Healthy Habits: Eat Healthy Fats

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!

It’s a lot easier to commit to 30 days of a new habit than a full year.  So this month’s goal is to eat more healthy fats.

The “myth” of fats has become so pervasive in our society that even physicians (and physicians in training) succumb to the idea that fats are somehow “bad”.  The type of fats we consume as a society have changed in the last few decades, a change that may have played a part in our current obesity epidemic (and associated diseases).  If you are interested in reading more about this, I would suggest starting with Michael Pollan’s In Defense of Food, David Kessler’s The End of Overeating:Taking Control of the Insatiable American Appetite, and Laura Sim’s The Politics of Fat: Food and Nutrition in America.

What kind of fats are in the food we eat?

There are three important dietary fats :  saturated fats, unsaturated fats, and transfats.

Link to source for this chart

  • Saturated fats are generally solid at room temperature.  All animal fats are primarily saturated (meat, lard, butter, cream, fish oil).  The majority of plant based oils are primarily unsaturated, but there are a few exceptions.  Examples of vegetable oils that have a high percentage of saturated fat include palm oil and coconut oil.

What fats should I eat?

Here is a great summary from mayoclinic.com– the “bottom line” of how to adjust your fat intake for an optimal healthy diet

  • Limit total fat to 20 to 35 percent of your daily calories. Fat has 9 calories a gram. Based on a 2,000-calorie-a-day diet, this amounts to about 400 to 700 calories a day, or about 44 to 78 grams of total fat.
  • Emphasize unsaturated fats from healthier sources, such as lean poultry, fish and healthy oils, such as olive, canola and nut oils.
  • Limit less healthy full-fat dairy products, desserts, pizza, burgers and sausage, and other fatty meats.

Fat content in “I forgot to bring my own food” on-call food….   Which is why it’s so important to plan your food on call.

  • McDonald’s Quarter Pounder with cheese:  26 grams of fat (12 saturated, 2 transfat)
  • McDonald’s Big Mac: 29 grams of fat (10 saturated, 2 transfat)
  • McDonald’s large fries: 30 grams of fat (6 saturated, 8 transfat)
  • Domino’s Pizza (2 slices Pepperoni): 26 grams of fat (11 sat, 0 transfat)
  • Chipotle Chicken burrito (all the way): 53 grams of fat (20 sat, 0 transfat)


Photo source

More information on dietary fat:

Dietary fats: Know which types to choose from mayoclinic.com

Fats and cholesterol from the Harvard School of Public Health

Fat – From the NY Times Health Guide

Advice for New Interns

The summer is the time that the roughly 16,000 new doctors in the United States start their residency training. For all new interns, even though it doesn’t feel like it, you are ready!  The first year of medical school gave you the “vocabulary” you needed for this new language. The second year gave you the “grammar.” Your rotations in the clinics taught you the “language”.  Now you get to actually use it every day!

This year will be one of the most profound transitions you will ever make…. and it will also be a year of intense and fabulous memories. Take some time to write down the stories, or take some photos (but not of patients unless you have their permission!). These notes and images will be precious memories in the future.

In talking to other physicians and thinking about my own experiences, here are a few words of advice for you as you start your internship:

Learn from every patient.

As an intern, you will need to know a lot of detailed information on your patients. You’ll need to use a system to keep track of all this information so that when you are asked, you know the last potassium level, which antibiotics were ordered and what the ID consultant said. If you have a system you developed as a 4th year medical student, great! If not, start with 3×5 cards. Keep one card per patient, clipped together or held together with a metal ring. In the era of the EMR, much of the information you need can be easily accessed… but not really organized the way you need it. If you have developed a good system that doesn’t require physical cards, please send me a message so I can see it!

