A Lifestyle Medicine Approach to COVID-19

We share your concern about the ongoing COVID-19 epidemic. It is important during this challenging time to practice self-care. Be informed, but balanced. It is important to limit over-exposure to the non-stop news cycle to prevent worry and overwhelm. Stress and anxiety about current events can lead to physical tension that builds up in the body and can trigger a host of health problems. Totally eliminating worry can be impossible but it’s important to explore ways to lessen the worry habit. Pause several times throughout the day to take a few calming breaths. The practice of mindfulness can help us to recognize thought patterns that lead to distress. Sit quietly and observe your thoughts without engaging them as you focus on your breath. Over time you will be able to detach from your reactions as you observe your thoughts. Find ways to invite more calm and relaxation into every day through yoga, deep breathing, reading, walking in nature, etc.

Self-care is not selfish care. During these trying times it is important to support others in our communities by sharing available resources and helping our neighbors.   

While social distancing, frequent hand washing, and not touching your face are important for slowing the spread of the disease, we can further reduce risk by employing the pillars of Lifestyle Medicine. We share these tips from our friends at Rochester Lifestyle Medicine Institute.


  • Nutrition – Move as far toward a whole-food, plant-based diet as you can.  In particular, eat lots of leafy greens, vegetables and fruits across a rainbow of colors, and eliminate animal products. This will help develop a healthy microbiome, reduce inflammation, and give you a spectrum of micronutrients to maximize health.
  • Activity – Exercise daily, aiming for at least 30 minutes of moderate activity per day.  Make sure that you work up a sweat.  This virus has the highest impact on people’s hearts and lungs, so you want to make sure that they are in as good shape as possible if you get the virus.
  • Substances – Avoid smoking, vaping, or inhaling any substance, which can be toxic to the lungs.
  • Sleep – Sleep is critical for your immune system.  Aim to get 7-8 hours of sleep nightly, and to wake up rested.  Go to bed at a regular time.  Make sure your room is cool, dark, quiet, and comfortable.  Avoid screens at least 90 minutes before bedtime.  Develop a “wind down” ritual, like listening to soft music, writing in a journal, or reading a book.
  • Stress – This is a stressful time.  Managing stress is important to reduce cortisol levels and optimize your immune system.  Some things to consider in reducing stress:  talk with friends and family; practice mindfulness and meditation; do deep breathing exercises. If you find that your stress is becoming unmanageable, seek help sooner rather than later.
  • Relationships – This is an important time to support and be supported by the people you love. Be kind; listen to each other; express your feelings and listen to the feelings of others.  Call friends. Try to help neighbors or others who may need a hand.
  • Time outdoors – being outside is calming.  And you can walk with a friend and still maintain social distancing! (Just stay 6 feet away.) Try to get outside every day, especially during the middle of the day.
  • Meaning and purpose – This is a time for reflection, as well as a time for action.  Reach out to others, to see if there is a way you can help.  If you are religious, use the power of prayer.
  • Positive emotions / finding joy – There is a saying that “It’s better to light a single candle than to sit and curse the dark.”  Be that candle.  Find the moments of joy and light, even if they are few and far between.  Think about all the things you are grateful for.  Smile and laugh when you can. Your immune system will thank you!

We look forward to seeing this through together! Thank you.

Ted Barnett, MD, FACLM
Partner, Borg & Ide Imaging
Board Member, American College of Lifestyle Medicine
Founder and CEO, Rochester Lifestyle Medicine Group
Founding President, Rochester Lifestyle Medicine Institute

Susan Friedman, MD, MPH
Staff Physician, Highland Hospital
Professor of Geriatric Medicine, UR School of Medicine and Dentistry
Medical Director, Rochester Lifestyle Medicine Group
Director of Clinical Research, Rochester Lifestyle Medicine Institute

GERD (Chronic Acid Reflux) – Finding Relief

Gastroesophageal reflux disease, or GERD, is a common gastrointestinal disorder where the contents of the stomach backwash into the esophagus. This occurs when the sphincter that closes the stomach off from the esophagus relaxes or weakens and opens up inappropriately. In normal digestion, this sphincter opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. The continual backwash of stomach acid irritates the lining of the esophagus and can cause it to become inflamed.


Anyone can develop GERD, some for unknown reasons. You can be more likely to have GERD if you are pregnant, taking certain medications or a smoker. According to the National Institutes of Health GERD affects about 20 percent of the U.S. population. It is believed that our modern, highly processed western diet and high rates of obesity are contributing factors.

Common Symptoms

The most common symptoms of GERD are heartburn or acid regurgitation. GERD symptoms most often occur after eating and in many cases adopting a healthy diet and lifestyle can lessen symptoms. In more severe cases medication or more chronic therapy may be warranted. GERD may increase your chance of developing Barrett’s esophagus which affects the lining of your esophagus and is precancerous. It is important to follow the direction of your gastroenterologist (a doctor who specializes in the digestive system).

