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  Many people have very outdated ideas of what is healthy and unhealthy.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!

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!

Recently, urgent care centers have been opening up in many cities across the US.  These are conveniently located health centers meant to address minor health issues, usually of an acute nature.  They are usually staff by trained emergency medicine physicians and staff and provide an excellent alternative to the often-packed and chaotic emergency rooms.  An urgent care center can do things like minor stitching of wounds, X-rays to check for fractures, treating sprains, and rapid flu/strep tests.  They should not be used to address issues such as heart attacks, strokes, appendicitis, or severe infections; these may possibly require invasive testing or hospitalization.  In general, if you have multiple medical issues such as diabetes, hypertension, heart disease, or cancer, an ER may be a better option as these issues may worsen with any acute medical issue.

If you can see your primary care provider during his/her office hours that would be the most ideal and most cost effective.  It is often helpful to let the front desk staff at your primary care office know the reason why you need an urgent appointment.  Most offices will set aside a few appointments each day for these issues.  Urgent care centers are great for after hour medical issues, but they often charge more than a primary care visit.  Do not use the urgent care center as your primary care center.  Many urgent care centers have different providers on shifts and you may see someone different each time.  True primary care providers are ones you see consistently and know your history.

If you do visit an urgent care, make sure you obtain a visit summary for what was done.  This way, when you see your primary care provider at a later day, you can give them this summary so they know what the diagnosis and treatment given.  You always want your healthcare team to be fully updated.

Fall and winter months are typically cold and dry months.  The air in our homes usually gets very dry during these times.  As a result, our skin loses a lot of moisture causing itchy skin, dandruff, worsening eczema (a skin condition that is related to allergies), dry noses, sore throats and chapped lips.

Here are some great ways to increase the humidity of your home so you can feel better:

• Grow indoor houseplants.  Plants release oxygen and moisture into the air.  They can also purify your home environment of toxins.  If you don’t have a green thumb, even having a “lucky bamboo” plant sitting in a vase with water can be helpful.  These just require you to remember to fill the vase with water every few weeks and do not require much sunlight.
• Fill a stainless steel bowl or cookie sheet with water and place it on top of a radiator.  The heat from the radiator will evaporate the water.  Be sure to change to water in the bowl every day to avoid mold growth.  Also, make sure it is out of reach or any children.
• Purchase a humidifier.  I recommend avoiding the humidifiers with the “blue plastic tanks” because they are difficult to clean and can be a breeding ground for mold.  The humidifier can then disperse the mold spores into your home and cause terrible allergies, nasal congestion, and even fungal pneumonias!  I highly recommend a humidifier with an easily cleanable tank which is called the Venta humidifier.
• Turn on your shower.  If you don’t pay for hot water, this is a great way to humidify your home quickly and cheaply.   Turn your shower on with warm water and leave the door open to the bathroom for about 20-30 minutes.  You can even put a fan at the doorway to your bathroom blowing the steam out into the rest of the apartment/house.
• Take a bath and leave the bath water in the tub afterwards.  If your home is warm and dry, the evaporation will increase.
• Avoid turning up the heat too much in your home.  Sure, 80 degrees feels great but forced heat is dry air.  Keep it in the low 70 degrees Fahrenheit and your skin will remain more moist.
• Open the windows on days when it is humid outside to let in moisture.  Check your local forecast and see if the humidity outside is high.  Generally morning hours are the most humid and mid afternoon are the least humid times of day.

Currently, our healthcare system is under stress.  Health care providers are seeing many patients and they may not have the luxury to spend as much time with them as they would like to.  This means you need to make sure you make the most of your appointment.  You need to cooperate with your healthcare provider and work as a team.  I have seen some rude and maladaptive behavior from patients who may not realize they are hindering their healthcare provider with their actions.  Here are some tips based on actual patient encounters.

• Turn the cell phone off.  You may use the cell phone for apps while you are waiting, but do not use or look at the phone while your healthcare provider is talking to you.  Not only is this rude, but you force the healthcare provider to repeat her/himself unnecessarily because you were distracted.
• Place less emphasis on self-diagnoses that you found the internet and more on what your provider says.  Many health websites are not written or verified by experts.  You may discuss what you have found with your physician, but don’t be offended if they do not think that is what you have.  Many conditions can present with the same symptoms.  Your healthcare provider is trained to do a full assessment specifically with you in mind.
• Don’t play “Stump the Doctor”.  I’ve had some patients who have withheld information hoping for the doctor to come to the same diagnosis they found on a website where they put in their symptoms.  Every piece of information is important when it comes to diagnosing diseases.  You should be open and honest with your provider.  You may think that your trip to Brazil last month isn’t an important piece of information, but it can be a very valuable clue to the right diagnosis.
• Write down a list of questions before your see your provider.
• Take notes so that you won’t forget any important information or instructions.  I always recommend bring a pad and paper.
• Bring all your current prescribed medications in their original bottles.  Many pills look the same and most physicians are not trained to know what each pill looks like.  Saying, “I take a small white pill for blood pressure” does not help to identify the medication.
• Write down your home blood pressure (if you have hypertension) or blood sugar (if you are diabetic) readings
• Ask about what signs/symptoms to watch for and what to do if your condition worsens.
• Ask for copies of test results, X-rays, and blood pressure readings for your own records.  We should all be keeping records of our health.
• Before you leave the exam room, let the provider know that you want to summarize the visit and to ask them to comment if everything was summarized correctly.  For example, “I came in today with a runny nose, it is likely due to seasonal allergies to pollen, I’m going to start taking anthistamines and buy an air purifier for my home and keep the windows closed.  If it doesn’t improve in one month, I am going to follow up with an allergist.  Is that all correct, doc?”