That covers the information, but not the learning. Learning is something that should be actively integrated into your day, not something you do at night when you are falling asleep. Work on a system that lets you record what you are learning during your daily tasks in a way you can review later. 3×5 cards are a simple, cheap and very effective system for studying medicine, which I’ve described in a previous post. Make a separate card (or use the back of your rounding card) to list something (anything) you learned from every patient you see. p.s. Don’t lose your cards!!!! (HIPAA violation)

Don’t confuse gathering information with studying information. Taking notes is a critical part of learning. Don’t just store chapters and articles in your Google drive… summarize them to review later by taking notes.

Be the doctor for your patients.

This may sound obvious, but in the everyday world of the hospital, it is really easy as an intern to get lost in the details of patient care… and forget about caring for the patient. Stop every once in a while and remember that you really are their doctor. Take a few deep breaths and put yourself in their shoes for a minute to ask something about their family, hold their hand, or just sit with them for a minute.

It’s very easy to get swept away by the velocity of the work most interns experience and lose the “big picture”. When you are confronted with something you haven’t seen before, push yourself to make a plan before you call your upper level resident or the attending. What if you were really the only doctor around? What would you do? Spend 2 minutes on UpToDate if you have to, but don’t just be a clerical worker – be their doctor.

Part of being a good doctor to your patients is to recognize your own limitations. You should never feel bad about calling someone with more experience, no matter how “dumb” you think the question is.  It’s the right thing to do for the patient.

Be deliberate about learning your field.

From day one, commit to an organized plan of study to cover everything you need to learn in your field. Make a plan to read (and then study to learn) a textbook every year. Make notes that are easy to review, so you don’t have to go back to the textbook to review the material.   Whatever system you use, make it easy to integrate the notes you are making in the hospital (e.g. the 3×5 card on each patient) with your organized study system. Adding articles into the mix is fine – but only after you have mastered the basics. Don’t let reading the latest finding take the place of really learning the material in the textbook.

Be kind and be part of the team.

Hard work is made easier when it’s done with your friends. You will all be tired, you will all be stressed, but be kind to each other. Staying 5 minutes more to help out a fellow intern is an investment that will help both of you. Look for ways to apply the golden rule of internship:  “Help others the way you would liked to be helped”.

Make your bed.

Do this simple act every morning to remind yourself to take care of yourself. Find time to consciously take care of your emotional, physical and spiritual health. Take good food to the hospital for your nights on call. Find ways to get stress reducing exercise into your weekly schedule, or at least find ways to increase your activity while you are at work. Watch your weight – if you are losing or gaining, it’s a sign that you need to focus on your own well-being by improving your nutrition and working on your fitness. Nurture your relationships – make your family and friends a priority. Take care of your spiritual needs in whatever way is best for you, but don’t ignore this important aspect of self-care.

Smile!

You have the enormous privilege of caring for other people and learning the art of medicine. Take a little time every day to notice the moments of joy in this work and, if you can, write them down to look at on the days you are tired.

Congratulations to you for all you’ve accomplished thus far!  Enjoy this incredible journey!

What To Do This Summer

This week approximately 16,000 US medical students are going to receive their diplomas and become physicians. There are also about 16,000 college graduates who will start medical school later this summer or early in the fall.  Congratulations to you all!

Nearly all of you have a well-deserved month (or two)  to rest and get ready for the next step in your training.  So, I thought it might be helpful to pass on a few words of advice on how to spend your time this summer.

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Do NOT study!

  • If you are starting your residency and you think it might help relieve your (normal) anxiety, here is what to do:  Buy one of the major textbooks and use it to get excited about what you are going to learn.   If you want to, plan how you are going to study for the year.   Skim the book if you really have to do something to feel less anxious, but don’t spend hours studying.
  • If you are getting ready to start medical school – step away from the books!  Seriously, there is nothing you can do that will make it any easier, so just enjoy your time off!

