TAKE PREDIABETES SERIOUSLY!

This blog entry will discuss one of the most prevalent but misunderstood conditions in medicine – prediabetes. A diagnosis of prediabetes means that your blood sugar is elevated but not high enough yet to be diagnosed with type 2 diabetes. It is estimated that one in every 3 adults has prediabetes and that the vast majority of them, 84 percent by one estimate, do not know that they have it. Persons with prediabetes are at significantly increased risk of developing full blown type 2 diabetes, heart disease and stroke.

Over the years I have seen many patients in my practice who have been told that that their blood sugar is a “little high” or “borderline.” What they likely have is prediabetes. Prediabetes is not just diabetes lite, it is a serious health condition in itself. Normally the pancreas produces insulin which causes the cells in the body to take in sugar from the blood to be used as energy. Persons with prediabetes have become insulin resistant. This means that the cells in the body do not respond normally to insulin which causes the body to make more and more insulin trying to get the cells to respond. This chronically high level of insulin that does not work properly is at the core of the problem. While this excess insulin no longer works properly to lower blood sugar it is very efficient at storing body fat. This is why persons with prediabetes tend to hold on to belly fat and have trouble losing weight!

Before the blood glucose is high enough for a diagnosis of diabetes, a person may have prediabetes for years because there are no reliable symptoms. If a treatment plan is not instituted, up to 30 percent of them will progress to type 2 diabetes within 5 years. Complications of diabetes are numerous and include heart disease, kidney damage, nerve damage and impairment of vision. Fortunately, if a diagnosis of prediabetes is made early it can often be completely reversed such that the person might never develop diabetes.

Risk Factors for Prediabetes

It is important to know if you are at risk for prediabetes so that you can discuss being tested for it by your primary care provider. It should be noted that African Americans, Latino Americans and American Indians and Pacific Islanders are at greater risk for developing prediabetes. If you have any of the following risk factors, you should be tested for prediabetes.

1. Being overweight or obese

2. Being age 45 or older

3. Having a parent or sibling with type 2 diabetes

4. Exercising fewer than 3 times a week

5. Having a history of gestational diabetes or of delivering a baby over 9 pounds

6. Having a history of polycystic ovary syndrome

One simple test that does not requite an overnight fast is the hemoglobin A1C. This test tells what the blood glucose level has been averaging over the last 3 months. An A1C level below 5.7% is considered normal. An A1C level between 5.7% and 6.4% is considered prediabetes. An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes. Once a diagnosis of prediabetes is made, it is usually within your power to return your blood sugar and A1C values to normal with a few very simple lifestyle changes.

How to Reverse Prediabetes

1. Eat a healthy diet! Remember that it is the sugars, simple starches and processed “junk” foods that keep the insulin levels high and lead to fat storage. Work with a nutritionist to learn which foods are likely to spike blood glucose and insulin the most so that those foods can be avoided. The optimal carbohydrate intake will vary from person to person but should certainly be significantly lower when trying to reverse prediabetes. The American DiabetesAssociation (ADA) recommends the “diabetes plate method” where one half if a 9 inch plate is filled with non-starchy vegetables, one fourth is protein and one fourth is complex carbohydrates. Complex carbohydrates like whole grains and beans have less impact on blood sugar than simple carbohydrates because digestion is slowed down by the fiber content. Using this simple method for most meals is a good place to start and does not require any tedious counting of calories or carbohydrates.

2. Losing weight. If you are overweight, losing as little as 5-10 percent of your current weight can improve your blood sugar levels. The weight loss should come naturally as you implement the above mentioned diet lower in simple carbs and processed foods.

3. Exercise regularly to reduce insulin resistance, increase your energy level and improve your mental health. The goal is 30 to 60 minutes of moderate activity at least 5 days a week. Regular exercise is also a great stress reliever. Walking, jogging, dancing, biking, swimming, exercise classes or videos are just a few examples of moderate exercise.

4. Quit smoking. Smoking is a risk factor not only for heart disease and lung disease but for insulin resistance, prediabetes and type 2 diabetes. Smoking has no place in a healthy lifestyle.

5. Drink plenty of water as a healthy alternative to sugary sodas, juices and energy drinks. How much you should drink depends on your size, activity level and climate. The color of your urine will tell you if you are drinking enough water. If your urine is dark yellow rather than pale yellow, you are likely not drinking enough.

6. Limit or avoid alcoholic beverages. Not only is alcohol a source of empty calories but it lowers your inhibitions making you less likely to make healthy choices with your meals.

In some cases, prediabetes is so far advanced that the lifestyle changes we have discussed may not be enough. If you have made those changes and continue to have abnormally high blood glucoses, your primary care provider may suggest medications to lower your blood glucose as an adjunct to your lifestyle changes.

On a personal note, my own diagnosis of prediabetes in my early 60’s turned out to be a blessing in disguise for me. I had nearly every risk factor on the list. However, once I made the lifestyle changes I have shared with you, my glucoses and A1C levels returned to and remained normal without medication. It is my prayer that if you you have been diagnosed with prediabetes, you too will be able to make the changes that will reverse the condition.

Be Blessed,

Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)

Confessions of a Mindless Eater

When I first started writing this blog 3 years ago, I was on a quest to finally solve the mystery of why I have been a yo-yo dieter for my entire adult life and how to get off that merry-go-round once and for all. I had also developed some medical issues that needed to be addressed. In the ensuing months I have learned a lot about myself and what it takes to get and stay healthy and I have tried to pass along some of what I have learned to you so that perhaps you might benefit not only from my successes but from my mistakes as well.

