VB6 by Mark Bittman

I had some friends recently recommend Mark Bittman’s new book, VB6: Eat Vegan Before 6:00 to Lose Weight and Restore Your Health . . . for Good.  I’d read and really enjoyed his previous books, including How to Cook Everything, a book I routinely recommend to medical students, residents (and anyone) who is learning how to cook. HL_Bittman_2372

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The story goes like this… world famous food critic, NY Time columnist, and writer is told by his doctor that he is insulin resistant, overweight, has high serum cholesterol and sleep apnea.  His doctor’s prescription?

“You should probably become a vegan.”

For a world famous omnivore who lives in the world of restaurants, food reviews and great cuisine, it wasn’t an option.  But, to his credit, neither was going on medication. VB6 is a personal account of how Mark Bittman combined his extraordinary talent as a chef and food critic with his new imperative to improve his health.

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Mark Bittman describes the three principles of the VB6 plan as …

“First, you make a commitment to eat more plant foods—fruit, vegetables, whole grains, beans … “

“Second, you make a commitment to eat fewer animal products and highly processed foods, like white bread. “

“And third, you all but eliminate junk foods, most of which are barely foods in the strict sense of the word anyway. (I say “all but eliminate” because everyone needs to break the rules occasionally.)”

VB6 is not a diet, it’s a lifestyle change.  It worked for Mark Bittman, and should work for anyone. This simple plan is a reasonable solution not only for health care providers who personally struggle with their weight and their health… but may also be an straightforward way to “prescribe” dietary changes for our patients with the same struggles.

Eating on the Run

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

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July 1st has arrived and a new group of interns are learning that’s 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

Setting an Example: Eating Well

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.

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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.

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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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Sitting is bad for you – Even if you exercise.

New findings about sedentary behavior have real implications for medical students, who spend a lot of time sitting during the first year or two of medical school. This is also an important issue for residents and practicing physicians, particularly those in the more sedentary fields of medicine like pathology, psychiatry and radiology.   However, this problem affects us all, regardless of specialty.  All physicians have become more sedentary due to the time we spend at our computers.

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The goal is to move on this continuum from less activity to more… in other words, to become less sedentary.  Here’s some ways to accomplish that goal:

  1. Make sure you move at least every hour.   Breaking up sedentary time is important. Although just moving (even a short stroll) is good, if you have time and the inclination do something a little more strenuous.  Walk up several flights of stairs, do 10 squats and 10 pushups, or whatever catches your fancy.  Try to find ways to incorporate more activity into your day on a regular basis.
  2. Stand when you can.  Stand when you are reading, working on the computer (with an adjustable desk), or just hanging out.
  3. Walk instead of looking up data on the computer on rounds.  I’ve recently discovered I can access our EMR (Epic) on my iPad by installing the Citrix app.  I’ve started taking my iPad with me on rounds, rather than sitting to look up notes, images and lab values.  I’m still not to the point where I write my notes on the iPad, but I’m going to work on it.
  4. Walk to meet instead of sitting around a table. Rounds are obvious, but we have lots of other meetings as well.  There are even physicians who have started doing a part of patient visits as a walk.
  5. Consider ways to move while you do your “sedentary” work:


Adjustable desks. Although there are a lot of these on the market that are really expensive, there are some that are more affordable, including desks marketed for kids in school.  Or be creative and make your own adjustable desk.

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Under the desk pedals are inexpensive, and are particularly effective if you are reading and studying.
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Put a desk on your stationary bicycle. Work while pedaling on your stationary bike.  If you have a bicycle, you’ll need to by a trainer to convert it to a stationary bike.  I recently bought  a desk (FitDesk Pro) for my spin bike and it really works.  If you don’t want to spend the money, there are other ways to use your laptop or read while you are on a stationary bike like using an ironing board, or putting your bike under an adjustable desk. I particularly liked this idea of a bicycle rack that doubles as a desk.

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Fit Desk.  If you don’t own a stationary bike, and don’t mind spending $200, look into the Fit Desk.  Friends who have tried this say it is very stable while pedaling.

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Treadmill desk.  This is the most expensive option, but for practicing physicians is not at all a reach.  For students and residents, if you can find an old treadmill, you can build this for $39.

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Fast, Easy Recipes: Kalyn’s Kitchen

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

Go Meatless One Day A Week – August’s Healthy Habit

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?

  • 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.

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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.

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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

Cold Summer Treats

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.

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Banana mango smoothie