Wellness Rounds

I’m always looking for good websites for recipes that are healthy, simple and easy to make.  In other words, the kind of food that makes it easy to avoid eating fast food when you are on call.   Kalyn’s Kitchen is a fabulous website for delicious, healthy, and often low calorie recipes that meet the “pizza rule” for medical students and residents (i.e. recipes that take less time to prepare than it takes to order a pizza). She also really goes out of her way to teach each step in the recipe, so if you are new in the kitchen, this is a fabulous website for you!

Tuna Salad Lettuce Wraps with Capers and Tomatoes

Not-so-Dumb Salad with Cucumbers, Tomatoes, Onions, Avocado, and Balsamic Vinegar

Mediterranean Tostadas with Hummus, Feta, and Kalamata Olives

Crockpot Double Lentil, Sausage, Brown Rice, and Spinach Soup

One of my New Year’s resolutions this year was to come up with monthly “resolutions” for myself and for anyone who follows this blog.  Cooking Light magazine (which is one of my favorite sources of recipes and ideas for healthy living) had the same idea, so I am shamelessly borrowing their healthy habits!  So, for August, think about setting a goal to go meatless one day a week.

It’s impressive to me how many of my colleagues, students and friends have become vegetarians.  They have different reasons, from ethical concerns for how animals are treated to issues with their health.  If you’ve thought about trying a vegetarian diet, this is a good month to experiment by going meatless one day a week.

What are the advantages of a vegetarian diet?

• There is growing evidence that vegetarian diets can help with preventing or even treating a variety of disease states “such as cardiovascular disease, hypertension, diabetes, cancer, osteoporosis, renal disease and dementia, as well as diverticular disease, gallstones and rheumatoid arthritis.”

• You’ll save money.  Meat costs more than fruits, vegetables, beans and grains.

• It will be easier to lose weight and maintain a healthy weight.

• You’ll help the environment by decreasing the “carbon footprint” related to your food choices.

• Here’s a list of 22 reasons to consider becoming a vegetarian

Photo source

What are the different kinds of vegetarian diets?

From Wikipedia: “An ovo-vegetarian diet includes eggs but not dairy products, a lacto-vegetarian diet includes dairy products but not eggs, and an ovo-lacto vegetarian diet includes both eggs and dairy products. A vegan diet excludes all animal products, such as eggs, dairy, and honey.”

How do you make sure you get adequate nutrients if you are not eating animal protein?

If you are going meatless a day or two every week, none of this will apply to you.  If you are thinking about a completely vegetarian diet you may want to look at the the USDA resource page on Vegetarian Nutrition.  The four nutrients that may be deficient in some vegetarian diets are:

• Protein.  If you include eggs and dairy products, it’s realtively easy to get enough protein in a vegetarian diet.  Good protein sources include beans, soy products (tofu has 20gm of protein per cup) and nuts.  In the past, people who ate a vegetarian diet were told to combine food to make sure they got complete proteins. Current thinking is a little different – as long as you are eating a variety of proteins during the day, you’ll be fine.  Women need about 50 gm of protein a day, men a little over 60 (unless you are an endurance athlete, pregnant or nursing). Here’s a list of protein sources from SportsMed Web.

• Calcium. If you include dairy products, calcium is not usually a problem.  For vegans, it’s important to include calcium rich foods or consider a supplement.

• B12 is only present in animal sources.  For that reason, vegans are particularly at risk for B12 deficiency.

• Iron Most vegetarians get enough iron if they eat a variety of foods, but a supplement may be necessary for some people.

Photo source

Where can I get good vegetarian recipes?

How to Cook Everything Vegetarian: Simple Meatless Recipes for Great Food by Mark Bittman

Vegetarian Cooking for Everyone by Deborah Madison

Moosewood Restaurant Cooks at Home: Fast and Easy Recipes for Any Day

Vegetarian Times

Vegetarian recipes from Epicurious.com

Vegetarian recipes from allrecipes.com

Food Network vegetarian recipes

It’s summer and it’s hot.  I’m on call this weekend.  That combination made me think about cold comfort food I could take to work.