Symptoms include:

  • Chest pain, painful burning sensations in the throat or chest
  • Difficulty in swallowing or a sensation of a lump in your throat
  • Persistent dry cough, hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)

Finding Relief

  • Anything that relaxes the sphincter can worsen symptoms therefore avoidance is helpful to prevent these symptoms. Foods to avoid include fatty foods (fried foods and fatty meats), soda (carbonated drinks), alcoholic beverages, cheese (red wine and cheese), excessive coffee (caffeine), chocolate, citrus foods and peppermint. Also avoid cigarette smoking.
  • Nutrition: It is important to eat small, frequent meals and slow down when you eat or drink. Choose whole foods and avoid processed foods such as processed meats and refined grain products, including packaged snacks such as cookies and chips. Focus on nutrient rich plant-based foods with a lower fat content, lean protein and complex carbohydrates. Choose healthy fats such as olive oil, avocado and nuts and seeds. Include probiotic foods such as fermented vegetables, yogurt or kefir. Ensure adequate daily water intake. Aim for one-half your ideal body weight in ounces.
  • Lying down too close to eating time can worsen symptoms for some people. Have a small dinner and try to have your last meal several hours before going to bed for the night.
  • Get regular exercise and maintain a healthy weight. Exercise benefits digestive health, helps with managing stress, improving sleep quality and lowering inflammation.
  • Speak with your doctor about whether any medications you currently take may be making your symptoms worse. It is important to follow your doctor’s recommendations. In the short-term, antacids and acid blockers can be helpful toward healing but long-term treatment with these medications is not usually encouraged. They can impact proper digestion as well as impede proper absorption of vitamins and minerals such as B12, Calcium and Vitamin D.
  • It is important to manage stress because stress can greatly interfere with digestion and can worsen symptoms because it opens our esophageal sphincter. Techniques that help calm stress and anxiety may help reduce symptoms of GERD. Incorporate relaxation techniques such as progressive muscle relaxation, deep breathing, prayer, or guided imagery. We can also manage stress through using anti-anxiety essential oils such as lavender and frankincense, exercising, practicing yoga or tai chi, and getting more rest.  
  • Incorporate good sleep hygiene habits and aim for 7 to 9 hours of quality sleep per night. In addition, it may help to elevate the head of your bed about 6 – 12 inches when sleeping.

By working with your doctor and understanding the causes and proper treatment for GERD, most people can find relief.

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Atlantis FL 33462.  Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook: Dr. Geni Abraham

Oral Health and Heart Health

Practicing good oral hygiene by brushing, flossing and seeing a dentist regularly for cleanings can protect the health of our gums. Since the body and mouth are not separate, taking good care of our teeth and gums can affect our overall health and may help us to live longer. There is scientific research that supports a potential link between dental health and heart health. Therefore, the simple daily habits of brushing and flossing may be more important than we think.

The Connection Between Gum Disease and Heart Disease

Bacteria. Plaque is a sticky film that contains bacteria and builds up on teeth. The bacteria in this plaque can cause decay and gum disease if it is not removed regularly through brushing, flossing and dental cleanings.

Inflammation. Gum disease is a serious driver of inflammation. Inflammation is a protective mechanism and indicates that the body is fighting something harmful and trying to defend itself. It is possible that inflammation in the gums triggers a cascade that can lead to inflammation in the cardiovascular system and plaque formation.

High Blood Pressure. New research in the American Heart Association’s journal ‘Hypertension’ accentuates the importance of good oral health in blood pressure control. The study findings showed that people with high blood pressure that have healthier gums responded better to blood-pressure lowering medications and had lower blood pressure than those who had gum disease. Over time, uncontrolled high blood pressure can lead to heart disease or stroke.

Tips to Improve Oral Health and Heart Health

Stop Smoking. Not smoking is one of the most important things you can do for your mouth and your body. Smokers have a much higher risk of gum disease and heart disease, and smoking promotes inflammation.

Manage Stress. When we are under stress the immune system’s ability to fight off infection is compromised. Increased stress also leads to elevated cortisol which increases blood pressure, makes us insulin resistant leading to diabetes, increases inflammation in our body and increases cholesterol.

Eat a Balanced Diet. A healthy diet helps to fight infection by boosting the immune system. Eating foods high in antioxidants can help our bodies repair damaged tissues. A plant based whole foods diet is key. Eating a rainbow of colors is important. It is important to reduce processed foods in our diet and take time to mindfully eat and enjoy our food.

Exercise. Being physically active is one of the best ways to strengthen the heart muscle, maintain a healthy weight and protect our arteries from damage. Aim for a minimum of 150 minutes per week with a combination of aerobic exercise, strength training and stretching. Find activities that you enjoy.

Sleep. Lack of sleep may weaken our immune system and our body’s ability to deal with inflammation or infection.  Lack of sleep can also lead to elevated blood pressure and blood sugars which are risk factors for vascular disease. Practice good sleep hygiene and relaxation techniques and aim for seven to nine hours each night.

Practice Good Oral Care. Be sure to brush and floss twice a day and make an appointment with your dentist for advice regarding your personal care and recommended schedule of visits. Taking good care of your oral health can be a part of your heart-healthy routine.

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Atlantis FL 33462.  Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook: Dr. Geni Abraham

Is Stress Overload Harming Your Thyroid?

Stressors in today’s busy society can seem never-ending. Stress appears in many forms from full schedules and long to-do lists to relationship challenges and financial problems. Not only can chronic stress negatively impact our overall health and well-being but it can affect our thyroid as well.

The thyroid is one of the most essential glands in the body. The hormones it produces are responsible for many things including our metabolism, health of our skin, and sleep quality. Imbalances occur when the thyroid produces too little or too much hormone and can result in unpleasant symptoms such as fatigue, feeling down or depressed, or having an inability to manage weight.

