Why You Should Eat Breakfast

Most of us start very early in the morning and have a variety of excuses why we don’t/won’t eat breakfast, most often “I’m never hungry this early” or  “I’m in too big a rush”.  You don’t have to go to medical school to realize that your blood glucose levels will be low after 8-10 hours of no food.  It’s why things like donuts and sweet cereals are so popular for breakfast  But a quick infusion of sugar to spike your serum glucose leads to a spike of insulin which leads to hypoglycemia.  Not a good idea if you want to stay awake in class or be sharp when seeing patients.

It’s much better to eat a breakfast with carbohydrates, protein and little fat if you want to sustain your glucose levels.  There are a lot of other advantages to eating a good breakfast.

No one with a busy schedule is going to spend time preparing a “fancy” breakfast in the morning.  But there are many, many good options that don’t take any time at all.  I’ve listed some great websites and recipes below – but don’t limit yourself to these.  Look into typical breakfast choices in other countries, eat the leftovers from last night’s dinner…. Just don’t skip breakfast!

15 ways to eat a beautiful breakfast

18 Quick Breakfast Recipes for Busy Mornings

12 Smart Ideas for Breakfast On the Go

Portion Distortion

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.

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 during residency, 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 CD.
  • 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).

As a guide, 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 or other vegetable protein in a day.

Photo credit

 

 

How Many Push-Ups Can You Do?

It may seem weird to do an entire post on push-ups…. but push-ups are an incredible exercise and not very time consuming.

New York Times article about push-ups

In the busy life of students, residents, and practicing docs it’s easy to lose track of your own fitness.   There’s no question that consistency, not quantity is the key to success in staying fit while you are busy.  Which means you have to give up the notion of working out for any specific time period and realize that even 10 minutes a day matters.

Which is where I got the idea for push-ups.   (Well, to be honest, I started thinking about push-ups when I heard about one of our residents who recently ended up in a tie-break challenge in a trivia contest.  The tie-break was to see how many push-ups you could do.  She beat two big guys…. in high heels and a strapless dress!)

For the fledgling anatomists (since a lot of first year students are studying upper body anatomy right now):  The primary muscles you use in doing a push-up are the pectoralis major and minor muscles.  The key secondary muscles are the triceps and anterior deltoids.  But – because a push-up is basically a plank with motion, you also use muscles in your abdomen, back, and legs, too.  This is why it’s such a fabulous exercise to maintain (and even build) fitness if you don’t have much time.

The form you use in doing a push-up is important.  Cheating not only diminishes the return on your exercise investment, it can actually hurt your back.   Here’s two websites that explain the details on proper form for a push-up:

How to do a proper push-up

How to do a push-up

Most women, and some men,  won’t have enough strength to start with “regular” push-ups.  The form is really important – if you can’t maintain your back straight during the push up, or get your body down all the way to the floor, you’ll need to start with a modified push-up.  Don’t worry, it won’t take long and you’ll be able to do the “regular” push-up.  Don’t risk hurting your back (even if you are feeding your ego) – start where it’s appropriate!   If you haven’t done push-ups before, you’ll probably need to start with knee push-ups and then move on to “hand elevated” push-ups.  Push-ups are easier to do if your hands are higher than your feet, like against a wall or hands on a table or chair.  An easy way to use hand elevated push-ups to train for “regular” push-ups is to use steps (like the stairs at work when you are on call or at school if you are in the basic sciences).   Start with your hands on the 4th or 5th step in front of you and do your set of push-ups. As you get stronger, move one step down.  Eventually, you’ll move down through all the steps until your hands are on the floor.

Training to do pushups isn’t hard, and, with a little planning and coaching, you’ll be able to do many more than you think.  Here’s the url for a great website that explains how anyone can get to the point that they can do 100 pushups:  http://hundredpushups.com/

Just for fun… the world record for consecutive pushups is 10,507, set in 1980 by Minoru Yoshida.

You are probably pushing the equvalent of about 50% of your body weight when you do a push-up.      http://www.funtrivia.com/askft/Question23103.html

Push-ups are called press-ups in the UK  http://en.wikipedia.org/wiki/Press-up

Breakfast Idea – Eggs Mugs

I recently found an easy breakfast idea for busy docs.  “Hungry Girl” is a website with interesting (and usually humorous) advice for people trying to lose weight – including recipes.  If you are trying to lose weight (or avoid weight gain), follow the recipe as written.  If you aren’t trying to lose weight, use whole eggs, real sausage, butter, etc.

One word of advice – if you are using whole eggs, make sure you scramble them before putting them in the microwave (unless you want an egg explosion and a huge mess to clean up!).  Even for egg whites alone, stop the microwave to stir every once in a while!