Chocolate (in any form) is always the answer… but I decided maybe I could find something a little more healthy (and a little less caloric) that could serve as the “treat” we all crave when we are working hard on call.  I’m thinking the team will like a little Salpicon mid afternoon tomorrow…

Salpicon – a sparkling fruit drink from Columbia

This soup looks delicious, but with the heavy cream probably isn’t in the “low calorie” list.  You can substitute milk or yogurt to cut calories (without too much sacrifice of taste).  But, then again, as an on-call treat this still beats McDonald’s!  This is just one example of cold soups – which are great for summer on-call days.

Cold avocado soup

Smoothies are great comfort food – but logistically not easy when you are on call.  If you love smoothies, you might want to invest in an inexpensive single-serve blender.  Take the fruit in a baggie, put some yogurt and ice cubes in… instant smoothie.  Alternatively, you can blend your smoothie at home and put it in a container in the refrigerator that you can shake up before drinking.

Banana mango smoothie

I went in search of an exercise equivalent for “fast easy recipes” and came up with a good find.   The Daily Fitness Solution provides 20 minute workouts that don’t require a gym or equipment.  It’s written by Reinhard Engels, who works in bioinformatics visualization at MIT.  So, as you might expect, his program is logical, simple and without hype.

The workout program is more than reasonable, with rest days built in (which could be swapped with a workout day if you are on call)  No matter how busy you are, you can probably find 20 minutes!

I also liked his approach to weight loss – the  The No “S” diet:

The No S Diet, also known as the “Grandma Diet,” the “Why Didn’t I Think of that Diet,” and the “No $ Diet” is a program of systematic moderation I invented for myself that I imagine might work for similarly minded people.

No funny science or calorie accounting involved, just a few simple and mnemonic tricks for giving your willpower the upper hand.

There are just three rules and one exception:

• No Snacks
• No Sweets
• No Seconds

Except (sometimes) on days that start with “S”

That’s it.

How could something this simple possibly work? Precisely because it’s simple — or rather, following the Einsteinian dictum, “as simple as possible, but not simpler.”

If one of your New Year’s resolutions is to lose weight, or just to eat “better” you might want to consider looking into the concept of “clean eating”.

Although eating clean works to lose weight, it’s not really a “diet” in the usual sense of the word. Clean eating is a lifestyle and way of eating that is medically very sound.  It’s getting rid of the junk food, eating often enough to maintain your energy and  “shopping the periphery” of the grocery store.  (Think about it – the food being sold on the periphery of the grocery store is mostly non-processed.)

Everyone has had the (horrible) experience during a call day of not eating anything all day, having a big meal in the evening  (often McDonald’s or an equivalent) and then being brain-dead from lethargy for 2-3 hours. In addition to helping you control your weight (and preventing weight gain during medical school and residency),  “eating clean” will prevent the on-call lethargy you get from eating junk food and can give you sustained energy during long work days.

In a nutshell, here are the “rules” for eating clean (Revised from lists published on ehow.com , eatingcleanworks.com and cleaneatingonline.com)

How to Eat Clean

1. Eat 5-6 small meals a day: breakfast, lunch, dinner and 2-3 snacks – and don’t skip meals! This means taking a cooler with you to work and/or having choices like meal replacement bars in your pocket. It’s important to eat every 3-4 hours to keep your insulin levels (and energy levels) from waxing and waning too much. It’s really important to never skip breakfast!

2. Eat a serving of complex carbohydrates at every meal (about the size of your fist). Grains should be unprocessed as much as possible (more fiber = more satiety) like brown rice or quinoa .

3. Minimize or (preferably) completely eliminate processed food, soft drinks and alcohol.

4. Eat fruits and/or vegetables at every meal.

5. Eat a serving (about the size of your palm) of lean meat, chicken or fish at (almost) every meal. Vegetarian options are fine, too (beans, tofu, etc).

6. Read labels. Try to avoid foods with white flour, sugar and sugar substitutes, saturated fats and trans-fats.

7. Take good snacks (like premeasured servings of nuts) with you to work so you don’t get tempted by vending machines and breakroom junk food.