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Take a vacation (or two or three…)

  • Visit family and friends – take a road trip and connect with people you haven’t seen in a while
  • Hang out on a beach, go for some great hikes, read some great novels
  • Sleep late, eat well, and just rest

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Develop (or strengthen) an exercise habit

  • Use this summer to develop a daily exercise routine that you can take into your new (and crazy) schedule.  Overall, your goal for the summer should be to develop a balanced exercise program (cardio, strength training and flexibility).  If you’ve never done any strength training, hire a trainer and learn about it.  Your goal should be at least 30 minutes of cardio 4-5 times/week, 2-3 strength training sessions/week and stretching every day. If you develop a balanced exercise routine this summer, it will be much, much easier to continue this once you start medical school or your internship. Commit to doing at least 30 minutes of exercise a day this summer.
  • Running is one of the best (and most convenient) cardio exercises for medical students and residents (because it’s cheap, efficient and effective)  Use this summer to become a runner. If you hate running, find another good cardio exercise habit to develop instead – but pick one!
  • If you don’t own a bicycle, think about getting one that you can use to commute to school or the hospital.

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If you don’t know how to cook, learn.

  • Unless you want to gain a lot of weight, have poor energy and feel bad, you are really going to have to cook for yourself (or at least plan for good food cooked by someone else).  You won’t be able to eat what you need, particularly as an intern, unless you bring the food with you.
  • Learn some basic skills to cook simple things.  If you have good cooks in your family, have them teach you.
  • If you don’t have family members who can teach you, find cooking classes near you and sign up.  Many high end grocery stores and gourmet stores offer classes for beginners – look on line for classes near you.

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Healthy Habit: Eat Breakfast Every Day

One of my New Year’s resolutions 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!

Cooking Light’s 12 Healthy Habits

It’s a lot easier to commit to 30 days of a new habit than a full year.  So this month’s goal is to eat breakfast everyday.

Granola with Yogurt & Berries from zestycook.com

Most residents and medical students start their day early.  At 5 am, no one wants to eat a big breakfast.  But, you really should eat something as you are heading out the door.  By 9 or 10 am, you’ll be hungry – and the muffins in the surgeon’s lounge (or breakfast at MacDonald’s) will be calling out your name.  You have to have a strategy to manage this rise and fall in insulin (and accompanying “starvation”).  If you don’t, you’ll end up eating nothing but fast food (and the box it comes in).

Physicians in practice and training should probably make a commitment to eat two breakfasts, not just one – an early breakfast to literally “break the fast” from the night before and a second breakfast in the mid morning.  (aka “Elevenses”)

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A good breakfast should give you a balance of protein and carbohydrate, with a little fat.   Here’s a list of suggestions for breakfast that provide the right mix of nutrients and are easy (fast) to prepare:

  • Cold cereal with milk
  • Yogurt with cereal and fruit
  • Oatmeal or other whole grains with milk +/- toppings
  • Leftovers from last night’s dinner
  • Frozen waffles or toast (whole grain is better) with peanut butter
  • Bagel or toast with cream cheese and salmon
  • Rice (or other grains) with eggs
  • Energy bars
  • Sandwiches
  • Egg mugs
  • Smoothies
  • Breakfast tacos (see below)
  • Scrambled eggs (plus whatever you want) in a tortilla
  • Healthy fast food
  • Homemade muffins or breakfast bars (make a batch on the weekend)
  • Hardboiled eggs and fruit

Healthy breakfast sandwich from foodnetwork.com

MLBs Breakfast Tacos

These breakfast tacos are my “go to” breakfast for hectic mornings.  I make them on the weekend in a big batch to freeze for the week

Buy 10-12 whole wheat tortillas, 1 can of fat free refried beans, 1 bag of reduced fat shredded Mexican cheese.   (if calories aren’t an issue for you, use regular refried beans and shredded cheese)

Spread all the tortillas out on the counter and divide everything up between them.

Add whatever else you want:

  • cooked chicken or turkey (grilled in the deli is best)
  • Sausage (regular or veggie)
  • Corn
  • Rice
  • Bell peppers or Roasted red peppers (from a jar)
  • Fresh or canned green chiles

Put the tacos in the freezer in individual freezer bag .  Put the individual bags in a big freezer bag if you want to further limit freezer burn.