When we experience stress our adrenal glands are signaled to release a mix of stress hormones, including cortisol. Cortisol, the main hormone produced in response to stress can suppress thyroid function. A delicate balance between stress hormones and cortisol must exist for proper thyroid function. Although we can’t avoid stress we can learn to adopt lifestyle habits that will help our overall stress levels and thyroid health.  

Practice Mindful Eating

In our fast-paced lives we are often eating fast foods on the run. It is important to think about how we are eating. When we take the time to sit and enjoy our meals our body will be able to digest food better. The best way to start the day is with a balanced meal that is low in sugar but high in protein, healthy fat and fiber. Overall energy levels will improve with a diet high in whole, natural foods and low in alcohol, caffeine and sugar. A healthy balanced diet is necessary to provide the micronutrients needed for proper functioning of the thyroid – iodine, selenium and B-vitamins.

Sleep Well

Getting enough quality sleep is vital for our health and well-being. Try to adopt a consistent bedtime and avoid technology for a few hours before bed. Blue light emitted from device screens and artificial light can disrupt biological sleep signals. There are blue light filter settings on most devices and blue light blocking glasses are available. Winding down before bed can reduce stress levels and improve sleep quality. Wind down with a relaxing hot bath, reading, soothing essential oils and herbal teas, deep breathing, or prayer and meditation.

Exercise for Stress Relief

Physical activity increases feel-good brain chemicals and other hormones that improve energy and mood and reduce stress. Choose activities and exercise you love such as swimming, going to the gym or walking in nature. Yoga can be a gentle and restorative way to find relief from the tension and stress of the day. Yoga, tai chi and Pilates are designed around controlled movement and breathing techniques which can support relaxation.

Relax and Restore

It is important to keep stress levels from building throughout the day. Make time during the day to take breaks or pauses. Taking deep breaths and concentrating on your breathing can have a calming effect and help you relax. Practicing mindfulness and staying focused on the present moment can change the way you feel about life. In contrast, focusing on problems or never ending to-do lists can lead to overwhelm. Guided imagery is a relaxation technique that uses positive mental images to influence how you feel. Imagine a peaceful visual image such as sitting in nature by a beautiful waterfall and experience the physical sensation of relaxation.

Self-care is an important part of maintaining balance and cultivating well-being. Spend time in nature or take a break to enjoy your favorite hobbies. Enjoy time with friends and family and make fun and laughter a regular part of your life. Set boundaries around your present moments such as not answering texts or phone calls after a certain time in the evening. Try different things until you discover what gives you peace.

Managing stress is important for supporting your adrenals and the associated impact to your thyroid. Keeping a positive attitude and learning tools and routines to relieve stress instead of letting it build within you will reduce one of the long-term effects of chronic stress – thyroid dysfunction.  

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Atlantis FL 33462.  Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook: Dr. Geni Abraham

New Beginnings

The first day of January rings in a new day and a new year. There is something about new beginnings that inspires us to review the things we’ve learned and experienced in the past and find renewed excitement for the times that lie ahead. We can use the momentum of the New Year to inspire us to set and achieve the goals we dream about. It is a good time to review our personal mission and vision statement. What do you see you and your family doing in your life? To be successful in pursuing our life goals optimal health is important. Pursue good lifestyle habits to maximize enjoyment of life.

To incorporate a healthy lifestyle it is best to start with small health goals. If we try to change everything at once it can be difficult and discouraging to sustain. These small goals can be as simple as replacing a morning bagel with a healthy protein smoothie or a vegetable omelet, or taking a brisk walk before or after dinner. When you are successful with smaller goals and see the change, you will be more motivated to achieve larger goals in the long term.

Practice Mindful Eating.  When we practice mindful eating we become aware of the food we put in our bodies and how it ultimately affects our health and how we feel. A good start is to incorporate more greens and other colorful foods on our plate. Aim to always have something green, such as dark leafy greens, and other colorful plant foods included at each meal.  These colorful foods have an array of health benefits from healthier skin and vision to improved brain and heart health. You will notice a significant improvement in your overall well-being when you regularly incorporate these foods. You can start small by adding one new vegetable to your lunch or dinner meal. Although dietary changes take some effort, it will be worth it in the long run. Aim for 9-13 servings of plant foods every day.

Increase Daily Activity. Regular physical activity contributes to our overall health. It strengthens our body and plays a role in our mental health. It can also improve our memory, mood and sleep. Find a form of exercise that is right for you. Find things you enjoy. This can be anything from a yoga class to a walk in nature. Anything that keeps your body moving is beneficial.  Try to start with small bits of daily exercise and increase this to at least 30 minutes per day.

Get a Restful Night’s Sleep. We all need to make a good night’s sleep a top priority.  Although we all have times we have to run on five or six hours of sleep, the ultimate goal should be seven to eight hours. In the long run, adequate sleep can affect our overall health and performance.  Insufficient sleep has been shown to raise a variety of health concerns including obesity, mood swings and increased risk of chronic disease. You can start by adopting some simple evening routines and adjusting your schedule to allow for a full night’s sleep. Your evening routine can be anything that promotes peace and serenity. It can consist of using aroma therapy such as lavender essential oil, adding yoga stretches, practicing deep breathing along with soothing music and gratitude thoughts, or reading. Wind down each evening and allow your brain and mind to relax. 