8. Don’t beat yourself up if you cheat – in fact, you’ll probably need to have a cheat day (on purpose) every once in a while. But recognize it’s a cheat day and not a permanent change from your new way of eating.

9. Keep things interesting by checking out recipes and cooking for yourself. You can subscribe to Clean Eating Magazine or at least pick up an issue to check it out.  The Diet Rebels Cookbook: Eating Clean and Green, Clean Food: A Seasonal Guide to Eating Close to the Source with More Than 200 Recipes for a Healthy and Sustainable You and Tosca Reno’s Eat Clean Cookbook: Delicious Recipes That Will Burn Fat and Re-Shape Your Body! are cookbooks with good recipes for clean eating. Here’s some websites with recipes, too: cleaneatingonline, cleaneatingclub, eatcleandiet, cleaneatingmag

Part 2 of a guest post from Jenny Scoville Walsh with wonderful advice on losing weight.

Losing weight should be seen as a way to take better care of yourself, NOT torture yourself!  But  everyone I know realizes they want more food than their body technically needs.  How do you handle that?

If you’re hungry, then you might want to spread your calories out.  Are you eating something with high fat?  Try the reduced fat version and you can have a larger snack for the same calories.  Instead of eating French fries, you can eat TONS of carrots for the same calories.  Instead of microwave butter popcorn, try the lowfat version or an airpopped version with a controlled amount of butter.  Instead of a cinnamon roll for breakfast, try cereal and non-fat milk.  Try drinking water while eating oats or other grains, which will absorb the water and make you feel full longer.  Choose fiber—which also makes you feel full longer.  So, choose the orange over the orange juice.  You get more bulk, and therefore more fullness for the same amount of flavor.  If you’re looking for something sweet, try fresh fruits instead of candy.

What if you’re craving flavor?  I recommend sugar free gum.  It comes in tons of yummy flavors.  Try herbal tea with sugar substitutes.  Diet soda is tastier than it used to be and may help you beat that crave occasionally.  Maybe you could take tinier bites and savor a small amount of a favorite flavor, instead of eating a full serving of it.  Maybe you need to smell yummy things, like perfumes and candles—smell and taste are closely related.

What if you’re looking for comfort, endorphins, fun, friends?  Well, Flylady shared a quote with me, and now I guess I’ll have to look up where she got it, that said “If hunger isn’t the problem, food isn’t the solution.”  And Mary Ellen Edmunds shared:  “You can never get enough of what you don’t need.”

Looking for comfort?  Get a comfy sweater, snuggle with a favorite blanket, watch a favorite movie, light a scented candle that you love, get a hug, get massage, talk to a friend, take a hot bath, read a favorite book, play your favorite music, look at favorite pictures, call a family member that can offer support, etc.

Looking for endorphins or fun?—exercise, cuddle, dance, do a favorite activity, listen to a pumped up song, use a talent (decorate, write, paint, draw , knit, design, build, remodel), clean an area of your space, smile at yourself in the mirror, doing something fun with an energetic friend, compliment someone, help someone, tell a joke, watch something funny and laugh your head off, etc.

What if you’re lonely?  Get involved at school, church, community organizations, sports groups, dance groups, groups that explore the natural and manmade environment (they go skydiving one weekend and explore the underground tunnels in the city another weekend, for example).  Look in your neighborhood for people close by to befriend.  Try looking for people more shy or lonely than you and reach out to them.  There are people at work that you may be overlooking.

What about leftovers and wasting food?  Are you a garbage disposal or are you a person?  If you’re not hungry and something is worth eating, save it for when you are hungry and need more energy.  Refrigerators and freezers are wonderful things.  If it is not worth saving, throw it away.