Because I am fighting personal battles with prediabetes and hypertension, the combination of 16:8 intermittent fasting and a low carb way of eating along with DAILY moderate exercise have gotten me healthier at 67 than I was at 40. My current lifestyle is what I call my “secret sauce” that has finally gotten me off the dieting merry-go-round. Regardless of what lifestyle choice gets us to our healthiest selves (it will be different for each of us) there is still one area of behavior that can derail all of our efforts to stay healthy. In a previous entry, I discussed emotional eating specifically but it turns out that it is only one of the many types of behaviors known as mindless eating. I am slowly coming to grips with the reality that I am now and have always have been a mindless eater.

I make this confession because it is an ongoing struggle for me and I know that it is a problem that many of us have without even knowing it. Recently I have been studying the concept of mindfulness as it applies to all areas of our lives. To be mindful is to be fully present and engaged in the moment without dwelling on the past or the future. Even the bible instructs us not to worry about tomorrow for it will take care of itself. Mindfulness is about focus and concentration without distractions. The opposite of mindfulness is mindlessness. We all have moments of mindlessness. Have you ever been reading a book or an article and had to go back and reread a section because you didn’t know what you just read? Your eyes may have been scanning the page but your mind was somewhere else. In a similar way, when we don’t give our eating our full attention in the moment, we are eating mindlessly and likely to eat beyond what we truly need to eat to stay healthy.

Here are just a few examples of mindless eating::

  • Eating anytime you are not “stomach growling'” hungry or continuing to eat beyond fullness
  • Standing at the refrigerator or pantry nibbling on whatever is there
  • Eating directly from a large container of food
  • Eating while watching tv, scrolling social media, reading, or working – this can lead to overeating
  • Eating popcorn at the movies or a hotdog at a sporting event out of habit – I call this recreational eating.
  • Eating because someone left treats in the break room at work
  • Eating because you are sad, angry, lonely, frustrated or tired or because you are happy or celebrating – also known as emotional eating
  • Eating in your car
  • Eating to satisfy a craving for a specific food even if you are not hungry
    The list goes on and on!

When I realized I have done all of these for as long as I can remember, a lightbulb went off in my head. Growing up I was a “latchkey kid.” That means that from the age of 10 through high school, I was home alone between 4 and 11 pm every day. I was not allowed to have company so my friends were the television and food. I ate dinner alone in front of the tv every weekday!! No wonder I became an obese teenager. Studies have shown that eating in front of the tv, or distracted eating, impairs our ability to recognize when we are full and leads to chronic overeating! Even if you are eating healthy foods, the tendency is still to overeat!

There are multiple strategies you can try to help curb mindless eating. It is a learned behavior and with a little effort can be unlearned. Here are a few tips to get you started.

Think before you eat. Ask yourself if the reason you are about to eat is for any other reason than stomach growling physical hunger. If it is, find other ways to address those reasons without food. Remember that physical hunger is the God given mechanism to let us know when to eat, learn to listen to it. You don’t go to the restroom just because you happen to pass one if your bladder isn’t full so don’t pop a cookie into your mouth just because you see it.

Do not eat a meal or a snack unless you are sitting down with a plate or bowl instead of eating from packages. The mere inconvenience of having to put the food on a plate might deter unnecessary eating. Avoid eating in your car or standing up.

Serve yourself adequate but not large portions of foods that nourish your good health. Try to keep sugary treats and highly processed foods to a minimum and EAT REAL FOOD! If you are eating out, recognize that most restaurants serve portions that are larger than what one person should be eating at a meal. Either share your meal or ask for a carry out container at the start of the meal and put half of the meal in it for the next time you are truly hungry.

Give your food your full attention by eating without multitasking with the tv, a book, a computer or phone. If you must eat alone use mealtime as a quiet time for reflection and gratitude. Take the time to appreciate the taste, aroma and texture of your food. If you do not like eating in silence, try playing some low volume soft jazz or instrumental gospel music in the background. It can make mealtime a very relaxing experience and a great way to de-stress.

Eat slowly and stop when you are comfortably full. It takes a full 20 minutes for your brain to realize your stomach is full. Pause between bites and sip water to slow you down. If you eat too fast you are more likely to overeat.

If you can think of other tips, feel free to add them in the comments. In the interest of full disclosure, while I have been researching this blog I have spent the last two weeks using myself as a test case to try to break my lifelong habit of distracted eating. I have eaten all my food sitting down at a desk or table from or plate or bowl without watching tv, reading or looking at my phone. I have to admit that distracted eating has been one of the hardest habits I have ever tried to break! I challenge you to try it for a week. It really takes effort! It is said that it takes 21 days to develop a habit, so after another week I should have an additional reliable tool in my toolbox to help me become a healthier me.

Be Blessed,
Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit. 3 John 1:2 (NLT)

IS INTERMITTENT FASTING RIGHT FOR YOU?

The health and fitness industry has been all abuzz in recent years about intermittent fasting (IF) or time restricted eating as if it is something new. Fasting simply means going for a period of time without eating. Many of the religions of the world have been using periods of fasting as a spiritual practice for centuries. There really is nothing new under the sun. All of us fast every day while we are sleeping. The only thing that makes today’s concept of fasting different is that research has now proven that extended periods of fasting can have a number of health benefits.

For the purpose of this blog entry, I will be giving you a basic introduction to the concept of time restricted eating of 24 hours or less without food based on the research as well as my personal experience. I will not be discussing the more extended fasting regimens that might go on for several days or even weeks. These extended fasts are best done under the supervision of a medical professional.

HOW INTERMITTENT FASTING PROMOTES GOOD HEALTH

Our bodies are always in either one state or the other, we are either in the fasted state or the fed state. During the fasted state our bodies are resting and repairing themselves. One of the most important aspects of the fasted state is the reduction in the hormone insulin which you will recall from previous blogs entries is known as the fat storage hormone. Any time you can lower your insulin levels for prolonged periods of time you are less likely to increase your body fat. In addition, fasting can reverse insulin resistance which has been linked to the development of obesity and Type 2 Diabetes. When the body no longer has food for fuel it turns to the glycogen stored in the liver. Once the glycogen stores are depleted, the body begins to burn its own fat. Hence, intermittent fasting has became a valuable tool for many of us both for weight loss and weight maintenance and for our attempts to achieve good overall health.

