Eating on the Run

Posted on July 5, 2013 by marylbrandt

“Downside, I skipped lunch and it is still in the work fridge. Upside, I don’t have to pack a lunch tomorrow!” – tweet from an intern on her first day

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It’s hard to eat well when you are crazy busy taking care of patients. Doctors really do know about nutrition, and we know we should set a good example. So why do we eat so poorly at work? I can’t do better than the list of reasons from this post:

1. The ”I don’t know when I’ll get to eat again” Phenomenon

2. The “Graham Crackers and Peanut Butter” Phenomenon

3. The “It’s free, therefore I must eat it” Phenomenon.

4. The “I’m so tired I have to eat something to stay awake” Phenomenon

5. The “I’m on call so I deserve a giant cookie” Phenomenon

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Why it’s important to make conscious choices about what you eat at work

1. You actually hurt your patients if you don’t eat well.

Physicians that don’t eat at work have slower simple and complex reaction times. You don’t think as clearly or respond as quickly. Start thinking about your own nutrition as a part of good patient care.

2. If you are like most people, not eating at work will result in gaining weight.

Even if you don’t gain weight, you will likely have a detrimental change in your body composition. (i.e. you’ll get flabby)

3. Not eating at work will result in losing weight for some people.

For some people stress leads to appetite loss. These are the residents that aren’t hungry even though they are not eating enough. The message here is that your weight during residency is a decent barometer of your stress level and how well you are coping. If you are losing or gaining, notice it early and adjust how you are eating, working out and coping with the stress of your job.

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There’s no question that the best option is to plan, prepare and bring your own food to work. Even though it takes time to do this, you’ll save time in the hospital by knowing what you have and where it is. (A good point made in the article “Strategies Resident-Physicians Use to Manage Sleep Loss and Fatigue” which you can download from http://med-ed-online.net/index.php/meo/article/download/4376/4558). Food choices in the hospital are limited, often poor, and not always available. Make time on the weekends to plan for the upcoming week and shop for good food. If you can, choose one healthy recipe to cook on your day off and make enough that you have plenty of meals in the refrigerator for when you get home.

General principles

Eat at least every 6 hours. It’s probably better if you eat smaller amounts every 3-4 hours. Eat even if you are “not hungry” if it’s been 4-6 hours since your last meal.
Make sure you are getting plenty of protein. Eating simple carbohydrates makes you less alert and creates bigger swings of insulin levels.
Don’t drink your calories. (But do drink enough water)
The processed comfort foods that appear like magic in hospitals (doughnuts, pizza, etc) seem delicious when you eat them, but are terrible for you.
Plan, plan, plan. It’s worth it.
Eat fruits and/or vegetables with every meal.
Bring good food from home. If you don’t cook, buy good food to bring.
Make sure you have “pocket food” in your pocket at all times. (Food that fits in your pocket and doesn’t need refrigeration.) You may not be able to stop for a real meal, but you’ll be able to eat something.

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Examples of “pocket foods”

Kind bars. Many meal replacement bars might as well be candy bars when you look at the ingredients. Clif, Larabar, and Odwalla are all good choices. Kind bars have no added sugar, a fair amount of protein and are made of only real food.
Peanut butter and jelly sandwich. (Whole wheat bread, fruit spread, peanut butter without transfats)
Cabot 50% cheese or string cheese (higher protein, lower fat than most cheese)
Edamame (shelled is easier)
Homemade Trail mix – mix different nuts and dried fruits together and put in snack bags
Baked or steamed sweet potatoes with a little salt
Fruit

Fast Food for Call Nights

Posted on May 24, 2013 by marylbrandt

It’s 2am on call. All of a sudden you are starving, not to mention craving comfort food. The only thing available is MacDonald’s or (on rare occasions) the leftover pizza from the noon conference. It’s a problem. Eating that kind of food at 2am will almost certainly result in food coma, not to mention that you really know it’s not healithy or what you would recommend for your patients.

Here’s the answer.

These tacos are a great breakfast on the run, afternoon snack or 2am call food. It takes ~15 minutes to make 10 of them on the weekend – which is enough to last for several weeks.

Start by chopping up the veggies you want to put in the tacos. My “go to” is one red bell pepper and a poblano pepper. Corn and rice work well, too. You can change the taste by using different cheese and different veggies (broccoli, carrots etc with Monterrey Jack, for example).

Buy the cheese you want already shredded. Lowfat Mexican is my usual choice, but any cheese is fine. I’ll often cut up a block of 50% Cabot cheddar cheese which is a great tasting low calorie cheese.

Put 10 whole wheat tortillas on the counter and divide one can of refried beans between them. Use nonfat if you are watching calories. Black beans, pinto beans, spicy or not – your choice!

Divide up your veggies and cheese onto the 10 tacos.

Roll them up and put them in snack size plastic bags.

Put the little bags in a gallon freezer bag (important to prevent the bad taste of freezer burn) and put them in the freezer. They last for weeks.