What about people that offer you food and even cajole you if you turn them down?   If you suspect someone will offer your food later and you want to say yes, save up calories for the occasion.  Then, take wise portions of the various foods so it adds up to the amount you intend to eat.  If you have eaten enough, it’s ok to say no to food. Say, “No thank you.  I’m full.”  Or “Thank you, that looks delicious.  Maybe some other time.”  Or, “I’m trying to keep my girlish figure.”  Or, “That smells AMAZING!  I would love to try that when I’m not so full.”  Or, “Thank you for offering. You are such a great hostess.”  Or, “That really was delicious.  I’d love to get the recipe!”  I doubt your host or hostess (or relative) is trying to fatten you up like in Hansel and Gretel. They want their efforts to be appreciated and to know you had a good experience.  And they may not want to have a house full of food left when their guests leave.  If that’s the case, maybe a bag of offered food for later may meet your host’s needs and your desire for a tasty snack (but when it would be wise to eat again).

Hopefully, this helps you on your own journey to losing weight.

A guest post from Jenny Scoville Walsh with wonderful advice on losing weight.

A lot of people are planning on setting weight loss goals for the New Year.  I set that goal this year and I’m succeeding!  Over this year, I not only lost all the weight I gained in med school (all that sitting to study and munching to stay awake did a number on me—we just won’t discuss WHICH number), but I also lost some beyond that.  And so next year’s goal is “keep up the good work.”  I’m going to tell you what is helping me and maybe it will help you.

First, whenever people talked about metabolism (pre-med school), it sounded like this nearly magical thing that if you were lucky it was fast, if you were unlucky it was slow, and if you weren’t careful you could ruin it.  However, metabolism is simply the sum of all of the processes in the body that build (anabolism) or break down (catabolism) things in the body.  (see my video on Metabolism on Youtube.  I’m Englishgalmd)  It isn’t magic and you can’t break it.  It is something you can understand well enough to make better lifestyle choices and lose weight.  It IS true that you can have a faster or slower metabolism based on a lot of things (like thyroid hormone levels, for example).  If you’re losing hair, getting fat, feeling weak, tired, and depressed, have dry skin  and brittle nails, experience constipation, cold intolerance, or loss of the outer 1/3 of your eyebrows ( you  can Google “hypothyroidism”) get that checked out!

If you’re overweight, you probably hope you have hypothyroidism, because it can be treated and as a result, it will be easier to lose weight.  However, most people who are overweight do not have hypothyroidism.  They have a math problem which is causing their weight problem.  This is the math problem:

(Calories in-Calories out)/3500 calories per pound=change in weight

Let’s break that down.

Calories in-Calories out=change in calories

If you take in more calories than you use, your body with have extra calories to store as fat.  If you take in LESS calories than you use, your body will have to use extra calories from fat (I’m saying this with caveats attached—see later) and you will have smaller fat stores.

Now, let’s examine the other part of that math problem.

Change in calories/3500 calories per pound=change in weight

If you take in an extra 3500 calories, (and a pound of fat is 3500 calories), then your body is going to store 3500 calories, or you will gain one pound of fat.  Even if you are eating only protein, you will still store extra calories as fat, because fat is the storage molecule.

There are ways to make this math problem more complicated, like you could exercise or live in a very cold climate or have a higher percentage of muscle.  And you may, if you’re building muscle, WANT to gain a pound of muscle which you’d do by working that muscle and then providing the proper amount of protein so when it rebuilds itself, it can be larger.   You might temporarily change your weight with extra bulk in your intestines or being very hydrated or dehydrated, but your body will normally balance those things out.  You might be retaining water somewhere if you have swelling at your extremities or have a sudden change in abdominal size.  That’s not a calorie problem and you should get that checked out by a doctor.

You could decide to not eat at all and live off your fat, but DON’T DO THAT!  Living only off your fat causes a lot problems, since your body still needs some glucose (it is your brain’s preferred food and the only food red blood cells can use), and fat can’t convert back into glucose.  The only way your body can make glucose once the glycogen stores are gone (after 24 hours of not eating glucose sources) is to break down protein in your body.  Protein is not a storage molecule.  You are using all of your protein for muscles, carrier molecules, enzymes, coating your nerves, etc.  So basically, you need some source of glucose to at least feed your brain and keep a few processes moving properly in your body.  However, you can use fat to fuel many processes in your body.  In addition, you need various vitamins and minerals.  Take a multivitamin, but realize that food sources are usually MUCH better than taking a vitamin pill, so please don’t starve yourself!