In addition to weight loss and the prevention of obesity and diabetes, intermittent fasting has been shown to have numerous other health benefits including improved mental focus, better digestion, decreased overall inflammation, better heart health and an improved immune system. Intermittent fasting also can play a major role in management of the symptoms of the perimenopause and menopause in women. As an aging woman, I have experienced those benefits myself and have begun recommending IF to patients.

TIME RESTRICTED EATING PLANS

1. Short fasts are fasts between 12 and 15 hours in a 24 hour period. For example, a 12:12 fast means that you fast for 12 hours each day. All of your meals are eaten within a 12 hour “window.” This usually means that you simply stop eating 3-4 hours before bedtime and have your first meal of the day 12 hours after whatever time you had dinner. If you are a nighttime snacker, this simple change in your eating habits will be a challenge at first but it is a great way to decrease your overall food intake. Close your kitchen by 8pm, stop eating for the night and you are well on your way to a fasting lifestyle. These short fasts are thought to be the easiest of the fasting approaches because most of the fasting is done while you are sleeping.

2. The most popular IF plan is 16:8 in which your eating window is only 8 hours per day. During your fasting window you are encouraged to drink water and 0 calorie beverages like black coffee and tea. With this plan you can usually get in two meals during the eating window. Some experts believe that unless you fast at least 16 hours you may be missing out on some of the health benefits of fasting. Some choose to stretch out their fasting window to 17 to 23 hours daily. These longer daily fasts are thought to be necessary to reap benefits of autophagy wherein the body begins to clean out the old, unwanted, and unneeded cellular material, as well as fixing and recycling damaged parts. Autophagy is thought to be important for being our healthiest selves as we grow older.

3. The 23:1 mode of daily fasting is also known as known as One Meal a Day or OMAD. You get to decide which single meal you choose to have but most OMAD users fast from dinner to dinner so they can have the evening meals with family and/or friends.

4. Eat Stop Eat is a strategy that has you refrain from eating for a full 24 hours once or twice a week and to eat normally on the non fasting days.

5. The 5:2 plan, also called the modified Alternate Daily Fast method, restricts calories to 500 on 2 non consecutive days of the week with normal eating on the other days. Many argue that this is technically not a fasting regimen but I include it here for the purpose of informing you of the option.

MYTHS ABOUT INTERMITTENT FASTING

1. Fasting starves the body and will zap your energy. The truth is that even lean individuals carry hundreds of calories in their livers in the form of glycogen and in their body fat. That is why we have stored fat in the first place, to use as a food source when food is not available. No one ever starved to death going a few extra hours without food. We have been told for years that we need to eat 5 times a day to keep our blood glucoses up. That is simply not true but is certainly what the food industry would like for you to believe. In the decades that we have followed this advice we have seen the rates of obesity and diabetes skyrocket. There must be a better way!

2. You will be ravenously hungry if you fast. A lot of the eating we do is out of habit because we have trained our bodies to eat at certain times. We can also train our bodies NOT to expect to eat by easing into the fasting lifestyle gradually. Most people have what I call head hunger at the expected mealtimes the first few days of a fasting lifestyle. That why it is a good idea to start a fast after a satisfying meal followed by overnight sleep then pushing your first meal of the day an hour later each week. Drinking water and zero calorie beverages are a big help in curbing hunger and cravings in the early weeks of a fasting lifestyle. Cutting back your consumption of sugar, simple starches and processed foods will also make you more successful at fasting. The body will learn to crave whatever you regularly feed it. If you continue to eat sugary treats, you will continue to crave sugary sweets.

3. Fasting will make it difficult to concentrate. Most people report that once their bodies adjust to a fasting lifestyle they actually have better mental acuity. It is not true that humans need food to be mentally sharp. Quite the opposite is true. Think of how sleepy you get after a big meal when the blood flow to the brain is compromised by digestion. Studies have shown that there is actually increased brain activity in mammals in the fasted state.

4. You can eat whatever you want during in your eating window. This is the most dangerous myth of all! Let us not forget that this is a healthy living blog. The key to a healthy lifestyle is not just when you eat, it is also WHAT you eat as well. You cannot use fasting as an excuse to pig out on junk food regardless of what you see on social media! Unless you nourish your body with leafy greens, protein, healthy fats and fiber, fasting alone will not help you reach your wellness goals.

WHY SHOULD YOU CONSIDER FASTING

According to Dr. Jason Fung, author of the Obesity Code and the Complete Guide to Fasting, there are several reasons to consider a fasting lifestyle.

1. Fasting is simple and convenient. Even if you eat just one less meal a day that is one less meal you have to plan and prepare and take the time to eat. Think of the time you will save.

2. Fasting is free. After all the money most of us have spent on diet programs, we finally have a strategy that doesn’t cost a penny. Not only that but you will be cutting your food budget by at least one third! In a sense you are being paid to lose weight and improve your health!

3. Intermittent fasting is flexible. It can be used with the dietary eating style of your choice. Because I am pre-diabetic, I use 16:8 daily IF in combination with a low carb/healthy fats eating style. Low carb eating is a great way to get rid of cravings and hunger and makes it easier to be a consistent faster. However, IF can also work wIth other healthy eating plans like vegetarian, vegan, plant based, whole 30, paleo, keto, etc. Once you find the eating plan that works with your health needs and goals, time restricted eating is a great adjunct to make that plan even more effective.

4. Intermittent fasting is great for maintenance of weight loss. Regardless of the method you use, 80-90% of persons who lose weight will regain it within 2 years. Intermittent fasting is a lifestyle that you can use forever in order to stay at a healthy weight.