2 minutes out of the freezer and into the microwave = breakfast.

Breakfast taco from cleananddelicious.com

Other links to ideas for fast, healthy breakfasts

Why You Should Eat Breakfast from wellnessrounds.org

Healthy breakfast: Quick, flexible options to grab at home from mayoclinic.com

10 Quick, Healthy Breakfast Options from thedailygreen.com

10 Tasty, Easy and Healthy Breakfast Ideas from zenhabits.com

Healthy Habit: Get Cooking

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!

Cooking Light’s 12 Healthy Habits

Last week I had a fairly common conversation with one of my residents.  She told me that with her schedule it’s almost impossible for either parent to cook for the family.  Secondly, she said when she does shop for food, she buys everything she thinks she might need… and half of it goes bad in the refrigerator.   They have resorted to picking up take-out as their solution to the problem.  There are at least two major problems with this strategy (and a lot of other minor problems): 1)  It costs a LOT more and 2) It is clearly not going to be as healthy.

I know this is a common scenario, hence why this month’s resolution is to cook at least 3 meals a week at home.  It’s doable!  Here’s how to get started:

Change your mindset about cooking.

Cooking is not hard and it doesn’t take as long as you think.  There are some basic skills you have to know, but you can start small and add new skills one at a time.  Make up your mind that you are going to acquire this important skill and practice!  Start with one simple act – sautéing an onion.  Here’s how to cut up an onion and how to sauté.  If you get this one simple skill down, you’ve learned the beginning of many, many recipes!

Make a plan

Decide ahead of time what you are going to cook and write it down. You can map out the whole week if you are a “gunner” – but,  at a minimum a) find 3 recipes for the week b) make a shopping list for the ingredients in those three recipes and c) go shopping.  If you plan ahead, you’ll have everything you need – but not a lot more (so no more growing interesting molds in the back of the refrigerator).  You’ll also be able to really eat well when you are on call (which is the hardest day to plan for).

Remember the pizza rule.

No one who is really busy has time to do fussy cooking.  You should look for recipes that take less than 30 minutes (the time it takes to order a pizza).  I’ve posted a lot of recipes that meet this requirement (use the tag marked “recipes” to the left of this web page).  Another strategy is to pick a cookbook, one issue of a magazine, or a website (some of my favorites are listed below) to choose the week’s recipes.  Another option is to subscribe to a site that will send you weekly menus (and will also automatically make your shopping list) – like Six O’Clock Scramble ($54.50/year) , Send Me Recipes ($65/year), Dinner Planner, ($60/year), or Make Dinner Easy (free).

Cook ahead for the week

It’s boring to eat the same thing over and over… but it beats buying fast food on the way home.  If you cook a big casserole or stew on the weekend, you’ll have it for meals on call, late at night or lunches.  If you really want to cook just once for the entire week, you can double the recipe or make two different dishes at the same time, and freeze portions for later in the week.

Supplement your main dish with lots of fruits and vegetables

If you don’t have a steamer basket, this is a cheap piece of kitchen equipment that is really worth having.  Almost any vegetable can be sautéed or steamed and it’s really easy to do.  Buy vegetables fresh, wash them, dry them and then store (clean) in the refrigerator (one less thing to do when you are tired). Refrigerator to plate will be less than 10 minutes for most veggies. (Here’s a table of cooking times for vegetables.)  Leftover steamed vegetables make a great “salad” by themselves (just add some olive oil, vinegar, salt and pepper) or as an addition to other salads.  You can also toss them into scrambled eggs or an omelet.  Having steamed potatoes in the refrigerator is particularly helpful – they are great in salads, with eggs, or just as a snack.  Frozen vegetables are more expensive, but are perfectly fine, too.

Make a list of  “emergency” meals (<5 minutes) for nights you are completely exhausted and really, really don’t want to cook. (And keep these items in your pantry and/or refrigerator.)