Find Time for You. Life can be demanding and we are often juggling many responsibilities at a time. But this can lead to burn out and exhaustion and can have a negative impact on our health. It is important to find time for you. An important part of life is having time for the activities that we enjoy. Start by finding small blocks of time during your week to devote to joyful activities. This can be anything from reading a book to having coffee with a friend. Find the activities that make you happy and consistently commit to making time each week to plan for these activities.

Being healthy and fit is important to living a successful life. Turning even the smallest goals into habits will transform your well-being and will help you achieve the life you desire.

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Atlantis FL 33462.  Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook: Dr. Geni Abraham

The 5 Elements of Physician Self-Care

by Rebekah Bernard MD

Studies show that medical students have a precipitous drop in empathy levels within just months of starting their third-year clinical rotations. While there are a variety of proposed explanations for the transition from naïve pre-med idealist to world-weary cynic, one likely culprit is the de-emphasis on self-care which occurs during these rotations.

Virtually overnight, medical students transition from a routine of regularly scheduled lectures and study periods to a brave new world of 4 AM rounds, overnight shifts, and wolfed-down meals in between operating room cases.  And if students dare to express feelings of hunger or fatigue, their senior resident or attending is likely to tell them to “suck it up!” or remind them that “you can sleep when you’re dead.”  By the fourth year of medical school, jaded senior medical students are passing on the same ‘words of wisdom’ to the juniors behind them.

The message: Patient needs come first. Doctors’ needs (and much less those of medical students!) are a mere inconvenience, something to be ignored and overcome. Or worse, something to be proud of.  (“You worked with a 103-degree fever?  Well, one time I went back to work after giving myself intravenous fluids in the call room from for a stomach flu!”)

While it’s possible to continue this superhuman behavior for a few days, weeks, months, or even years, it’s not good and it’s certainly not healthy.  Moreover, doctors develop dangerous habits that are hard to break, following them even after their student and resident days are long gone.  Case in point:  Unless there is another doctor present, I’m always the first person done eating at the table, as if some invisible code pager is going to pull me away from my meal at any second.

By continuously deferring our own physiological needs, physicians harm not only ourselves, but also provide a disserve to our patients.

Geni Abraham, MD, an internist and wellness expert, notes that when physicians don’t take care of their own needs, they can’t be “good medicine” to their patients.  Abraham compares physicians treating patients while they are physically depleted to “trying to fit a twin-sized sheet onto a king-sized bed”—a futile and impossible task. 

“Do as I say, not as I do”                                                                                                                                                

In order to provide the type of care that patients deserve, physicians must prioritize their own needs. “We’ve got to get back to the fundamentals of personal health care,” says Abraham.  “We need to be doing exactly the things that we are telling our patients.”

She recommends that doctors start by focusing on the following aspects of self-care:

1.      Nutrition.  “I don’t care if you want to follow a vegan or a keto-diet, as long as you are eating whole foods and a balance of nutrients,” says Abraham.  It’s also important for physicians to practice mindful eating—actually tasting and enjoying our food, rather than gulping it down as if we are on 24/7 duty and expecting to be called to a patient’s bedside at any moment. 

Abraham notes that eating is a social activity, and great enjoyment can be gained from eating in the company of others.  Take the time to schedule and plan meals with family and friends, rather than eating over the sink or in your car (guilty on both counts).

2.     Exercise.  “Exercise is the cheapest drug for anxiety and mild to moderate depression,” says Abraham.  “It’s also one of the best ways to help students and residents learn, as movement has been shown to promote learning.”  While physicians certainly understand the benefits of exercise, the challenge is often finding the time to exercise. 

“You have to find the time,” advises Abraham.  Even if you can only do 10 or 15 minutes, schedule that time into your week and make it non-negotiable.  Consider an app like the “7-Minute Workout,” which gets your heart pounding and can be done in the comfort of your living room.  It may also help to find something active that you might enjoy like a sport or dance class.

3.     Sleep.  “Lack of sleep causes memory loss, irritability, and chaotic thinking,” says Abraham.  “And chaotic thinking doesn’t help our patients or ourselves.”  Abraham recommends getting enough hours of sleep at night and practicing good sleep hygiene.  “Put your phone upside down to avoid the blue light that it emits and avoid watching intense television shows before bedtime.”  Instead of looking at screens before bed, Abraham recommends practicing mindful meditation or deep breathing exercises.

If you still feel sleepy even after getting enough hours of sleep, consider getting tested for sleep apnea.  Robyn Alley-Hay, MD, a retired obstetrician-gynecologist who is now a physician coach notes that starting CPAP for her previously undiagnosed sleep apnea was a life-changer.  “I wish I had been tested for sleep apnea years ago,” says Alley-Hay.  “I no longer have to start my day exhausted, slow, muddled, and generally grumpy.”  Alley-Hay recommends that doctors get tested and treated.  “It is hard enough to recover from call nights, irregular shifts, and short nights as a physician.  Add sleep apnea on top of that and it’s a recipe for exhaustion, burnout, irritability, and even depression.”

4.     Nontoxic relationships.  Physicians need support from family members, friends, and colleagues.  We need to take the time to nurture those relationships by scheduling activities, like date-night with your spouse and lunch with a colleague.  Show up for medical society meetings and physician socials.  Knowing that we are all dealing with similar issues can provide a great deal of support. 

On the flip side, extricate yourself from relationships that are toxic or emotionally draining.   Say ‘no’ to people, employers, committees, or memberships that fail to add value to your life. 