Two minutes in the microwave directly from the freezer gives you a great breakfast, snack, or middle of the night comfort food!

Healthy, Fast, Easy (and delicious) Recipes: CookingLight.com

Posted on February 17, 2013 by marylbrandt

It’s not easy to eat well as a medical student, resident or busy physician. Besides setting a good example, eating well is important to feel well when working hard. .. not to mention it really pays off in the long run. You don’t have to spend hours in the kitchen to eat well at work but you do have to cook (some) and plan (always).

One of my favorite sites to find healthy, easy, delicious recipes is cookinglight.com. They have sections like Superfast Stir-Fries and Sautés and Quick and Healthy Recipes which are fantastic for busy clinicians. If you aren’t a cook, they also have a section called Cooking 101 where you can learn basic techniques. Before you say you “can’t cook” remember – If you can learn anatomy, you can learn to cook!

Coconut Curried Pork, Snow Pea, and Mango Stir-Fry

Healthy, homemade steak house pizza

Chickpea Bajane

Setting an Example: Eating Well

Posted on August 5, 2012 by marylbrandt

At some point all physicians give advice to their patients about dietary changes to improve health. Let’s be honest. We don’t do so well ourselves. The “classic” fare of residency (donuts or muffins for breakfast, pizza for lunch, and some fast food on the way home) doesn’t really give you much credibility when you are talking to patients.

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No medical student or resident is going to be able to eat perfectly, exercise regularly, and do all the other things that lead to a healthier lifestyle. But every little change you make now will pay off. You’ll feel better and have more energy. You’ll be less likely to gain weight. And – you’ll be able to talk to patients – with specific examples – about what they can do to improve their own health.

In the crazy busy life of medical school and residency, it’s hard, if not impossible, to spend time and energy to shop, cook and eat really well. It doesn’t get much better once you start your practice. What is possible, no matter how busy you are, is to realize that there are some simple things you can do to improve what you are doing now.

My top 10 tips for better eating in medical school and residency

1. Eat fruits or vegetables with every meal or snack. This may mean buying a bag of apples once a week and just eating apples twice a day (boring but effective). Even better, follow the “USDA plate” recommendation – ½ fruit and vegetable, 1/4 protein 1/4 grain/complex carb on every plate of food you eat.

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2. Eat breakfast. If you are up too early to really eat, make a smoothie the night before to put on the blender when you wake up and take it with you in the car. My personal favorite: ½ cup plain Greek yogurt, ½-1 cup of fruit, ¼ cup egg whites (pasteurized, in a carton), 1-2 Tblsp honey.

3. Eat more eggs (especially egg whites). Eggs have gotten a bad rap, but they are very cheap and very easy to cook. Cook hard boiled eggs on the weekend to eat for breakfast or snacks during the week. Make omelets or huevos ranchero for dinner. Go ahead and spend a little more to get cage-free eggs to do the right thing.

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4. Don’t skip meals. Even on the worst call day you can keep a meal replacement bar or two in your pocket.

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5. Pack the food you need for call days the night before so it’s ready to go in the morning.

6. Chop up a bunch of veggies on the weekend to throw in salads, soups or in wraps.

7. Cook or buy one good meal on the weekend that will last for part of the week. A good stew or soup? Lasagna? Look for good recipes on the web. If you really don’t want to cook, find a healthy caterer or restaurant to buy it instead.

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8. Take a good sandwich to work for one or more meals. Peanut butter on whole wheat may be monotonous, but a) it doesn’t have to be refrigerated and b) it beats McDonald’s.

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9. Free pizza isn’t really free. It’s incredibly high calorie and the ingredients in the cheap kind aren’t good for you. (Same for take out Chinese, donuts, muffins, etc)

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10. Skip the liquid calories. Cokes may give you an energy boost, but you are better off with real calories from a piece of fruit, a sandwich and some coffee or tea. (but learn how to use caffeine effectively)

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Starting Internship (I know what you are worried about)

Posted on June 24, 2012 by marylbrandt

I sat at the table this week with our new interns and the outgoing chief residents. Listening to our new interns as they asked questions, I realized everyone starting their internship has the same fears, whether or not they express them: Will I kill or hurt someone? Will I look stupid? What if they find out I’m not as smart as everyone else? Will I get divorced/separated/alienated from my friends? Will I gain weight? How am I going to find time to take care of myself?

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What you are feeling is normal. Every doctor who ever started an internship felt exactly the same way. The best way to manage your (healthy) fear is to have a strategy. I’ve written in the past about how to succeed as an intern. But if I were going to condense that advice into three easy rules (for every day except your day off) it would be these:

1. Read at least one section from a textbook in your field every day

2. Learn something (in detail) from at least one patient every day

3. Do something to take care of yourself every day

Read at least one section from a textbook in your field every day.

Your goal for the year should be to read a major textbook in your field cover to cover. You don’t have to buy the physical book. It’s fine if it’s on line or downloaded onto your iPad.