Here are some ideas to get you started:

1.    Scrambled eggs or egg whites (with leftover veggies and/or cheese if you have them) with toast.

2.    Angel hair pasta (takes 3-5 minutes) with bottled spaghetti sauce with a green salad

3.    Veggie (or regular) hamburgers (from the freezer) with a green salad

4.    Couscous with canned beans, canned tomatoes and any leftover (or frozen) vegetables you have

5.    Sandwiches

6.    Pancakes

Websites for “pizza rule” recipes

eatingwell.com

cookinglight.com

myrecipes.com

foodnetwork.com

My favorite magazines to cook from

Cooking Light

Bon Appetit

Clean Eating

Vegetarian Times

Cookbooks worth buying

How To Cook Everything

The Silver Palate Cookbook

The Art of Simple Food

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January’s Healthy Habit: Fruits and Vegetables

I had already decided that I would propose a “resolution” every month this year for myself and anyone who follows this blog when I came across Cooking Light’s 12 healthy habits.  Cooking Light is one of my favorite magazines, so I’m going to take their idea and run with it!

It just makes sense to spend 30 days working on a single habit to change, rather than creating a long list of resolutions without an endpoint. If this idea works for you, take these habits (one at a time) and work on them for a month.

Here is January’s healthy habit:

Add at least 3 servings of vegetables and fruit to your daily diet

Here’s some suggestions for how to accomplish this goal.  These are some of my ideas and other ideas compiled from suggestions on thedietchannel.com, nutrition.about.com, cancer.org, and health.harvard.edu

  • Take fresh fruit or veggies with you to work to eat as a morning and afternoon snack.  The best fruit for your pocket are apples, clementines carrot and celery sticks, cherry tomatoes (in a Ziplock bag), and grapes (in a Ziplock bag).
  • Cut-up celery, carrots, bell pepper, cucumber, etc and keep them front and center in your refrigerator for snacking.   If you don’t like them plain, dip them in hummus or ranch dressing.  They’ll be fresher if you do this yourself, but if you need to, buy them already cut up in the grocery store.
  • Add fruit like berries, a banana or a cut up peach to your cereal in the morning.
  • When you shop, buy the ingredients to make a mirepoix, chop them up and store them in the refrigerator.  A classic mirepoix is carrots, celery and onion.  The Cajun “trinity” is a variation – celery, onion and bell pepper.  Pick anything that can be cooked (mushrooms, bell peppers,  are a good addition), and chop them up when you get home.  Grab a handful for stir-fries, salads, omelettes or soup.
  • Steaming vegetables is really easy and very fast.  If you don’t have fresh vegetables (or don’t want to take the time to steam them), make sure you keep steam and serve frozen vegetables in your freezer as an easy way to add vegetables to your meals at home.
  • Keep frozen fruit in your freezer to throw in a blender with yogurt or milk to make smoothies.
  • Dried fruit is a good occasional substitute for fresh fruit, but beware – it’s very caloric!
  • If you are making a sandwich to take to work, pile on veggies – spinach, shredded carrots, cucumbers etc.  Use avocado instead of mayonnaise.
  • Fruit or vegetable juice is not a great substitute, but will do in a pinch.  Most fruit juices are high in calories.  It’s always better to eat the fruit if you can so you get the fiber and other nutrients, but if there are no other options, juice is better than nothing!
  • Applesauce and canned fruit (in water) can be bought in single serving portions, or you can share larger portions!
  • If you are buying food for lunch in a cafeteria or fast food restaurant, look for vegetable soup or a salad bar than lets you pile on the veggies.
  • Sweet potatoes can be microwaved in 10-12 minutes and make a great meal when paired with a salad or some frozen veggies.
  • Choose desserts that are fruit based – and have as much fruit as possible.  Chocolate dipped strawberries or a berry cobbler are better than cheesecake!

Clean Eating

If you want 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 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, eatcleandiet, cleaneatingmag

On Losing Weight – Part 2 (The Roadblocks)

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.

On 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.

Easy Fast Recipes: The Six O’Clock Scramble

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.

logo_scramble

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 25th: 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!