On a personal note, I originally started IF 2 years ago searching for a way to maintain the weight loss I had attained by switching to a low carb way of eating. I was determined not to do what I had done so many times before when I regained the weight. Not only was I able to maintain the weight loss, I was able to do all my morning workouts in the fasted state without feeling hungry! I have even done several half marathons in the fasted state with no need for carbs before, during or after the races. In the past few weeks I have been experimenting with stretching my fasting window to up to 23 hours a couple of days a week and I am amazed at the amount of energy I have on those days. I can also report that my gimpy left knee hardly ever talks to me any more. I think she likes this fasting lifestyle!

As always, I do not claim to have all the answers to how to become a healthier you but it is my prayer that the information you find here will help you in your journey. I encourage you to share the blog with your friends and family and to contact me in the comments if you have questions.

Be Blessed,

Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)

PCOS and Insulin Resistance

For this month’s entry I would like to pivot to writing about one of the specific disorders that patients have asked me to discuss. The goal here is not to give individual medical advice but to help you understand these disorders and how they might be impacting your overall health. Even if you personally are not dealing with a particular disorder, you likely have a wife, a daughter, a mother, a sister or a friend who might benefit from the information I will be sharing.

The first topic I would like to discuss is Polycystic Ovarian Syndrome (PCOS). I selected PCOS because I have found it to be a prevalent problem in my Gynecology practice as well as in the general population. While it often goes undiagnosed, it is the most common reproductive disorder in the world. PCOS is a condition whose primary signs are irregular menstrual cycles due to failure to ovulate (anovulation), male pattern hair growth (hirsutism) or balding and multiple small cysts on the ovaries. Not all women have all three signs but any two of the three make the diagnosis. The reason understanding PCOS is so important is that it is associated with a number of other medical problems including infertility, acne, obesity, type 2 diabetes, heart disease and hypertension.

Anovulation

The most common initial presentation of those with PCOS is irregular periods due to anovulation. Irregular cycles are very common in early adolescence so it is important to delay a diagnosis of PCOS until at least three years after the onset of menses unless the other two signs are present. In the normal menstrual cycle, only one follicle progresses from what is called a primordial follicle to a mature follicle which is released by the ovary (ovulation). In PCOS, multiple primordial follicles start the process but are unable to complete it due to an excess of the male hormone testosterone. These arrested follicles form tiny cysts that can be seen on USG. The failure of even a single egg to reach maturity in some or all cycles is the reason why so many women with PCOS may have difficulty becoming pregnant. Those enlarged ovaries have also been known to cause chronic pelvic pain.

The traditional treatment for the irregular cycles has been oral contraceptive pills (ocp’s) to suppress the ovaries and provide the patient with regular, although artificial periods. This works fine for the woman not desiring pregnancy but does not get to the root cause of the problem. Moreover, ocp’s and other hormones may not be acceptable to all women for a variety of reasons.

In the woman desiring pregnancy, the traditional treatment of PCOS has been with powerful ovulation induction drugs which work for a significant percentage of women and help them to become pregnant. However, some of these drugs are not well tolerated and have some potentially dangerous side effects. More recently doctors have added the diabetes drug metformin to treat anovulation to increase the likelihood of ovulation and pregnancy (more on why this strategy works later).

Hirsutism

Hirsutism

Male pattern hair growth and/or balding along with acne are visible manifestations of excess male hormones (androgens), primarily testosterone, produced by the ovaries in PCOS. Here again treatments with OCP’s and other drugs to block the effects of the androgens treat the symptoms but do not get to the root of the problem. Neither do electrolysis and other hair removal medications and procedures. These can successfully get rid of unwanted hair but do not inhibit regrowth.

Polycystic Ovaries

Now that we can easily see very small cysts in the ovary on ultrasound we can use such studies to contribute to the diagnosis of PCOS. In spite of the name, having ovaries with multiple cysts does not necessarily mean that a woman has PCOS because they can be present in normal women and not all women with multicystic ovaries have PCOS. It is only when the cysts are accompanied by excess facial hair, thinning scalp hair and/or irregular menstrual cycles that the diagnosis is made.

USG of Polycystic Ovary

PCOS and Insulin Resistance

No single cause has been identified for PCOS but we do know that there is a genetic predisposition, making it more likely to occur in daughters and sisters of women with the condition. PCOS is often linked with both obesity and Type 2 diabetes although neither condition is considered to be the direct cause of PCOS. Greater than 50 to 70 percent of women with PCOS are overweight or obese and there is a markedly increased risk for the development of diabetes in women who have PCOS. In fact it is recommended that women diagnosed with PCOS be screened for diabetes at diagnosis and every two years thereafter. Recent research has confirmed that the common denominator for these three conditions; obesity, diabetes and PCOS appears to be insulin resistance.

Insulin resistance is a condition in which the pancreas can produce insulin normally but the insulin does not function properly. Insulin is the hormone responsible for moving glucose out of the blood and into the cells where it can be used for energy. When the insulin does not do that effectively, the body responds by releasing more and more insulin leading to hyperinsulinemia (elevated blood insulin levels). High insulin levels signal the body to store fat rather than burn it, leading to weight gain and obesity and making it difficult to lose weight. When insulin resistance is at work, the excess fat is stored primarily in the midsection. This increased abdominal circumference is a risk factor for multiple metabolic diseases. High insulin levels are a precursor to prediabetes and diabetes because even though a lot of insulin is being produced, it is unable to perform its main function of lowering blood sugar. In addition, high blood insulin levels can trigger the increase in male hormones produced by the ovaries that cause the anovulation, hirsuitism and acne seen in PCOS.