5.     Mindful self-compassion.  Abraham suggests that physicians pay attention to how they talk to themselves.  She reminds us that humans are wired to pay more attention to negative thoughts than to positive ones, and that we need to practice and work to counteract negativity in our lives.  “It takes five positive thoughts to overcome one negative thought,” says Abraham.  One way to achieve mindful self-compassion is to keep a journal of your emotions, and to take a moment at the end of each day to focus on the things that went well. 

When one of my patients is being hard on themselves (“I’m stupid, I’m a failure”), I take a cue from Martha Beck and ask them if they would speak to a child the way they are speaking to themselves.  The answer is usually: “Of course not!”  In the same way, physicians need to be kind to ourselves and forgive ourselves when we make a mistake.

Achieving self-care

As overachievers, physicians often try to take on too many tasks at the same time.  That’s especially risky when it comes to self-care.  “If you try to make 19 different changes at the same time you won’t succeed – it will be too overwhelming,” says Abraham.

Instead, she advises executing one idea at a time.  “It can be as simple as increasing your water intake or eating two fruits per day to begin.” 

Abraham also advises us to think of ourselves like a boat.  “If you want to turn a boat, you have to do it slowly by degrees, not as a pirouette.  If we turn the wheel too fast, we will just end up at the same point where we began.”  Instead, she advises that we focus on change idea by idea, degree by degree.

By making slow and intentional positive change towards self-care, physicians can function better and more effectively—and that will pay off in patient care.  As Abraham says, “Eat right, move right, sleep right, and think right, so that you can feel right.”

Rebekah Bernard MD is a family physician in Fort Myers, FL and the author of Physician Wellness:  The Rock Star Doctor’s Guide


Top 10 Myths About Cardiovascular Disease

How much do you really know about your heart’s health? It’s easy to be fooled by misconceptions. After all, heart disease only happens to your elderly neighbor or to your fried food-loving uncle, right? Or do you know the real truth – that heart disease can affect people of any age, even those who eat right?

Relying on false assumptions can be dangerous to your heart. Cardiovascular disease kills more Americans each year than any other disease. But you can boost your heart smarts by separating fact from fiction. Let’s set the record straight on some common myths.

  1. “I’m too young to worry about heart disease.” How you live now affects your risk for cardiovascular diseases later in life. As early as childhood and adolescence, plaque can start accumulating in the arteries and later lead to clogged arteries. One in three Americans has cardiovascular disease, but not all of them are senior citizens. Even young and middle-aged people can develop heart problems – especially now that obesity, type 2 diabetes and other risk factors are becoming more common at a younger age.
  2. “I’d know if I had high blood pressure because there would be warning signs.” High blood pressure is called the “silent killer” because you don’t usually know you have it. You may never experience symptoms, so don’t wait for your body to alert you that there’s a problem. The way to know if you have high blood pressure is to check your numbers with a simple blood pressure test. Early treatment of high blood pressure is critical because, if left untreated, it can cause heart attack, stroke, kidney damage and other serious health problems. Learn how high blood pressure is diagnosed.
  3. “I’ll know when I’m having a heart attack because I’ll have chest pain.” Not necessarily. Although it’s common to have chest pain or discomfort, a heart attack may cause subtle symptoms. These include shortness of breath, nausea, feeling lightheaded, and pain or discomfort in one or both arms, the jaw, neck or back. Even if you’re not sure it’s a heart attack, call 9-1-1 immediately. Learn you risk of heart attack today!
  4. “Diabetes won’t threaten my heart as long as I take my medication.” Treating diabetes can help reduce your risk for or delay the development of cardiovascular diseases. But even when blood sugar levels are under control, you’re still at increased risk for heart disease and stroke. That’s because the risk factors that contribute to diabetes onset also make you more likely to develop cardiovascular disease. These overlapping risk factors include high blood pressure, overweight and obesity, physical inactivity and smoking.
  5. “Heart disease runs in my family, so there’s nothing I can do to prevent it.” Although people with a family history of heart disease are at higher risk, you can take steps to dramatically reduce your risk. Create an action plan to keep your heart healthy by tackling these to-dos: get active; control cholesterol; eat better; manage blood pressure; maintain a healthy weight; control blood sugar; and stop smoking.
  6. “I don’t need to have my cholesterol checked until I’m middle-aged.” The American Heart Association recommends you start getting your cholesterol checked every 5 years starting at age 20. It’s a good idea to start having a cholesterol test even earlier if your family has a history of heart disease. Children in these families can have high cholesterol levels, putting them at increased risk for developing heart disease as adults. You can help yourself and your family by eating a healthy diet and exercising regularly.
  7. “Heart failure means the heart stops beating.” The heart suddenly stops beating during cardiac arrest, not heart failure. With heart failure, the heart keeps working, but it doesn’t pump blood as well as it should. It can cause shortness of breath, swelling in the feet and ankles or persistent coughing and wheezing. During cardiac arrest, a person loses consciousness and stops normal breathing.
  8. “This pain in my legs must be a sign of aging. I’m sure it has nothing to do with my heart.” Leg pain felt in the muscles could be a sign of a condition called peripheral artery disease. PAD results from blocked arteries in the legs caused by plaque buildup. The risk for heart attack or stroke increases for people with PAD.
  9. “My heart is beating really fast. I must be having a heart attack.” Some variation in your heart rate is normal. Your heart rate speeds up during exercise or when you get excited, and slows down when you’re sleeping. Most of the time, a change in your heartbeat is nothing to worry about. But sometimes, it can be a sign of arrhythmia, an abnormal or irregular heartbeat. Most arrhythmias are harmless, but some can last long enough to impact how well the heart works and require treatment.
  10. “I should avoid exercise after having a heart attack.” No! As soon as possible, get moving with a plan approved for you! Research shows that heart attack survivors who are regularly physically active and make other heart-healthy changes live longer than those who don’t. People with chronic conditions typically find that moderate-intensity activity is safe and beneficial. The American Heart Association recommends at least two and a half hours of moderate intensity physical activity each week For Overall Cardiovascular Health. Find the help you need by joining a cardiac rehabilitation program, but first consult your healthcare provider for advice on developing a physical activity plan tailored to your needs.