Photo credit

 

How to Eat Well On Call

It’s Saturday and I’m on call – and it’s going to be a busy day!  We have about 75 patients on the service, we already have 4 cases done and another 4 posted, and it’s still early (~4pm)   I have a fantastic resident with me today.  We just were chatting about what we are going to do for meals today.  He didn’t have breakfast and has only had a Coke and a “borrowed” bowel of Kix cereal from the recovery room so far.  I had whole wheat toast with some goat cheese before I left my house this morning, and I here’s what I have to eat today:

  • Strawberries
  • A handful of frozen cooked shrimp with cocktail sauce (they’ll thaw by the time I want to eat them)
  • Frozen peas (I put them in the microwave for a minute but, like the shrimp, frozen would be fine because they’ll thaw) + goat cheese, olive oil, vinegar, salt and pepper
  • Leftover whole wheat orzo, artichoke hearts, tuna and lemon pasta from last night
  • An apple
  • Lemon wedges for water

My resident’s Coke is probably more than I used to have as an intern… which is STUPID.   Eating well is important to feel well, perform well and do the right thing for your patients. There is one word that explains the difference between my resident (and what I used to do) and what I do now… planning.   “I’ll just get something from the restaurant across the street later…”, “There will probably be food leftover from the GI conference…” .. “I can always eat a bagel from the lounge..” … NOT.   When you finally have a minute to grab something to eat, you won’t usually have time to go look for the food.  It’s a lot easier if its’ there and ready to eat.

Here’s how to do this right:

1. Buy a good “lunch box” .

I like the hard plastic ones that fit in an outside, insulated carrying case.  It’s a lot easier to clean up if something spills than the usual “lunch box”.

You can use plastic (disposable) containers to carry your meals with you.  I’ve switched to glass containers because some of the data about heating the plastic containers in the microwave started sounding convincing.  It does mean you have to keep track of them and bring them home, but I suspect in the long run (if I don’t lose them) it will be cheaper than the plastic containers.   I particularly like the ones I bought because the seal is so tight that they don’t ever leak  (even for things like soup).

2. PLAN.

The night before call, figure out what you are going to take. Make it good stuff, too!  Call nights are not the “what I know I should eat” nights.  You need to have real food (i.e. not processed) but don’t skimp.  When you get to the “I really deserve those french fries” time of your call (which we all do) you will have really delicious and balanced food  in the refrigerator.

3. Pack your meals for the next day the night before (no matter how late it is or how tired you are).

It’s the only way you’ll actually do this.   None of us when we work this hard have the energy to put together meals for the day at 5am.  This takes a little effort but the payoff is real.  You will absolutely eat better, have more energy, maintain your weight and do a better job.  Don’t forget to throw some fruit in – and to make sure it’s washed so you can just pull it out of the refrigerator for a snack.

Cooking for Yourself in Medical School and Residency

Most medical students and residents eat poorly.  It’s not really a surprise – the days are packed with work from sun-up to sun-down.  There are no planned meals because there can’t be.  Food is a quick bite when it is available.  It’s feast or famine.  On the far end of the scale, the stereotypical diet of a resident is no breakfast (but usually coffee), a doughnut and coffee grabbed on the run once you get to work, some mid-day meal of fast food, and pizza on call.  Food, particularly fast food, becomes solace.  In the stressful world of residency, this kind of “comfort food” becomes a “reward” for the hard work and tribulations. It’s not rocket science.  This kind of diet doesn’t give you the energy you need to function at your peak.  It is also a diet that is very likely to lead to weight gain.  In your 20s, your body can cope with this suboptimal fuel, but it’s not ideal.  However, what “works” in your 20s won’t work as you get older and could even be responsible for a heart attack, diabetes, or other medical problems in your 40s and 50s.  On a more philosophical level, you would never advise this kind of diet to one of your patients.  None of us want to be hypocrites.

The answer is to cook for yourself.  Not everyone likes to cook, and not every one knows how.   I’m going to make a case that you should learn.  Trust me – if you can learn to take out an appendix, or diagnose a pneumonia, you can learn to cook.   I’m going to assume that you are single for the sake of this description.  But, if you have a significant other, it’s even more important to cook at home.  He or she can participate in helping with the meal preparation, and, by doing this together and for each other, there is added benefit for your relationship.  Having dinner at home with a significant other will become an “anchor” to your day that will become very important to you.  As hard as it is to work around a busy schedule, if you can eat together, and have a real conversation, you will both benefit greatly.