This link between PCOS and insulin resistance explains why metformin, a drug used to treat diabetes, can be useful in the management infertility caused by PCOS. One of the mechanisms of action of the drug is to reduce insulin resistance which results in a decrease in testosterone and a higher likelihood of normal ovulation. Some infertility specialists now use metformin alone over traditional ovulation induction drugs as the first line treatment for anovulation in patients with PCOS.

In addition to the medications previously discussed, doctors are also recommending lifestyle changes that can result in significant improvement in symptoms of PCOS. These lifestyle choices are aimed at decreasing insulin levels and improving insulin resistance. Those efforts include weight loss when appropriate, increased physical activity and dietary changes.

Weight loss, whether it is achieved by lifestyle changes in diet and exercise, medications or bariatric surgery results in decreased insulin resistance. As little as a 15% reduction in weight can improve symptoms. The same can be said for regular physical exercise which increases muscle mass which improves insulin resistance even when not associated with weight loss.

Dietary strategies to improve PCOS focus on lowering insulin levels which indirectly lowers androgen secretion by the ovaries. This involves reducing or eliminating the consumption of sugar and simple carbohydrates (bread, potatoes, pasta, rice, etc.) and processed foods. These foods are known to spike glucose and insulin levels and increase insulin resistance. Such a low carbohydrate way of eating should focus on eating foods with a low glycemic index which means they are less likely to spike glucose and insulin levels. These would include complex carbohydrates like green and cruciferous vegetables as well as protein sources like fish, poultry, and eggs and healthy fat like nuts avocado and olive oil. Dietary changes that improve insulin resistance should also focus not only on what to eat but when to eat as well. Another strategy to keep insulin levels low is to avoid snacking between meals and late night eating by practicing time restricted eating or intermittent fasting (see previous blog entry).

Because PCOS is associated with so many more dangerous health conditions, any woman who believes she might have it should see her healthcare professional for a diagnosis and close monitoring. The sooner the diagnosis is made and treatment and lifestyle changes are adopted, the more likely the woman with PCOS is to reverse her risk of conditions that might impair her long term health and quality of life.

Be Blessed,

Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)

Is Sitting the New Smoking??

I hope this blog entry finds you all safe and well. It is the purpose of this blog to provide you with information you can use to maximize your good health. In previous entries (which are all still available) we have looked at the effects of unhealthy eating, hormonal changes, poor sleep, and too much stress on our overall health. Today I want to alert you to another important factor that might be endangering your health – TOO MUCH SITTING!

We have all seen the headlines that read, “Sitting is the New Smoking.” The implication of those articles is that our sedentary lifestyles are as dangerous to our health as cigarette smoking. This notion has become even more of a hot topic in the last several months as we have been sheltering at home due to concern over the spread of Covid 19. It is not just those adults who are working from home, it is also our children who are now attending virtual school who are being forced to sit for most of the day in front of a computer. With many of our normal activities being curtailed or cancelled, we are all sitting more than ever now.

It should be obvious to all of us that it takes more energy to walk than it does to stand still but it also takes more energy to stand that to sit. The simple act of holding your own body upright uses up more energy than letting a couch or chair support you. Not only are we sitting more at work and at school but our favorite leisure time activities often involve binging streaming videos, playing video games and scrolling social media. Granted, many of us have been getting out and taking walks, cycling and running more during the last few months. However, even a full hour of such activities every single day cannot compensate for the 8-12 hours a day spent sitting at a computer for work or school or for the hours on the couch binging Netflix or surfing the internet.

Our sedentary lifestyle is not entirely our fault. Just a quick assessment of the ways in which every day life has changed in the last 50 years offers some clues as to why we are more sedentary now. I am old enough to remember washing clothes on a scrub board and hanging them on a clothesline to dry. In the past many of us walked to school or had to walk considerable distances to the bus stop to get there. There were no remote controls. If you wanted to change the television channel, you had to walk across the room. There were no dishwashers or trash compactors doing simple tasks for us. We now even have little robots to vacuum our floors! The list goes on and on. The point is that as automation has increased, physical activity has decreased. As activity has decreased there has been an increased incidence of deadly diseases.

Studies have shown that our sedentary lifestyle has now become a public health problem. Sitting too much has been linked to an increase in the risk of obesity, heart disease, diabetes, depression and anxiety. In addition, there are direct physical effects of prolonged sitting. One of the most obvious effects of sitting is the weakening and wasting away of the leg and gluteal muscles. Many have witnessed such muscle loss in relatives whose medical conditions have left them bedridden. Weak muscles that are meant to keep you upright increase your risk of falling and of strained muscles when you do try to exercise! Moreover, prolonged sitting causes your hip flexors to shorten which can lead to hip problems. Too much sitting can also lead to back problems from poor posture which can be a cause of painful disc disorders.

The good news is that we are not doomed to becoming victims of the effects of prolonged sitting. There are many ways to build activity into our daily lives, even if we are spending more time at home. Most of the recommendations I am making are strategies that I have personally used to avoid prolonged sitting. We sit or stand still during some activities because it has become a habit to do so – not because that is the only way those activities can be done. For example, marching in place or walking around the room during your favorite tv show (or at least during the commercials) can be just as relaxing as watching it couch potato style. As long as you don’t wander out to the kitchen for an unhealthy snack, this one simple change can make a big difference. The same is true of making phone calls to check on friends and relatives during this time of social distancing. Consider walking around the room during those phone calls. You can also increase your activity at home by walking while you brush your teeth, heat up food or brew coffee. Break household tasks into smaller tasks like unloading your groceries one bag at a time from the car or making several trips to the laundry room instead of trying to take the entire load at once. If you venture out to shop for necessities, park as far from the door as you can to add some extra steps to the outing. Using an activity device and setting a step goal of at least 10,000 or more steps per day will keep you accountable to move more each day.