Once you have the book, make a list or spreadsheet of all the sections in all the chapters. For most textbooks, it’s probably going to be a list somewhere between 150 and 200 topics. When you look at the 48-50 weeks you will be working this year, it works out to basically a topic a day (with some days for review).

The real goal is not just to read these topics, but to really learn them. So, when you read, don’t just skim. Read to learn. That means taking notes – and reviewing them.

Put a chart on the wall with the list and give yourself a gold star when you finish a topic if you have to, but find a way to make sure you cover all the topics (at a steady pace) during the year.

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Learn something (in detail) from at least one patient every day.

It’s really easy, as an intern, to get caught up in the work and forget that you are fundamentally here to learn – not to provide service. Make it a daily habit to learn in detail about one patient in your care. It will overlap nicely with your goal to read a complete textbook. When you admit a patient with pneumonia, read the section (and make notes) on pneumonia and then check it off your list.

One other important point (that none of us like to hear) – You will make mistakes. Be humble, be honest, and learn from your mistakes. The mistakes you make (and maybe more importantly your “near misses”) are absolutely your most valuable teacher. When you do make a mistake, use it as the topic you will review for the day. You are going to be really upset but be easy on yourself. Being upset is the mark of someone who cares, but don’t let it escalate beyond a healthy response. Talk to your mentors and senior residents. They’ve been there.

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Do at least one thing to take care of yourself every day.

This may sound trivial, but it’s not. If you can, try to eat well, get some exercise and be social every day. At a minimum, though, pick one specific thing you are going to do for yourself and then do it.

Eat well

Get Some Exercise

Be social

Fast, Easy Recipes: Kalyn’s Kitchen

Posted on January 17, 2012 by marylbrandt

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

Fast, Easy Recipes: Simplyrecipes.com

Posted on October 20, 2011 by marylbrandt

I’m always looking for new websites that have easy, delicious and healthy 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).

My latest find is simplyrecipes.com. It’s a great site run by Elise Bauer. These are mostly recipes she and her family have created. There is a section on “budget recipes” and another one on “Quick Recipes” both of which are great for students and residents. She also has a lot of instructions about cooking if you are new to the kitchen.

Baked Shrimp with Tomatillos

Sesame and Cilantro Vermicelli Salad

Chicken Breasts with Mushroom Sage Sauce

This Month’s Healthy Habit: Eat More Fish

Posted on September 14, 2011 by marylbrandt

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! This month’s healthy habit is to eat more fish.

Seafood is a great high protein, low fat food. It’s also a great source of Omega-3 fatty acids. It also has the advantage of being very fast to cook, a big plus for medical students, residents and busy docs.

How do you decide on which seafood to buy?

There are two things that should guide you in picking fish. Importantly, one of them isn’t price. You need to know about sustainability and toxicity when choosing your seafood. Seafood that is caught or raised in a sustainable fashion with low toxicity is more expensive, but worth the extra cost.

It’s a sad fact that the oceans are being heavily overfished. It sounds like an easy fix to farm raise the fish, but it’s not always true – sometimes the pollution that results from fish farms is worse than the overfishing.

The Seafood Watch from the Monterey Bay Aquarium is an amazing resource to find out which seafood is being caught or farmed responsibly. It’s available on line or as an app for your phone. Look for labels from the Marine Stewardship Council or Friend of the Sea, too.

For docs, it’s important to know that, like all foods, there are contaminants that can occur in seafood. The risk – unless you are immunocompromised – is tiny compared to the benefit, though. Another serious issue is the concentration of heavy metals (mercury and lead, in particular) in some of the larger fish. This is particularly important for women of child-bearing age and for children. Heavy metals are concentrated in large fish because of the food chain. It makes sense that smaller fish will have negligible (or absent) levels. Fortunately, they are also higher in omega-3 fatty acids making them an even better choice! Sardines, anchovies and mackerel may not be on your usual list of foods, but give them a try. Here’s some good sardine recipes to get you started.

What about tuna?

Canned tuna is a cheap and high-quality food, so it’s high on the list for medical students and residents. Unfortunately, all tuna is not created equal – so you have to pay attention. It’s more expensive, but look for pole-caught tuna in the store. Blue fin tuna, and most other tuna used in sushi is incredibly overfished and should be avoided.

Fast, easy recipes to get you started

Thai Red Curry Shrimp

Marinated Salmon with Mango-Kiwi Relish

Fish Tacos with Cabbage Slaw

Fast, Easy Recipes: The Gracious Pantry

Posted on August 21, 2011 by marylbrandt

The Gracious Pantry is written by a full time student who “creates simple, clean eating recipes with everyday ingredients.” The recipes are healthy, simple and beat eating fast food when you are on call. This website has a lot of delicious looking, healthy 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).

Butternut Squash Soup with Coconut Milk and Cilantro

Southwest Breakfast Muffins

Weeknight Spaghetti

Healthy Habits: Go Meatless (at least) One Day A Week

Posted on July 30, 2011 by marylbrandt

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

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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.