So, the equation can get really complicated, but fundamentally, it can help to think about how to manage the calories taken in or calories used.  Excess calories (the stuff you don’t need to build your muscles, repair things, move, maintain your body temperature, and perform all of your normal body processes) will get sent to fat cells and stored as fat.  And, as long as your body has enough glucose to do its job and enough protein to repair itself, then eating less calories than you use will lead to weight loss (mostly from fat).

The next thing I learned is that one part of the equation is actually a lot more important than the other.  Calories IN can change a lot faster than calories out.  If you don’t believe me, go check out how many calories various exercises burn in an hour.  Then compare that to how much junk food you could eat in an hour.  You can easily outeat your exercise capacity.  So, be wise with what you put in your body in the first place.  Don’t get me wrong.  Exercise is great!  You tone your muscles and help your heart and lungs function better.  If you do weight bearing exercises, it can make your bones become stronger.   It can release natural endorphins.   It can even give you 200-400 extra calories to play with in your calorie equation.  However, it cannot undo an extra 2,000-3,000 calories every day unless you also run a marathon every day.   And I notice if I work out VERY strenuously, I am ravenous afterward and also take it easy for the rest of the day.  That doesn’t help my cause, you know?

So, how many calories ARE you taking in a day?  You can get some pretty good estimates with calorie counters.  There are TONS of them online.

Calories out is trickier.  There are estimates on line for different exercises you do and your general activity level and how tall you are and your gender.  If you don’t want to mess with that, just weigh yourself every day and then see if you are going up, going down, or staying the same.  If you can maintain your weight on 1800 calories, then you know how many you are burning daily, right?  If you’re gaining weight on 2200 calories, then you already know you need to back off on your food intake because you don’t need as much as you think you do.

Now, here’s how to use the equation for good.  Let’s say you know you maintain your weight taking in 1800 calories.  You don’t have to do anything super drastic (especially if you’re nursing a baby or pregnant or still growing up).  Just try USING 1900 to 2100 calories.  How?  Move a little more. OR, you could TAKE IN 1500 to 1700 calories by eating less food at lunch or dinner and fill the rest of the way up with water.  Eat half the dessert you normally eat.  Cut out a splurge a week or chew sugar free gum instead of pretzels when you want something to munch.  You could cut out more, but if you cut out too much (like going down to 1 meal a day, or taking in less than 1200 calories a day) first of all, you start bringing in some of the more complicating parts of metabolism which I glossed over (getting enough glucose to make your brain function properly without using up all your body protein, being nice to your kidneys by not breaking down too much protein a day, etc.).  But, second of all, you’re setting yourself up for an unworkable long term plan.  If you’re planning on losing more than just a few pounds, it’s going to take a while.  I’ve been working on weight loss since January and I will be working on it for at least several more months.  There is NO WAY I could do it if I were starving myself, eating only the foods  I hate, or working hard to always bring limited foods I’m allowed to eat with me.  My perspective is, do it in a maintainable way.  If you do something really drastic (even if you somehow aren’t hurting your muscles and kidneys), you won’t be able to stand it for very long and then you’ll revert.

One of the keys to eating well as a resident is to plan your meals.  I’ve posted before about how to cook for yourself in medical school and residency (i.e. how to plan) but came across a site this morning I thought I should share. The Six O’Clock Scramble is a service you can subscribe to that sends you recipes (with shopping lists) for the week.  Most importantly, the recipes follow my “pizza rule” i.e. they take less time to cook than it takes to order a pizza.   You can customize it for vegetarian or other specific diet needs and also for the number of meals you want in the week.

For those of you that “don’t cook” – here’s a FAQ from the Website:

I am not a very good cook and I actually hate cooking!  How can the Scramble® help someone like me?

Scramble® recipes are designed to be EASY with all instructions clearly spelled out and few, simple ingredients.  Most importantly, the Scramble® takes the stress out of planning for meals by designing a week’s worth of balanced menus complete with healthy sides.

