Nutrition pearls. I am often asked how to eat “better”…

Burning Man 2019

Why is it important to eat a healthy diet? Eating the right foods can keep you healthy now and later on in life.

Which foods are especially healthy?

 ●Fruits and vegetables – Eating fruits and vegetables can help prevent heart disease and strokes. Fruit may also help prevent certain types of cancers. Try to eat fruits and vegetables at each meal and for snacks. If you don’t have fresh fruits and vegetables, frozen or canned ones can be substituted. Physicians recommend at least 2 1/2 servings of vegetables and 2 servings of fruits each day.

●Foods with fiber – Eating foods with a lot of fiber can help prevent heart disease and strokes.  Fiber can help control your blood sugar. Foods with a lot of fiber include vegetables, fruits, beans, nuts, oatmeal, and some breads and cereals. You can tell how much fiber is in a food by reading the nutrition label. Physicians end eating 25 to 36 grams of fiber each day.

●Foods with folate – Folate should be taken by all females of child-bearing age.  Folate helps the fetus form an intact spinal cord.  Folate is found in many breakfast cereals, oranges, orange juice, and green leafy vegetables.

●Foods with calcium and vitamin D – Babies, children, and adults need calcium and vitamin D to help keep their bones strong. Calcium and vitamin D helps to prevent osteoporosis. Osteoporosis is a condition that causes bones to get thin and break more easily than usual. Often we don’t get enough calcium and vitamin D in our diets and a supplement may be needed. Supplements are pills, capsules, liquids, or tablets that have nutrients in them.

●Foods with protein – Protein helps your muscles stay strong. Healthy foods with a lot of protein include chicken, fish, eggs, beans, nuts, and soy products.

Some experts recommend a “Mediterranean diet.” This involves eating a lot of fruits, vegetables, nuts, whole grains, and olive oil. It also includes fish, poultry, and dairy products, but not much red meat. Eating this way can help your overall health, and may lower your risk of having a stroke.

What foods should I avoid or limit? To eat a healthy diet, there are some things you should avoid or limit. They include:

●Fats – There are different types of fats. Some types of fats are better for your body than others.

Trans fats are especially unhealthy. Avoid margarines, many fast foods, and some store-bought baked goods. These can raise your cholesterol level and thereby increase your chance of getting heart disease.

The type of “polyunsaturated” fats found in fish seems to be healthy and can reduce your chance of getting heart disease. Other polyunsaturated fats might also be good for your health. When you cook, choose oils with healthier fats like as olive oil and canola oil.

●Sugar – Limit or avoid sugar, sweets, and refined grains. Refined grains are those in white bread, white rice, most pasta, and packaged “snack” foods. Whole grains, like whole-wheat bread and brown rice, have more fiber and are better for your health.

Avoiding sugar-sweetened beverages, like soda and sports drinks, can also help improve your health.

●Red meat – Red meat can increase your risk of certain health problems, including heart disease and cancer.

Can I drink alcohol as part of a healthy diet? People who drink a small amount of alcohol each day might have a lower chance of getting heart disease. But drinking alcohol can lead to problems. Men should drink 2 or less drinks on average per day, women 1 drink.

How many calories do I need each day? The number of calories you need each day depends on your weight, height, age, sex, and your activity level.

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Do you suspect dementia in your loved one?

Do you suspect dementia in your loved one? There are many ways to investigate if dementia is present.

Your physician may give a screening test like the Mini Cog, the General Practitional Assessment of Cognition, or the Ascertain Dementia 8-item informant questionnaire. These will help determine if further investigation is needed.

Blood work may also be needed to rule out other causes of mental confusion. A blood count to rule out anemia, Vitamin B deficiency, hypothyroidism, vitamin B12 deficiency, diabetes, and liver and kidney insufficiency/failure. To view the brain, magnetic resonance imaging (MRI) without contrast is the preferred test to exclude other intracranial abnormalities such as stroke, normal-pressure hydrocephalus, subdural hematoma (blood pooling in the brain) or a mass.

Investigate the confusion, it may be treatable.

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Thyroid cancer. Should we screen for this?

Thyroid cancer. Should we screen for this? There are organizations who look over all the known data and update us, physicians, on what screening tests are beneficial to the population as a whole. The U.S. Preventive Services Task Force (USPSTF) does this.

The USPSTF recently delineated the guidelines for thyroid cancer screening in asymptomatic adults. There is not enough evidence to show that screening for thyroid cancer is helpful in those without symptoms. Thyroid cancer is rare and observational evidence shows no change in mortality over time even after introduction of a mass screening program for thyroid cancer. There are also harms in overdiagnosing possible thyroid cancer. These patients undergo additional tests or biopsies or surgeries which can cause laryngeal nerve damage or vocal cord paralysis.