Like to get lost in a good book? Instead of curling up on the couch to read, try audiobooks and/or podcasts and listen to them during your walk, run or bike ride. In that way you are improving your body and mind simultaneously. (In the interest of safety, experts advise that you use only one earbud or use bone conducting head phones so that you can be aware of your surroundings.)

Whether you are going in to the workplace or school or working from home, find ways to move around in the course of your day. Consider investing in a standing desk or stack boxes or books so that you can stand while working at your computer. Charge your phone on the other side of the room and move the trash can so that you cannot reach it without getting up. Take the longest route to the restroom and the break room. Set a timer on your watch or phone to remind you to get up and walk around for a few minutes once per hour. A recent study found that just 2 minutes of walking for every hour spent sitting has a positive impact on your health. Do a few yoga stretches to work out the kinks in your neck and shoulders after your mini walk. Try to spend a portion of your lunch break going outside for a stroll or walking the stairs if the weather is unfavorable. You will be amazed how a short walk outside can improve your mood and make you more productive! It really is true that “movement is therapy.”

As all of us become accustomed this new existence in the wake of Covid 19, we will have to make adaptations so that we can each be the healthiest versions of ourselves. The recommendations in this blog entry are just words on a page until YOU decide to incorporate some of them into your life. I pray that you will find them helpful.

Stay Safe and Be Blessed,

Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit”

3 John 1:2 (NLT)

Don’t Let COVID-19 Make You Unhealthy

From what I read on social media, a lot of you have given in to the notion that this order to stay home will inevitably lead to weight gain which can wreak havoc on your overall health.. I for one am determined not to let that happen. I am healthier and fitter now than I was 10 years ago and I refuse to let COVID-19 take that away from me. A lot of what is happening to us during this Pandemic is beyond our control. Whether or not we turn into junk food eating couch potatoes is entirely up to us.

What follows are just a few commonsense suggestions to help you stay healthy under the stay at home orders.

The first step to a healthy lifestyle begins in the grocery store. Leave the chips, candy, ice cream, and pastries in the store. If you cannot resist snacking between meals, stick to low sugar fruits and veggies and SMALL quantities of nuts and seeds. Make an effort to have at least 90 percent of what you eat be real whole foods instead of processed fake food with ingredients you can’t even pronounce. Make wise decisions when ordering foods from restaurants and try to prepare your own food at home as much as possible so you know exactly what is in it. Take advantage of this opportunity to try some new healthy recipes for you and your family now that you have the time. Think of eating a healthy diet as something you can do to help boost your immunity during this Pandemic.

Consider using that cell phone that is constantly with you to journal what you are eating and your exercise habits. Apps like My Fitness Pal and Lose It will keep you honest if you track everything you eat and how much you are exercising. It may sound like a pain but studies have proven that journaling is a very effective tool in the weight control arsenal. You can even use old fashioned pen and paper to accomplish this. If you are on lockdown, don’t tell me you don’t have time.

Practice portion control. Simple strategies like using smaller plates and utensils fool your brain into thinking that you are eating more than you really are. A saucer sized plate or small paper plate will hold as much as you need to eat at a meal. This is a good time to learn to eat more slowly to give your brain a chance to signal your stomach that you are full. You will automatically eat less when you do this. Remember, there is no reason to rush through your meals when there is no place to go!

Drink more water, especially when you are tempted to do mindless snacking. Sometimes what we perceive as hunger is really thirst. Aim to drink at least 64 ounces of water daily. All those trips to the rest room will help keep you off the couch.

Make a concerted effort to wait until you are stomach growling hungry before you eat. Try to distinguish between head hunger due to boredom and physical hunger. If you are already full but craving to eat something else, distract yourself by getting as far away from the kitchen as you can. Why not go out and walk around the block? As you are walking, the craving will likely go away. Getting some fresh air every day is important to prevent “cabin fever” and depression. You might also use the moment to call and check on a friend or loved one. Social distancing does not mean disconnecting from the people you care about.

Make staying active a priority. Even those of us who are allowed to go to work are still home more than usual. We now have more time to go for walks and runs, do home workouts and try the many workout videos that are available. If you don’t enjoy structured workouts, why not make a playlist of your favorite upbeat music and dance like no one is looking. This is also a great time to tackle some of those household chores you have been putting off. Even if you choose to binge watch your favorite series, you can get up and march in place for a few minutes between episodes. The point is just to get you to move as much as possible. Not only is activity good for your heart and your blood pressure, it can also ward off anxiety and depression. Like I always say, “movement is therapy.”

Last but not least, one of the best things you can do for your long term health is to GO TO BED EARLY! A lot of us are so conditioned to staying up late that we have forgotten how to go to bed early like we did when we were children. We have made it a habit to stay up watching late night television and often find ourselves mindlessly snacking. The average adult should get 7-9 hours of sleep per night yet most of us are lucky to get six. Look at it this way. You are going to wake up at whatever time you are used to getting up regardless so the easiest way to work toward getting adequate sleep is to get it on the front end. You will be amazed at how much better you will feel once you start getting adequate sleep!

I hope these tips will help all of us get through these difficult times without letting stress eating and inactivity get the best of us. If you have other tips you would like to add, feel free to leave them in the comments section. Be safe everyone!

Be Blessed,

Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)

 

STAYING HEALTHY IN TIMES OF CRISIS: Updated (3/20/20)

I haven’t made an entry into this blog for a few months due to a series of personal and family struggles. As I continue to navigate the waters of grieving the loss of both my mother and my husband, I am now joined by all of you as we are grieving the loss of life as we knew it due to the impact of the Corona Virus. Along the way, I have learned some valuable lessons about what it takes to stay healthy in crisis situations. I would like to share what I have learned with my readers hoping that it might help someone else.