I have used this site myself in the past – the recipes are good and they are easy!  They also come with complete nutritional information, so if you are trying to control calories, limit fat or increase protein, you will have the information.   This service is a good compromise for students and residents that want to plan their meals, but don’t have the time.

The main reason I am posting this today is I came across a deal to subscribe at a discount if you do this before December 25^th: http://www.snack-girl.com/snack/healthy-dinner-recipes-six-oclock-scramble/ This would also make a great holiday gift for a busy medical student or resident!

Most operating room lounges provide food for the surgeons, residents and medical students.  In our operating room it’s usually bagels and muffins.  The muffins don’t seem that big… until you realize they are at least 2 servings each!  Check out this picture from fooducate.com.

Here’s a lot more eye opening examples: http://hp2010.nhlbihin.net/portion/

Knowledge is power when it comes to your diet – particularly if you are trying to lose weight (or at least not gain weight).  One of the biggest eye openers for people struggling with weight is to learn about the “portion distortion” that has occurred over the last decade or two.   This information will not only help you counsel patients, it will help you “walk the walk” by taking care of your own nutrition.   Weight gain is extremely common during clinical rotations and residency.  If you are interested in losing weight, or at least preventing weight gain, one of the first steps is getting a grasp on normal serving sizes, food groups and how many servings of each food group you should eat.

Here’s a good list of how to “eyeball” what constitutes a single serving (from Webmd.com)

• Vegetables or fruit is about the size of your fist.
• Pasta is about the size of one scoop of ice cream.
• Meat, fish, or poultry is the size of a deck of cards or the size of your palm (minus the fingers).
• Snacks such as pretzels and chips is about the size of a cupped handful.
• Apple is the size of a baseball.
• Potato is the size of a computer mouse.
• Bagel is the size of a hockey puck.
• Pancake is the size of a compact disc.
• Steamed rice is the size of a cupcake wrapper.
• Cheese is the size of a pair of dice or the size of your whole thumb (from the tip to the base).

Ultimately, a healthy diet should have (roughly) 8-10 servings of fruits and vegetable, 6 servings of grains or starches,  2-3 servings of milk or milk products and 1-2 servings of meat in a day.  One of the best resources to learn about how to plan your healthy diet is Canada’s Food Guide.  With all due respect to the USDA, the USDA Food pyramid is just not quite as intuitive (although it’s very complete!)

We all know the basics about how to be healthier and how much that can influence our risk of cardiovascular (and other) disease in the future.  Knowing is easy.  Changing is hard.

There is no doctor who wants to be fat, smoke, or eat poorly.  If you smoke, don’t exercise, eat poorly or are significantly overweight you already know

a) you have a higher risk of premature death and, worse, disablility

b) you’ll have decreased energy and generally feel worse than people who are fit

c) it’s going to be a lot harder to counsel patients about what to do for their health

It would be fantastic if we were all issued a magic wand as part of our medical supplies.  It would be so much easier to make changes in our lives and our patients lives by a wave of a magic wand.  There is no magic wand, but we (and our patients) can make changes using what is known about behaviors and changing behaviors.

The American Heart Association has recently published a review of the literature and recommendations on how to sustain changes that improve health.  I’ve put the link below to the entire article but here’s my summary (and slight translation) of what they found worked to change behaviors:

1. Set goals
2. Use a system to monitor the change
3. Create or discover a support system you can use on a frequent and regular basis
4. Establish a way to get regular feedback on your progress
5. Believe you can do it (and work on strengthening this belief)
6. Reward yourself when goals are achieved
7. Find role models for your new behavior and spend time with them (or what they have written)
8. Brainstorm to use your innate ability to problem solve.  Don’t accept “I can’t”
   or “never” in your vocabulary of change – find creative ways to move past these obstacles.
9. Learn from the times you fail (which is normal). ‘Try again. Fail again. Fail better.’  Samuel Beckett

Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults. A Scientific Statement From the American Heart Association Artinian et al, Circulation. 2010;122:406-441

Do’s and Don’ts of Goal Setting from www.sparkpeople.com

Elements of Change from zenhabits.net