Want more information? https://www.aafp.org/afp/2018/0315/p406.html

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Saline irrigation. It’s worth your time.

Saline irrigation. It’s worth your time.

Saline irrigation of your nose decreases the severity of allergy symptoms. You buy the nasal irrigation (like a Neti Pot) once and then it washes away allergens in your sinuses.

Allergic rhinitis is the nose reacting to allergens with an immunoglobulin E-mediated hypersensitivity reaction. You may feel this as nose running, nasal itching or sneezing. Allergic rhinitis can also impair sleep quality and social interactions.

Nasal irrigation may be similarly effective as when oral antihistamines or intransal steroid spray are used. But, with nasal irrigation, it is essentially non-pharmacologic and you buy the irrigator once and then it’s free.

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Here’s the medical school I teach at…

A great YouTube video about the medical school I teach at and the gorgeous scenery we partake in.

Enjoy!

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How can we treat threatened miscarriages?

We have begun using progetogens to reduce the risk of miscarriage. This significantly decreases the rate of miscarriage compared to placebo.

How common are miscarriages? Miscarriages occur in 15 to 20% of pregnancies. A “threatened” miscarriage is defined as any vaginal bleeding (with or without pain) in a pregnant woman with a closed cervix and an otherwise viable fetus inside the uterus.

What is NOT found to help? Bed rest, pelvic rest (nothing in the vagina meaning no sex, douching or tampons), vitamins, uterine relaxants, and administration of beta HCG. Progestogens (medications that mimic progesterones) may help. A meta-analysis of 7 research studies with nearly 700 women showedthat oral administration of progestogens had a lower risk of miscarriage compared to those receiving placebo.

The National Institute for Health and Care Excellence is currently developing a guideline with regard to progestogens and miscarriage. More research is definitely needed.

For more information: http://www.cochrane.org/CD005943

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Do omega-3 fatty acids prevent cancer or cardiovascular disease?

Do omega-3 fatty acids prevent cancer or cardiovascular disease? A study of nearly 25,000 patients found no benefit as primary prevention (someone who does not already have the problem) of cardiovascular disease or cancer.

Want more information: New England Journal of Medicine 2019: 380 (1) 23-32.

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Interesting nail finding

I was teaching at the residency program this week and had an interesting nail finding in a child. The girl had a rash 2 months before on her hands and feet and then all of her fingernails started peeling. She otherwise was in good health and felt fine.

What was it? It is called onychomadesis. It can happen 1-2 months after hand-foot-mouth viral illness caused by the Coxsackie virus. The nail plate separates from the nail bed. This makes it look like the nails are peeling. Normal nail growth occurs within 1-4 months and will resolve without any assistance.

I’m glad we could put the patient and the parent’s mind to rest. Reassuring them that this was a normal process was all that was needed.

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When to potty train?

As a physician of a significant pediatric population, I am often asked questions about potty training… when it goes well, it goes well. When it does not, parents think/talk about it for years.

When to start potty training? More than 2/3 of US children achieve what is considered the cognitive and emotional development necessary for toilet training by 18 to 30 months of age. This also means that as many as 1/3 of children are NOT ready until nearer to age 3 or afterwards.

How do parents assess a child’s readiness? They need to walk, put on and remove clothes, follow simple instructions and have social awareness including an interest in using the toilet. Children may also show awareness of the need to urinate or defecate and discomfort sitting in soiled diapers. Other signs of readiness are asking to wear “big kid” underwear, regular predictable bowel movements and nighttime bowel control, stays dry for 2 hours at a time or during naps.

What if the child can urinate into the toilet, but refuses to defecate in the toilet? This happens in about 20% of children. The causes are many: pain from constipation, fears regarding defecation or using the toilet, local sin irritation. This is more common in children who bgin training after 3 1/2 years of age. First, your physician should rule out organc causes. Once that is done, avoid any advances in training for a few weeks and just observe to identify psychosocial issues causing the child to not want to defecate into the toilet. Some children will only defecate in a diaper or will hide to defecate. These issues will resolve. Rarely, your physician will refer your child to occupation or physical therapist, behavioral therapists or developmental pediatricians. Children with Down syndrome, autism or cerebral palsy may have more issues with toilet training.

I hope this helps.

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As an academic family physician, I have taught hundreds of medical students at and resident physicians over my 20+ years of teaching.

The article below is a powerful reminder of each of our vulnerabilities and what we think we are teaching may be different from what the learner learns.

https://jamanetwork.com/journals/jama/fullarticle/2753375

My loves…
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