Finish this Year Strong

At the first of the year many of us create a list of health and wellness goals that we want to accomplish. We often feel that this will be the perfect time to get things started. But imagine what it would be like to start your New Year feeling and looking your best. Due to the busyness of the season, the last few months of the year are usually when we make the worst decisions regarding our health. Imagine building momentum toward your goals now with an intentional plan to overcome the various stresses and unhealthy lifestyle habits that distract so many during this time of year.

Become intentional and make good choices through the end of the year.

This is about more than just healthy eating; it’s about creating healthy habits and consciously creating the life you desire. Do you feel that your schedule gets out of control this time of year with too many responsibilities and obligations? How many gifts do you really have to buy and how many functions do you need to attend? Does your house really need to look like the pictures in Pinterest – do not let this overwhelm the joy of the season. Reserve some time over the next few months for personal self-care. Choose self-care activities that reenergize you. Find joy in the season and in positive change. It’s not about the end goal, it’s always about the journey. Discover different types of exercises that you like and focus on eating whole foods, enjoying the flavors of the fall harvest.  

Enjoy the Season.

There is no need to deprive ourselves during this holiday season, but we should be choosy and budget our holiday eating wisely. When faced with large buffets and feasts at holiday gatherings don’t feel obligated to eat something just because it’s there. Focus on eating the foods you really love and be sure to make room for veggies. Enjoy your food and pace yourself, take your time and stop eating when you feel full. If you are going to drink alcohol, try alternating between water and alcohol to minimize intake and stay hydrated. If you know that you will be indulging in a few extra calories this time of year be sure to increase daily physical activity. In addition to walking, consider adding activities the whole family can enjoy.

Focus on high quality, nutrient-dense foods. Imagine what your health and body would look like if you multiplied the nutrient-density of your diet. Think roasted vegetables vs French fries. Eating whole foods vs refined, processed or fast foods. Increase healthy fat intake (such as avocados, nuts and seeds, and olive oil) and get away from sugar and refined carbohydrates. Incorporate intermittent fasting – start by not eating after 7 pm. Don’t skip breakfast – starting your day with a balanced meal focused on protein and healthy fats will set your healthy metabolism for the day and put the brakes on cravings and overeating later in the day. Incorporate vegetable omelets, avocados, crustless quiche or protein smoothies.

Invited to a party and need to bring a dish? Consider bringing a dish of non-starchy vegetables or a low-carb Mediterranean-style platter. Fill your low-carb snack tray with cooked meats such as sliced roast beef, turkey and pepperoni (choose the best quality you can, with minimal processing and minimal added ingredients). Add fresh ingredients such as a variety of cheeses, olives, avocado, stuffed mini peppers, mixed nuts, vegetables, fruits and low carb crackers. At least you know there will be a variety of low-carb snacks (brought by you) that you can enjoy.

Let this season be a time of celebration and also relaxation.

Enjoy your family and friends and if you do fall overboard and lose sight of your goals just try to get back to your healthy habits as soon as possible. Incorporate these Healthy Habits to Finish This Year Strong:

  • Stay hydrated with 6-8 cups of water daily.  
  • Stay energized: exercise 3 times per week.
  • Pace yourself during this season to avoid overscheduling or overspending.
  • Make time for self-care and find balance and joy in the season.
  • Make adequate sleep a priority.    
  • Find ways to walk more.
  • Add more vegetables and fruit.
  • Snack on whole foods like nuts and seeds.
  • Commit to a daily gratitude practice.
  • Get connected with friends & family.
  • Balance meals with protein and healthy fat to prevent cravings. 
  • Reserve sweet treats for special occasions.
  • Bookend healthy eating around parties and never go to a party hungry.
  • Have small daily goals to help you achieve success.

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Atlantis FL 33462.  Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook: Dr. Geni Abraham

Healthy Aging: Preserving Your Bones and Joints

Whether you’re a young adult, baby boomer or senior, here’s what you can do now.

By Lisa Esposito, Staff Writer May 13, 2015, U.S. News

PAUL SCHNEIDER, 90, OF Palm Harbor, Florida, starts his morning exercise with 100 situps. A couple golf matches a week, plus weight and aerobic workouts at his fitness club, also keep him flexible and strong.

Schneider stays slender and watches what he eats. He drinks water, not soda. He takes Tums for calcium, as well as fish oil and vitamin D supplements. He was never sedentary, either as a sales manager in the emerging computer industry or as a father of four. “I have fortunately – knock on wood – never broken a bone,” he says.