I have had numerous people inquire of me over the last few months “are you taking care of yourself?” I took those inquiries to heart and made conscious efforts to develop some simple strategies to keep myself healthy. Let me preface what follows with recognizing that it is the grace of God and the caring and prayers of others on my behalf that are getting me through these tough times. That said, I do feel that there are steps we can take in times of crisis that will help us to stay healthy.

1.GET ENOUGH SLEEP

Sleep deprivation in and of itself is a stressor on the body. Lack of sleep and chronic stress can cause elevations the stress hormone cortisol. This wrecks havoc on your immune system, increasing your risk of becoming ill. It is wise to establish a good sleep routine and stick to it as much as possible during stressful times.

2. FIND WAYS TO BE PHYSICALLY ACTIVE DAILY

I am sure that most of you have heard of the “runners high” which is the sense of well being that comes from the endorphins that are released by running. Well, you don’t have to be a runner to tap into that natural mood elevator. You can get it from any type of activity that you truly enjoy. That can be anything from a stroll in the park to dancing around your house to great music – as long as you are moving your body with purpose, it will make you feel better and will help ward off depression. There are countless workout videos available for FREE on YouTube. Even during the grief process, movement is medicine.

3. DON’T EAT YOUR FEELINGS

As a lifelong emotional eater who has now adopted a healthy lifestyle, I can report that the temptation to run to comfort foods in times of crisis never really goes away. Being comforted by sugary or starchy foods is embedded in our DNA. From the time we are infants, our parents and caregivers respond to every cry with a bottle or breast! It is no wonder that most of us feel a primal urge to eat in times of stress! If you choose to try to be your healthiest self in a crisis, you must continue to make healthy choices with your eating. Continue to choose real whole foods over starchy and processed convenience foods and drink plenty of water. The same is also true for those who find themselves losing weight when they are grieving because they neglect to fuel themselves properly. Eating foods that are healthy for you over the junk you may be craving takes a conscious effort. Don’t let time pressures be your excuse to eat poorly. Even fast food restaurants and grocery stores now offer salads and other healthy foods.

4.CARVE OUT TIME FOR PRAYER AND MEDITATION

There is nothing that nourishes a struggling spirit like a strong prayer life. Often the comfort and security you need can be found in daily quiet time communicating with God and meditating on His Word. Taking the time to meditate on the things you still have to be thankful for even in the worst of times can also help to lift your spirits during a crisis.

5. STAY CONNECTED TO OTHERS

Social distancing does not mean social isolation.The last thing you need to do in times of stress and grief is to isolate yourself from friends and loved ones. There is strength to be found in sharing your situation with family and close friends. This is a great time to take advantage of social media, texting, facetime, etc. Why not make it a point to phone a friend or distant loved one once a day?

6. BE WILLING TO ACCEPT HELP!

People do not usually offer to help you unless they mean it. They do, however, need for you to be specific about what help you need. Recognize that you cannot do it all and tap into the resources of others when you find yourself overwhelmed. A few hours of “me time” to focus just on yourself can make all the difference in the world. Taking time for a little self care is not selfish but is necessary to your overall well being.

Be Blessed,

Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit”

3 John 1:2 (NLT)

Love the Foods That Love You Back

When it comes to using food to help you lose weight and/or just be healthier, there can be a lot of confusion about what constitutes the healthiest eating plan. Patients have expressed to me how they are hesitant to try eating a healthy diet because there is so much conflicting information out there. When it comes to eating to promote your best health, we should not get the idea that one eating plan fits all. Take me, for example, a 66 year old prediabetic with a history of hypertension and childhood obesity. A LCHF (low carb healthy fat) lifestyle along with regular exercise is the approach that has made me healthier now than I was 20 years ago. Others whose medical profile or personal preferences are different might not find this approach either desirable or sustainable long term. That said, I believe there are some universal concepts that hold true no matter what WOE (way if eating) we choose. One of those concepts is that you must learn to love the foods that love you back!

Often when I try to advise patients on healthy eating they tell me that they cannot sustain a long term healthy eating plan because they “love” ice cream (or chips or cookies or cornbread, etc). My response to anyone who has struggled with their weight for this reason is, “what has ice cream ever done for you?” Having an unshakeable love for foods that are unhealthy for you is like being in a relationship with someone who is physicalIy abusing you. We keep letting that person back into our lives and expecting it to be different this time but it rarely is! We can’t keep returning to eating french fries and other junk foods every day and expect them to make us healthy this time around. That is part of the reason why 95% of people who lose a significant amount of weight gain it back within 2 years!

I totally understand the passion we have for food because I LOVE to eat. That love led me to take up interval running in my late fifties with the notion that “I run so I can eat.” That turned out to be a big fat lie! As I have said in a previous blog, you cannot “outrun”a bad diet. We need to acknowledge that we eat as much for enjoyment as we do for fuel. We just need to train ourselves to love the foods that love us back with positive changes in our health.

When you make a commitment to becoming a healthier you, why not take the focus off the foods you should no longer eat but instead focus on learning to love those foods that you know are good for you? The disease causing foods like sugar and sugary drinks, processed carbs (junk food) and deep fried foods pretty obviously have no place in your pursuit of good health. Regardless of which healthy eating plan you choose you will be told to reduce your intake of these foods. Instead of mourning the loss of the “bad” foods you shouldn’t eat, try to forget them and get excited about all the wonderful things you get to enjoy eating and still be healthy! You can take control of your own health by making this simple shift in your mindset!

Here is just a partial list of some of the wonderful things to eat that will promote wellness in your life. The closer any food can be to its natural state the better. Make it a habit to shop the perimeter of the grocery store to find the real food! I have included some of my personal favorites in this list but the list is not exhaustive by any means. Identify the good foods that you already like and eat more of those before venturing out to the foods you think you don’t like right now.

