Eating out at a restaurant can be a fun activity.  Trying new foods, meeting with friends, and a sense of freedom from not having to cook and clean are all part of the experience.  However, eating out can mean trouble if you are trying to lose weight or maintain a low cholesterol level as I have discussed in my previous blogpost.  Here are some tips you can consider trying at your next outing.

• Order an additional appetizer instead of an entree.  Many restaurants make sizable appetizers that are filling enough.  If you think you may be hungry, order a vegetable side with that appetizer.
• If you are having dinner with others, consider eating “family style”.  Order one less entree than people in your party.  Again, most portions are very generous at restaurants and I can almost guarantee that you will feel full.
• Create multiple small courses.  In the Mediterranean region, people eat small portions of food but with many courses.  When you spread the meal out like that, you actually feel full gradually, rather than suddenly feeling too full.  The stomach was not meant to become stuffed within a few minutes.  Indigestion, esophageal reflux (GERD) and gastritis (inflammation of the stomach) can all become worsened by eating too quickly.
• Order less food than you think will make you full. If you need more food, you can always order a side of vegetables.  Over-ordering almost always results in over-eating.  We have been taught to “finish what’s on our plates”.  If you are dining in a new place and the portions are much larger than you normally would eat, ask the waiter to wrap up half your meal, BEFORE you start eating.  It’s always much more difficult to stop eating after you’ve started.
• Skip the bread basket.  Ask the waiter to take back the bread basket and butter.  These are excess carbs and fat that can increase the calories of your meal.
• Always order a vegetable or salad as an appetizer.
• Drink plenty of water.  Water helps with digestion and helps to fill your stomach.
• Ask for dressings and sauces to be placed on the side.  This allows you to control how much you add to your food.
• Bring a friend and talk to him/her throughout dinner.  Having conversations slows down the speed of your eating and increases your enjoyment.

During the annual physical exam, I typically ask my patients to categorize themselves as:  Underweight, Normal Weight, Overweight, or Obese.  Then I calculate their Body Mass Index (BMI) with an online calculator.  Usually, I get a look of shock or dismay when I tell people that they are overweight when they think they are normal weight.  Next, I recalculate their BMI with their guess as to what they think their weight should be.  Often, this is also above the normal weight for height.  Eventually, we come to a weight that when entered into the calculator is normal.  Then I usually hear another sigh, and a pause, followed by the statement “If I weighed that much, I would look sick and unhealthy!”

The BMI has not changed over the years, however our perception of what is “normal weight” has changed because many of us as a whole have gotten larger.  Imagine you are average height and you take a picture next to an NBA basketball team.  You would certainly feel short.  In this same way, if you are around people who are obese or overweight, you may not perceive yourself to be any different, or may even think of yourself as being thin.  The next time you are “people-watching” look at each family.  Obese parents will often have obese children.  Another good example is the sizes of clothes.  Over time, clothing manufacturers have had to increase the size of clothes to the point where a “Medium” today would be what was considered “Large” or “Extra Large” a few decades ago.  So when you think you have been a “Medium” for the past 20 years, you have actually been fooled.  Anyone who has travelled outside of the US and tried to buy clothes in Europe or South America will understand this.  In women’s clothing, they have had to make dresses in size “00” just to make sizes change with the times.  In New York City, there are subway car seats where very few people can fit in them comfortably today.  This is because the subway seats were designed in the 70’s when most people were smaller than they are today.

Portions of food are another way to see the change in caloric intake over time.  I recently purchased an antique dinner plate.  It was 9 inches in diameter.  These days, the average dinner plate start at 13 inches or more.  Portion sizes of all foods have increased and we are eating way too many calories.  It is not surprising that our waistlines are increasing as a result!

The BMI is as standard for good health.  Being in the overweight or obese categories increase risk of heart disease, diabetes, high blood pressure, and even depression!  Know your BMI and your goal weight.  Work on it!

