over the years, I have seen many people, including myself, mix up this routine with pills missing, misplaced, or just forgetting to take them on time. Why does such a simple task have a high failure rate?

It’s extremely difficult to keep on a schedule when it has an intermittent nature.  Imagine you have an exercise schedule or goal to go to the gym five times per week.  Your best friend calls and says she wants to go the movies since a great movie just opened, but that movie just happens to play when you were going to workout at the gym.  Wouldn’t it be easy to think you could move that workout to the Saturday?  But will you follow through when the weekend comes?  Possibly, but the chances are much less likely.

As I’ve said in my blog before, our bodies crave routine.  It does not like shifting bedtimes, eating habits, and alcohol habits.  Jet lag is one such example of how changing our lives too much can result in poor mental functioning.  Another example is being “Hangry”, which is a nickname for that short-tempered feeling when one is extremely hungry.

So what have I done with exercise?  I have been doing it daily for at least thirty minutes.  Sure, I may not always have time for a full gym workout, simple exercises such as the Seven Minute Workout could be just as good (if you have the luxury of more than seven minutes, you can do it twice or three times).  If I have more time on certain days, then I can indulge in a longer workout.  I consider even short intermittent bursts of exercise to be “placeholders” so at least I am consistent with my routine.  Be creative, even the stairs in your apartment building can be your personal “stair master”.  The most important thing is that you incorporate exercise into your life.  Need more convincing?  Read this blog.

I love going to the movies.  They can be a great way to escape reality for two or more hours, but I love movies where the main subject is about illness, disease or health and wellness.  There are plenty of movies in this genre.  Here is a list of some of my favorites that I recommend.  Not only are they very entertaining, they can help you understand certain illnesses from a more personal perspective and the impact these illnesses can have on the lives of individuals and the people around them.  The next time its rainy or snowy outside, saddle up to your couch and watch one of them!

1. A Beautiful Mind– A moving story based on mathematician, John Nash, and his struggle with schizophrenia.  This was one of the best depictions of schizophrenia I have ever seen.  You really understand how the illness creates an altered perception of reality.
2. Inside Out– Extremely well done children’s movie about depression that is a great metaphor for how the brain’s neurotransmitters control our emotions and feelings, which sometimes don’t gel with our environment.
3. Iris– Very touching story about Alzheimer’s disease from its early beginning and its impact on the caregiver.
4. Supersize Me– Think that hamburger and fries are not affecting your mood and liver function?  Think again!  This was an amazing experiment which nearly cost the writer his life.
5. Sicko– There is no doubt the US healthcare system is on life support.  Many of the policies do not make sense and the cost of healthcare is skyrocketing.
6. Awakenings– This movie is based on a true story of a rare form of Parkinson’s disease and a doctor who finds a way to cure his patients.
7. The Doctor– A must-see for anyone in the healthcare profession or currently in school.  A surgeon learns about compassion when he becomes the patient.
8. Dying Young– Depicts a battle with leukemia and drug addiction and the toll they take on a relationship.
9. Forks Over Knives– Want to eat healthier?  This will convince you that eating right can reverse many diseases such as diabetes and high blood pressure.
10. Outbreak– I love suspenseful thrillers!  This one is a fictional account of how a single disease can spread rapidly given our current age of extensive air travel.
11. Silver Linings Playbook– Bipolar disorder is depicted realistically, and breaks the stereotype that the disease is just about “mood swings”.
12. The Normal Heart– Very touching movie about the AIDS epidemic and how one group faced discrimination but through unity and civil disobedience were able to help millions.
13. Flight– Depicts an airline pilot and his personal struggle with alcoholism.
14. Steel Magnolias– Though not central to the story, a very realistic depiction of diabetes and it’s effect on the body.

When I see a person, I see not just one living organism but one giant ecosystem composed of billions of different species most of the time co-existing together, but sometimes an “evil” one takes over and wreaks havoc.  Doesn’t this sound like science fiction rather than medicine?  More and more we are learning the bacteria in our intestines, skin, stomach and even arachnids (mites which are relatives to spiders) that live in our eyebrows can influence our health.

Not surprisingly, the pharmaceutical industry is creating and selling an increasing number of products that are meant to restore or maintain the populations of beneficial bacteria in our body.  Scientists are not completely sure if this is the correct approach and the topic is debated hotly at conferences.  On one hand, many people who suffer from IBS (irritable bowel syndrome) have noticed dramatic improvement with taking probiotics.  However, many of the bacteria found in commercial probiotics are not actually common in humans.  Acidophilus is one of the most common species of bacteria in probiotics, but it is more ubiquitous in yogurt not the human colon.  So should we be populating our bodies with yogurt making bacteria?  Perhaps, if this bacteria prevents “evil” bacteria such as C. dificile (which is notorious for causing a life-threatening diarrheal disease after any antibiotic use), I could see the probiotic as being beneficial.  Ultimately, we don’t have a real answer.

Interestingly enough, if you look at foods around the world almost every single culture has a “probiotic” food.  I believe this is no simple coincidence.  When people eat foods that make them feel better, or anecdotally prevent or cure illness the knowledge gets passed along.  Ultimately, this knowledge becomes tradition.  Here are some probiotic foods from around the world.  I recommend eating them regularly, as they are also usually quite delicious!

• Greek Yogurt (Greece and Middle East)- great source of calcium and full of lactobacillus/acidophilus
• Kefir (Middle East)- a yogurt drink made from cow milk and grains, similar in probiotic profile to yogurt
• Miso Soup/Paste (Japan)- fermented soy beans create this umami-rich paste that is commonly made into a soup
• Sauerkraut (Germany)- fermented cabbage, great source of fiber as well
• Kim Chi (Korea)- spicy, preserved bok choy which can also inhibit growth of bad bacteria
• Dark Chocolate (South America)- while this may not actually contain bacteria, the good bacteria in our intestines thrive on dark chocolate and multiply faster.
• Kombucha (Japan)- this fermented tea is filled with Saccharomyces bacteria
• Gochujang (Korea)- a spicy condiment made from fermented chilis, rice and soybeans
• Natto (Japan)- fermented strongly flavored sticky soybeans, a very acquired taste!
• Cheese (Europe)- some cheeses are more probiotic than others, typically the more pungent ones such as gouda, parmesan, and blue cheese contain more beneficial bacteria.
• Fruit Chutney (India)- a staple condiment with most Indian dishes, chutneys add a touch of sweetness to your meal and many bacteria to your gut.
• Harissa (Africa)- a seasoning paste of mildly fermented chilis.
• Tempeh (Indonesia)- fermented soy product that is often used in place of meat, sometimes called “mock meat”, also rich in protein and fiber.
• Pickles (Europe/USA/Asia)- this picnic favorite should be a regular addition to your diet.  It has no fat, no carbs, can be stored for a long time in the fridge and tastes great.
• Sourdough Bread (USA)- the “yeasty” flavor is a sign that it contains plenty of healthy bacteria.
• Dosa (India)- a giant crepe-like pancake made from fermented rice and lentils often served with savory ingredients.
• Pickled Herring/Fish (Scandinavia)- an easy way to get protein, probiotics, healthy fish oils and vitamin D!
• Lassi (India)- a fermented dairy drink often incorporated into fruit shakes (e.g. mango lassi).
• Poi (Polynesia)- a purple root vegetable that is often pounded into a paste and allowed to ferment before eating
• Fish Sauce/Nuoc Mam (Asia)- made from fermented anchovies, adds a very distinct pungent flavor to any dish.