As aging conspires to chip away at your bone and joint health, experts explain what you can do to maintain these through every phase of life:

Start Early

Bone and joint health begin in childhood, says Dr. Sundeep Khosla, director of the Aging Bone, Muscle and Joint Program within the Mayo Clinic’s Kogod Center on Aging.

“Physical activity is important for loading the bones and helping them develop as strong as they can,” Khosla says. Parents can watch that kids don’t replace milk with sodas, thereby missing out on calcium. And it’s never too soon to discourage smoking, which can affect bone mass.

The adolescent growth spurt brings a marked rise in fractures, Khosla says. It’s believed when the skeleton is rapidly growing, an increased need for calcium may cause thinning, especially in delicate wrist bones. “So when these kids fall, they get wrist fractures,” he says.

If these fractures occur with mild injuries, like falling from a low height, that’s a sign kids have skeletal defects tied to low bone mass, Khosla says. “And that low bone mass tracks into young adulthood.”

Pillars of Bone Health

When it comes to healthy aging, Paul Schneider has an expert in his corner. His daughter, Dr. Diane Schneider,​ is a geriatrician, osteoporosis expert and author of “The Complete Book of Bone Health.” 

Calcium, vitamin D, diet and exercise are the cornerstones of bone health, she says. Staying at a healthy weight is important: “You don’t want to be carrying around extra weight because that’s what’s going to start wearing out your hips and knees.”

What’s good for the bones isn’t necessarily good for the joints. “For your skeleton, you want weight-bearing exercises,” Schneider says. “But for your joints, weight-bearing exercises may also contribute to wearing them out.” She advises moderation and variety: If you’re a dedicated runner, for instance, work out with weights at the gym for a change.

Young Adult Challenges

“Your late 20s, early 30s is when you achieve what is called peak bone mass,” Schneider says. But college and career demands can disrupt health and exercise regimens, even for people who were active as teens.

Diet also changes for young adults, like drinking less milk. Schneider advises limiting caffeinated beverages – soda and coffee – particularly if your calcium intake is low. She recommends water instead. Alcohol consumption can affect bone health. “Moderate drinking, which would be one or two alcoholic beverages, is OK,” Schneider says. “More than that is too much.”

If you can’t cover the recommended calcium intake for your age group, Schneider says, either do a “menu makeover” to put calcium-rich food in your diet, or use a calcium supplement.

“Try to limit meals on the go,” she says. “They tend to be higher in sodium and carbohydrates and scant on vegetables.” And like alcohol, they can lead to putting on pounds.

Staying active isn’t always easy. “Try to schedule your exercise time and spend more time on your feet,” Schneider says. In the workplace, innovations like standing desks let employees sit less.

Maintain Bone Mass in Midlife

Middle age is a critical period for bone and joint health. After 50, calcium requirements for post-menopausal women rise from 1,000 to 1,200 milligrams,​ Schneider notes – but calorie requirements don’t. As metabolism slows, weight can creep up. “So women may need more time to maintain their fitness,” Schneider says.

Making time to exercise isn’t easy for the sandwich generation. Try working fitness into your day: strapping on a pedometer for 10,000 steps, parking farther from your building, taking the stairs instead of the elevator.

Exercises to strengthen muscles also help protect the joints they support, Schneider says, which is important when arthritis shows up in middle age.

“With women, of course, the menopausal transition is when you really start accelerating bone loss because of the hormonal level fluctuations,” she says. Men also experience hormonal changes, with both testosterone and estrogen, but their bone loss is more gradual and less marked, Schneider says.

Avoiding osteoporosis–the silent condition that eats away at bones, leaving them thin, weak and vulnerable to breaks – is paramount. The National Osteoporosis Foundation offers guidelines for when people should undergo a bone-density test (dual-energy X-ray absorptiometry or DEXA scan) based on their age, gender and risk factors – such as family history, smoking and certain medications.

Senior Strong

Faye Strum, 75, a retired teacher in La Jolla, California, hasn’t let osteoporosis disrupt her active life. About 18 years ago, she learned she had the condition after undergoing a bone scan during a routine checkup. Until then, Strum had no idea her bones were at risk. “I am of small stature,” she says. With the diagnosis, “I didn’t want to lose any height. And I’ve always been active, so I wanted to keep my muscles strong.”

Strum has taken bone-building medications and safeguards her bones while staying active. “I do more specialized exercise. I take in plenty of calcium. And I’m careful in how much I do in terms of lifting,” she says. “I don’t pick up little grandchildren and hold them up high.” She continues to walk and play tennis, and attends a healthy-bone class twice a week at a nearby sport-and-health center, where she works out with weights and bands and does balance exercise. And she attends a weekly gentle-yoga class.

Balance and core-strength exercise such as yoga and Tai Chi reduce your risk of falls and resulting fractures, Schneider says.

Improve Your ‘Health Span’

It’s never too late to optimize your bone health, Khosla says. “There are now drugs – and more drugs on the horizon – that can build your bone back up,” he says. “So you can at least partially reverse the bone loss.”

His group is working to better understand the underlying causes of bone aging and pinpoint people at higher risk of fractures. While DEXA is an “excellent” diagnostic tool, he says, upcoming imaging tools can provide detailed information on bone structure. And researchers are working on new tests to determine the quality of a patient’s bone.