1. Green leafy vegetables, especially the dark leafy greens like spinach, mustard and collard greens and kale are encouraged in almost every diet I have ever seen (Lord knows I have tried them all). It is a good practice to eat a big salad topped with healthy proteins and fats every day as one of your meals.

2. Other non starchy vegetables that you should be eating on the regular include cabbage, cucumbers, broccoli, brussel sprouts, cauliflower and tomatoes. Learn to prepare these in ways that will tickle your palate and they will become your go to side dishes instead of the starches that gave you love handles but no love!

3. Foods containing protein and healthy fats like fatty fish (i.e. mackerel, lake trout, herring, sardines, albacore tuna and wild salmon) are excellent choices. Seafood, poultry, eggs, cheese and other dairy products and even meats can also be a part of a healthy diet depending on your medical history.

4. Raw Nuts and Seeds (i.e. almonds, pecans. walnuts, flaxseed, chia seeds, hemp) are also good choices in small quantities.

5. Berries – strawberries, blueberries and raspberries are preferred over the tropical fruits because their sugar content is so much lower.

6. Avocados. This stone fruit with a creamy texture is chock full of healthy monounsaturated fats, vitamins C, E, K and B6 as well as potassium and magnesium! This is the one healthy food that inspired me to write this post. I never even knew that I liked avocados until I found out how good they were for me. Now I eat them almost daily! During a recent run-cation to New England, we were celebrating my birthday at a nice restaurant. I ordered the lobster cocktail thinking I would eat the fresh lobster and bypass the sugar laden cocktail sauce. Imagine my sheer delight when they put it in front of me and it was topped with guacamole!! I was tempted to ask them to put a candle on it so I could pretend it was my birthday “cake!” I was even surprised at myself for getting that excited over unexpected avocado!! I can honestly say that I love avocados in the same way that I used to love potato chips! Amazing! Here is a picture of that lobster cocktail and it was delicious!

All joking aside, I hope you get my point. If you eat a food that you thought you didn’t like and it contributes to your feeling great, you will soon learn to love it!! Give yourself the chance to fall in love with healthy foods and I promise they will love you back by making you a healthier you!

Be Blessed,

Yvonne Moore, MD

“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit”

3 John 1:2 (NLT)

It’s Never Too Late

Those who know me well know that I am a big fan of in home exercising and using YouTube videos for fitness. While I LOVE interval running outside and try to do at least one half marathon each month, I never stray far from my Walk Away the Pounds videos from back in the day! Now such videos are as close as that cell phone that is always with you! I have shared with many of my patients that we no longer have any excuse not to exercise. That is why I was so excited when a friend posted this video about an 87 year old lady who has lost weight and gotten fit by ditching her unhealthy diet and walking daily INSIDE her 2 room apartment. If her story does not inspire you to get off the couch, I don’t know what will!

Be Blessed,

Yvonne Moore

“Dear Friend, I hope all is well with you and that you are as healthy in body as you are in spirit.

3John 1:2 (NLT)

What is Your Why?

2018 has been the year that I finally took charge of my own health and the results have been amazing. As I have shared this journey through this blog and in my conversations with my patients and friends I have been saddened to hear all the excuses that I used to make being told to me by others. The list of excuses for not adopting a healthy lifestyle is a long one but these are some of the most common that I hear.

1. I LOVE _______! Fill in the blank with your drug of choice: bread, desserts, potatoes, chips, chocolate, etc.

2. I don’t have the time or energy to exercise regularly.

3. I don’t like vegetables.

4. My job is so stressful that junk food is the only thing that calms me.

5. I have lost weight many times before and I always gain it back so what’s the point?

As I reflect on what it has taken for me to get to the place in my life where I have stopped making those excuses, I realize that it did not happen overnight. I have done you a disservice if I have given any of you the impression that the road to good health is an easy one. It most certainly is not. This is particularly true if you hate to exercise and/or have a love affair with unhealthy food as I did.

I have recently asked myself what it took for me to stop making excuses. What it took for me and what it will likely take for you is to find your own individual “why.” Finding your why has become a catch phrase in corporate America as the key to success in the workplace. It is also the key to the long term maintenance of a healthy lifestyle. Your why is that thing that motivates you from deep within yourself. It is that thing that is more powerful than any of the excuses you have ever made and any of the lies you might have told yourself. The German philosopher Frederick Nietzsche once said, “He who has a why can endure any how.”

The initial why that sparked my desire to get healthy was wanting to lower my blood pressure. Sitting at my mother’s bedside while she lay in a coma from a hypertensive stroke solidified my resolve to do whatever I could to avoid the same fate. During the time that I was trying to make exercise and healthier eating a priority, I found out that not only was I still requiring blood pressure medication, I had also become pre-diabetic. This shook me up even more because I have watched family members lose limbs, vision and kidney function from diabetes. I now had a more imperative why – I do not want to have hypertension OR diabetes! With that focus, I now see the junk food that I once loved as poison to my body! Fear of disease and infirmity can be a powerful motivator!

As we enter 2019, I would urge each of you to take a different approach with you into the new year. Instead of making a list of resolutions that are doomed to fail, take some time to discover “why” you want to be healthier and let that be your focus. You may be a parent whose motivation is to set a good example for your children. Perhaps you have grandchildren and you would like to have the stamina to have fun with them. Maybe you have noticed the beginnings of arthritis in your joints and have been told that walking will help you have less pain. Your why might be depression and you remember how much better you felt after exercising. Whatever your why is, make that the reason you are choosing to change to a healthier lifestyle in 2019! Whenever you are tempted to veer off track, remind yourself that your why matters more to you than whatever it is that might be tempting you in the moment. Keeping that all important why at the forefront of your mind will help you stick with your healthy lifestyle for the long run.

Happy New Year to all of you!

Be Blessed,

Yvonne Moore

“Dear Friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.”

3 John 1:2 (NLT)