Cooking is a wonderful therapy for the stress of medical school and residency.  If you’ve never learned how to cook, this is a hard time to learn complicated techniques, but it’s not hard to learn simple techniques.  There are several advantages of cooking for yourself that outweigh (on most days) the hassle of spending the time.  The act of cooking for yourself can be a time of “decompressing” from work.  Arranging vegetables, cutting them, smelling the odor of the food appeals to all your senses and is a moment in the day that you can intentionally slow down.  It’s very important that the recipes you choose are simple and quickly prepared.  No one wants to come home to a 2 hour task in the kitchen after a hard day.  Cooking for yourself has other benefits as well.  First, it is tangible evidence that you are taking care of yourself.  This is not a trivial point.  There are days during your training when it seems no one is taking care of you.  Having concrete evidence that you are caring for yourself is an antidote to that feeling.  Secondly, you will eat better.  By cooking from fresh ingredients, you will decrease the amount of pre-packaged and fast food.  Even without medical school, you know that this will result in better nutrition.  Thirdly, you will eat cheaper.  Other than the “free” pizza (ethically debatable, but financially clear), processed food is usually more expensive.  And lastly, you can share.  It isn’t any more work to make 4 or 6 portions of a dish than it is to make 2, and it usually isn’t that much more expensive, either.  If you can convince one of your colleagues that this is a good idea, you can cook for each other on alternate days.   Likewise, you can cook larger amounts and, using freezer ready containers, freeze portions for yourself for the future.  Doesn’t homemade pasta with a side of fresh vegetables really sound better than the greasy middle of the night food that is available in most hospitals?   It’s true that you can’t cook just anything with the kind of schedule you will have in medical school and your residency.  But, there are few key rules that will make it possible for you to do this, enjoy it, and eat well.

Rule 1:  Don’t cook anything that takes more than 30 minutes to prepare.

Let’s be realistic – you are not going to walk into your home at 8 o’clock at night, hungry, and spend an hour preparing something.  But – there are very nutritious dinners that take less than 10 minutes, so getting home late is no excuse.

Rule 2:  Plan ahead.

The first step in preparing dinner for most busy people is to open the refrigerator door and ask “What can I eat tonight?:  If you are anything like I was in residency, the refrigerator had some cheese, some vegetables (often way past their prime), and maybe some leftovers.  Not very appetizing.  There is an easy way to prevent this from happening.  On whatever day you have off and have time to shop, spend 30 minutes making a menu.  Start by making a table for the week with what is happening.

Breakfast Lunch Snack Dinner Comments
Sun
Mon On call – take Tues meals, too
Tues
Wed Out Out with friends after rounds
Thur
Fri On call
Sat

Once you have an outline of your week, fill in the blanks with the meals.  Now, most of us can handle “hamburgers” or “Raisin Bran” as a menu item… but it’s more fun, and healthier to branch out a bit.  So, if you are not used to looking for new things to cook, how do you find recipes?  Cookbooks can be fun, particularly if you are looking for a particular ethnic food or a style (e.g. low-fat) of cooking.  If you like cookbooks, and bookstores, find the used book store nearest you and go to town!  There are also web sites for recipes.  Many of them also have “cooking lessons” on line.  Most cooking shows have a web based recipe site as well.   So, say you start by searching the web and find this recipe. (for this particular recipe, I’m assuming you have no concerns about calories)  It looks easy, and like it would taste good.   So you print it out.

NEW ORLEANS PASTA

ESSENCE OF EMERIL (FOODTV)   SHOW #EE123 – http://www.recipesource.com/main-dishes/pasta/11/rec1100.html

1 tablespoon olive oil

16 ounces chicken breast half, cut into strips (about 1/2 cup)

1/4 cup chopped chorizo sausage

2 tablespoons chopped green onions, plus extra for garnish

1/2 tablespoon chopped garlic

Tabasco and Worcestershire sauce

3/4 cup heavy cream

1/4 cup grated Parmesan cheese

1/4 pound shrimp, peeled and deveined

1/2 pound penne pasta, cooked al dente and tossed in oil to coat

Creole spice, salt and pepper

In a large saute pan heat oil, add chicken and sausage and cook 5 minutes, stirring often. Add green onions, garlic, 2 dashes each Tabasco and Worcestershire sauce or to taste, and cook for 1 minute. Add cream, cheese, shrimp and pasta. Cook, tossing, to heat through. Adjust seasoning to taste with Creole spice, salt and pepper. Serve garnished with green onions.

Yield: 2 servings

Now what?  First, cut and paste the ingredient list to a shopping list.  If you are compulsive, you can organize it into meat, dairy, produce, etc (it makes shopping easier, but it’s not essential).  You’ll need to add a vegetable or salad to balance this out nutritionally. (I picked broccoli as an example) If you can afford the calories, add a desert. (Ice cream in this case)  Then decide what night in your schedule this will work best.  This recipe will take about 12 minutes total so it would be great for a night you are getting home late.  You can either share the other portion with your significant other or you can take it with you the next day as lunch.  You can double the recipe and have it more than one night.   For example:

Breakfast Lunch Snack Dinner Comments
Sun
Mon On call – take Tues meals, too
Tues
Wed Out Out with friends after roundsThaw shrimp for tomorrow
Thur NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoliIce Cream Freeze one portion for later
Fri NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli On call
Sat NEW NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli

Shopping list:

2 lbs chicken breast (16 oz x 2)

1/2 cup chopped chorizo sausage

1/2 pound shrimp, peeled and deveined

heavy cream   (need 1 1/5  cup)

Parmesan cheese  (need 1/2 cup grated)

Olive oil

Creole spice

green onions

garlic

broccoli (4 portions to steam)

One pound penne pasta

Ice cream

Rule 3:  Cook (or prep) today today to eat tomorrow

As soon as you get home from the grocery store:

  • Freeze any meat that is for later in the week (and make a note to yourself to put in into the refrigerator to thaw a day or two before you are going to use it.)
  • Wash the vegetables, dry them and put them away
  • Wash lettuce for salads and dry completely (a spin dryer is the best).  Store in a zip lock plastic bag with a paper towel in the bag (which absorbs any residual water).  Make sure you squeeze out all the air you can before closing the bag.

Take advantage of days off to cook things that may take a little more time or effort.  While  you are watch the football game on Sunday, you can cook chili in a crock pot for Wednesday.  If you know that your vegetable stir fry on Tuesday is going to be after a long day, go ahead and chop all the vegetables and meat a day or two before when you have the time and have them stored in the refrigerator.   When Tuesday rolls around (and you are exhausted from work), you’ll have all the ingredients chopped and ready to throw in the pan.

Preventing Weight Gain in Residency

This is the time of year when 4th year medical students are winding down and preparing for the “big move” into internship.  Our 4th year students take a special 3 week course to get them ready – a wonderful mix of small groups on professionalism, ACLS training, first night on call beeper emergencies…etc, etc.  It ends with a small group of senior faculty who talk about making the transition to residency.  I wish we’d recorded the talks – they were all really wonderful.  In addition to giving wonderful professional advice,  all of the faculty included advice on taking care of yourself.  It struck me that one of the specific issues that each of them mentioned (well, four out of five) was how much weight they had gained in their internship and residency.

Losing weight is not easy for those that struggle with this issue – but preventing weight gain is not as hard – and should be a goal for every intern and resident!   It’s not hard – you need to increase your activity (a little) and watch out for stupid food choices.   Here’s the “rules” I wish someone had given me before I started my residency (if you have rules you would add, please send a comment!)

1.  No junk food (doughnuts, pizza, hamburgers, etc)

2.  Take healthy food with you to work – especially for call nights.  Keep emergency healthy food in your locker i.e. high quality energy bars, dried fruit/nuts (in appropriate small portions).

3.  Make sure you get an hour of real exercise on days when you are not in the hospital

4.  Take the stairs instead of the elevators.

JAMA. 2010 Mar 24;303(12):1173-9.

Physical activity and weight gain prevention.

Lee IM, Djoussé L, Sesso HD, Wang L, Buring JE.

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA. ilee@rics.bwh.harvard.edu

CONTEXT: The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of moderate-intensity activity for “substantial health benefits.”

OBJECTIVE: To examine the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet.

DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study involving 34,079 healthy US women (mean age, 54.2 years) from 1992-2007. At baseline and months 36, 72, 96, 120, 144, and 156, women reported their physical activity and body weight. Women were classified as expending less than 7.5, 7.5 to less than 21, and 21 or more MET hours per week of activity at each time. Repeated-measures regression prospectively examined physical activity and weight change over intervals averaging 3 years.

MAIN OUTCOME MEASURE: Change in weight.

RESULTS: Women gained a mean of 2.6 kg throughout the study. A multivariate analysis comparing women expending 21 or more MET hours per week with those expending from 7.5 to less than 21 MET hours per week showed that the latter group gained a mean (SD) 0.11 kg (0.04 kg; P = .003) over a mean interval of 3 years, and those expending less than 7.5 MET hours per week gained 0.12 kg (0.04; P = .002). There was a significant interaction with body mass index (BMI), such that there was an inverse dose-response relation between activity levels and weight gain among women with a BMI of less than 25 (P for trend < .001) but no relation among women with a BMI from 25 to 29.9 (P for trend = .56) or with a BMI of 30.0 or higher (P for trend = .50). A total of 4540 women (13.3%) with a BMI lower than 25 at study start successfully maintained their weight by gaining less than 2.3 kg throughout. Their mean activity level over the study was 21.5 MET hours per week (approximately 60 minutes a day of moderate-intensity activity).

CONCLUSIONS: Among women consuming a usual diet, physical activity was associated with less weight gain only among women whose BMI was lower than 25. Women successful in maintaining normal weight and gaining fewer than 2.3 kg over 13 years averaged approximately 60 minutes a day of moderate-intensity activity throughout the study.

PMID: 20332403 [PubMed – indexed for MEDLINE]