• How much alcohol can I drink safely? My recommendation would be no more than 2 drinks for men and no more than 1 drink for women in 24 hours.  [1 drink = 1/2 oz or 15 mL ethanol (e.g., 12 oz beer, 5 oz wine, 1.5 oz 80-proof whiskey)]  Any more than this amount and your blood pressure could actually become elevated.  If you plan on driving a car, have a history of gastrointestinal bleeding, or taking medications that affect the liver (including over-the-counter medications such as tylenol/acetaminophen), I would not recommend any alcohol intake.
• How many calories are in alcohol?  This varies, but most beers have about 180-200 per bottle.  To put that into perspective, one can of soda has about 150 calories.  The next time you look at a bottle of beer, think of it as a can of soda.  Would you be drinking 3 or more cans of soda if you were trying to lose weight?  Though alcoholic beverages don’t taste sweet, they contain carbs and sugars.  Wine is made from fermented grape juice, which is high in sugars.   Alcohol can hurt your diet in other ways.  Read more at my blogpost on the subject.
• Can alcohol cause cancer?  Certain cancers have been linked to excessive alcohol intake including esophageal cancer, gastric (stomach) cancer, pancreatic cancer, and liver cancer.  Asians have a higher risk of esophageal cancer, especially those who develop flushing of the skin after imbibing alcoholic beverages.  Here is an NBC News story about this phenomena and it’s associated cancer risk.  If your skin turn red after drinking even modest amounts of alcohol, you may want to limit your alcohol intake.
• What are the health benefits of alcohol?  In small amounts (generally <2 drinks in 24 hours), alcohol can lower systolic blood pressure (the top number) by 2 to 4 mm of mercury.  This is a very small drop but shows there is some benefit.  However, more does not mean better.  Further drinking beyond that will actually cause your blood pressure to increase above your baseline.  Anyone who has had a stressful day and unwinds with a glass of wine knows there are some anti-anxiety properties to alcohol.  Red wine has been shown to raise HDL (“good”) cholesterol and is a part of the heart-healthy Mediterranean Diet.
• Can alcohol cause other health problems?  Alcohol impairs absorption of certain vitamins and can actually cause deficiencies.  This includes Vitamin B (B1 and B12), Vitamin A, Folate, Calcium, and Potassium.  These are needed by the body for proper nerve functioning and muscle contractions.  It is important if you drink any amount of alcohol to make sure you are having a balanced diet rich in these vitamins and minerals.  Alternatively, you can take a multivitamin which contains all of these.  Dehydration is also something to watch for.  Alcohol is a diuretic, meaning it will cause you to urinate more.  Make sure you drink one or more non-alcoholic drink such as water for every glass of wine, beer or liquor.  Drinking alcoholic beverages is one of the main causes of car accidents, accidental falls, and violence.  Alcohol abuse is associated with a whole set of medical issues.  To determine whether you have a problem with alcohol, you can ask yourself the CAGE questions (answering “yes” to two or more questions may indicate that you need to seek a medical professional.     (Have you ever felt you needed to Cut down on your drinking?  Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about drinking? Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?)

Here are 10 items that help you get through illness, cold, or muscle injury.

• Sinus Rinse–  This is a must-have for allergy sufferers.  It removes pollen and dust accumulating in your nasal passages and sinuses.  In my office, we also use it for people who have sinus congestion due to viruses.  Please make sure you use distilled or pre-boiled water that you allow to cool down.  My favorite brand is NeilMed
• Saline Nasal Spray– When you don’t have time to do a full sinus rinse, spray one or two times in your nostrils and you will feel a difference.  It also helps when the room air is very dry.  NeilMed also makes this product.
• ACE Bandage– For muscle aches and joint pains, be sure to wrap the area with an ACE bandage to control swelling and to add support.  Sprained ankles, and   tendinitis can get worsen if the joints continue to be unstable.
• Topical Analgesic (aka Bengay, Biofreeze gel, Aspercream,Tiger Balm etc.)  Got a muscle injury?  These act the fastest to control pain.  Massage into the area deeply and remember to wash your hands thoroughly afterwards as it can seriously irritate your eyes if you rub your eyes.
• Epsom Salts–  Great for adding to your bath when you have muscle pain, soreness after a workout, or body aches when you have a flu.  Also good for soaking your feet after a long day.
• Hydrocortisone cream– For all sorts of insect bites, hydrocortisone cream is the best for itching.  For best results, apply immediately after being bitten.
• Saline eye drops (Natural Tears)- Whether you wear contacts or not, we all experience dry or irritated eyes at some point.  Never use pure water or tap water as these can actually cause more irritation because of the chlorine in the water.  Use these drops instead.  They are also good for rinsing out pollen from your eyes.  At the first sign that your eye is turning red, immediately use saline eye drops to flush the eye out.  It may actually prevent you from progressing to full pink eye or red eye.
• Pepto Bismol– For the occasional diarrhea/indigestion.  This should be your go-to medication for most gastrointestinal issues. *Note:  You cannot use this if you have an Aspirin allergy, as it contains salicylates
• Saline Wound Wash– For years, people used betadine, iodine solution, hydrogen peroxide, and even alcohol to clean wounds.  Studies have shown that these can actually delay wound healing and don’t really prevent infection.  If you get a cut or scrape, use the wound wash immediately followed by bacitracin or neosporin ointment.
• Tweezers– Great for removing splinters and ticks from your body

Is your pillow as flat as a pancake or more than 2 years old?  Are you waking up with neck pain?  The human head weighs about 10 pounds, approximately the weight of a bowling ball.  Your pillow is mainly responsible for supporting this weight while you sleep for approximately 7-8 hours per night.  Over time, the fibers or feathers in your pillow become compressed and unable to maintain their structure.  When your pillow is unable to do its job, the weight of your head is supported by your neck and upper spine.  As a result, you may wake up with neck stiffness or upper back pain.  It is crucial to recognize this and change your pillow regularly.  I change my pillows once a year.  You should also invest in a good quality pillow.  It may save you from having a “pain in the neck”!

If you suffer from allergies, make sure you do not have feathers in your pillow and you change your pillow regularly.  Dust mites are present everywhere and over time they secrete feces that accumulate in your pillow.  Many people with allergies are allergic to this material.  If you are waking up with crusted eyes or nasal congestion, getting a new pillow made of synthetic fiber could be your solution.  They also sell dust mite covers for your pillows to prevent the dust mite feces from escaping your pillow.  Be sure to wash these covers and your sheets weekly.

While you’re doing your spring cleaning this weekend, take a look at your pillow.  It may be time for a new pillow!