“While extending lifespan is important, it doesn’t really help if that lifespan you extend is full of disability and pain,” Khosla says. In the aging-research community, the newer concept is extending “health span,” he says. “So you may not necessarily extend the actual life from 95 or 100 or whatever. But within that time frame, you’ll have more years of the better quality of life and healthier life.”


Are Faux-Meat Burgers Good for You?

Non-meat burgers have become very popular. People are drawn to these foods because they are trying to reduce their consumption of red meat and believe that plant-based foods are healthier and better for the environment. While plant-based diets have been connected with good health, are these “fake meat” products healthy? 

Highly Processed Foods

Our bodies were designed to thrive on whole, natural foods. The overconsumption of processed foods in the Standard American Diet (SAD) has led to a myriad of health problems. Two of the most popular faux meat products (designed to mimic the taste of meat) on the market right now are ‘Impossible Burger’ and ‘Beyond Beef’ which are heavily processed foods. The following list of ingredients was obtained from their websites.

Impossible Burger: Water, Soy Protein Concentrate, Coconut Oil, Sunflower Oil, Natural Flavors, 2% or less of: Potato Protein, Methylcellulose, Yeast Extract, Cultured Dextrose, Food Starch Modified, Soy Leghemoglobin, Salt, Soy Protein Isolate, Mixed Tocopherols (Vitamin E), Zinc Gluconate, Thiamine Hydrochloride (Vitamin B1), Sodium Ascorbate (Vitamin C), Niacin, Pyridoxine Hydrochloride (Vitamin B6), Riboflavin (Vitamin B2), Vitamin B12.

Beyond Beef: Water, Pea Protein Isolate, Expeller-Pressed Canola Oil, Refined Coconut Oil, Rice Protein, Natural Flavors, Cocoa Butter, Mung Bean Protein, Methylcellulose, Potato Starch, Apple Extract, Salt, Potassium Chloride, Vinegar, Lemon Juice Concentrate, Sunflower Lecithin, Pomegranate Fruit Powder, Beet Juice Extract (for color).

A Few Ingredient Highlights

Both products use ‘natural flavors’ which are derived from substances found in nature (plants, animals, etc.) but can also contain preservatives, emulsifiers, solvents and other incidental additives.

The Impossible Burger contains GMO soy. At this point there is not enough evidence to know what effect GMOs will have on us or on the earth. There are current concerns including increased allergy risk, negative impact on the balance of our gut microbiome/gut health and increased antibiotic resistance in humans. Although GMO crops are often contaminated with glyphosate, their website claims that their products are tested for glyphosate. The yeast extract found in this product can pose problems for MSG-sensitive individuals.

Beyond Beef contains pea protein isolate. Popularity of plant-based protein alternatives has led to increased use of pea protein. However, the supply has not been adequately tested to ensure Americans are getting clean products. The Detox Project (a research agency that tests levels of pesticides in our food and supplements) has found many products containing pea protein are contaminated with glyphosate. Glyphosate is an herbicide that has been linked to cancer. In 2015, the World Health Organization classified glyphosate as ‘probably carcinogenic to humans’. It has also been shown to disrupt hormone balance and the gut microbiome in the body.   

Be aware of sodium levels in restaurant offerings of 0% beef burgers. The Impossible Whopper served at Burger King contains 1080 mg of sodium. The American Heart Association recommends no more than 2,300 mg of sodium per day and an ideal limit of less than 1,500 mg per day for most adults, especially for those with high blood pressure.

Whole Foods Are Always the Best Option

Natural beef can have a place in a healthy, balanced diet. Red meat is a complete protein source and contains a variety of bioavailable nutrients including heme iron, zinc, and B vitamins. As always, portion size matters and you can make better choices at the supermarket by choosing meat from animals raised with no antibiotics or added hormones. Another good choice is grass-fed beef which may contain less total fat than grain-fed beef, but a lot more omega-3 fatty acids and CLA (conjugated linoleic acid), which are both linked to health benefits.

The best plant-based protein alternatives should be focused on whole foods. If you are interested in non-meat burgers, veggie burgers would be the best alternative and the best choice would be to make them at home. These burgers will provide natural vitamins and minerals from actual vegetables. There are a lot of plant-based protein options available such as quinoa, beans, lentils, nuts, seeds, peas, soy, mushrooms, chickpeas – and even whole grains and green vegetables offer varying amounts of protein.  

One of the most researched diets for providing a healthy lifestyle, the Mediterranean diet, recommends focusing on whole, natural foods and eating lots of vegetables. This diet does recommend limiting red meat to a few times per month. Overall, we should eat less processed foods, but on occasion a pre-made veggie burger can be a viable option. Just be sure to read the ingredients and choose the most natural option. The bottom line is that if you would like to have a burger then have one. Just limit this to occasional indulgences. It is best to eat foods where you can identify them for what they are. The more mysterious the ingredients are, the less likely that it will be nutritious for you.

-Diane Duvall, Life Coach and Certified Health Coach for the Lifestyle Medicine Practice of Dr. Geni Abraham, Board Certified, American Board of Internal Medicine.  Our Internal Medicine Practice is an integrated medical practice with a focus on Lifestyle Medicine. We offer health coaching sessions to help you reach your personal goals. Dr. Geni Abraham, Medical Specialists of the Palm Beaches, Inc., 205 JFK Drive, Atlantis FL 33462.  Phone: (561) 432-8935, Visit DrGeniAbraham.com and Follow us on Facebook: Dr. Geni Abraham