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 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 and Follow us on Facebook: Dr. Geni Abraham

Ultra-processed foods appear to cause overeating and weight gain

Published: August, 2019

Eating food that’s ultra-processed — not just chips or cookies, but also things like breakfast cereal, deli meat, or canned fruit in syrup — makes people overeat and gain weight, compared with eating food that’s unprocessed. That’s according to a small randomized controlled trial published online May 16, 2019, by Cell Metabolism. It involved 20 men and women who stayed at a research facility for a month and were randomly assigned to one of two diets. One group was given ultra-processed foods (such as a breakfast of a bagel with cream cheese and turkey bacon), and the other group was fed unprocessed foods (such as a breakfast of oatmeal with bananas, walnuts, and skim milk). After two weeks, participants were switched to the opposite diets. Both diets were evenly matched for total calories, macronutrients, fiber, sugars, and sodium, and participants were allowed to eat as much or as little as they wanted. But they ate more calories when they were eating ultra-processed foods, compared with when they ate unprocessed foods, and they gained more weight on the ultra-processed diet. Why? It’s not exactly clear, but researchers did find that appetite-suppressing hormones decreased and hunger hormones increased when people ate processed foods. Bottom line: Eat whole, unprocessed foods with as few ingredients as possible.

Image: © 4kodiak/Getty Images

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Iron Rich Foods for Your Daily Diet

Iron is an essential mineral. Our body needs adequate iron to make enough healthy oxygen-carrying red blood cells. About two-thirds of our body’s iron is found in a protein of our red blood cells called hemoglobin. Hemoglobin carries oxygen from our lungs to the tissues of our body. Our body can’t get enough oxygen without healthy red blood cells. Iron is also necessary to maintain healthy cells, support our immune system and it contributes to normal cognitive function. Low iron is a common nutritional deficiency in the U.S.  When iron levels are low you may feel fatigued, weak and irritable. The solution, in most cases, is to consume more foods that contain adequate amounts of iron.

How Much Iron Do You Need?

The Recommended Dietary Allowances (RDA) for iron are set to meet the average needs of the general population. The current RDA for iron (daily): for males, age 14-18: 11 mg, for males, age 19+: 8 mg, for females, age 14-18: 15 mg, for females, age 19-50: 18 mg, and for females over 50: 8 mg.

Speak to your health care provider for your specific needs. An additional need for iron may result from: medications, medical conditions, pregnancy, a woman with heavy menstrual periods, if you are a frequent blood donor or if you are a vegetarian or vegan.

What Are the Best Sources of Iron?

A healthy, varied diet will generally provide the iron you need. You may have heard that you can get iron from liver and red meat, but there are many other foods that naturally contain iron.

 The most easily absorbed form of dietary iron is called heme iron. This is iron attached to the hemoglobin protein and is found in red meat, poultry, and seafood.  Heme iron is readily absorbed by our body.

Iron found in plant foods such as lentils, beans and spinach is non-heme iron. To increase the absorption of the iron found in plant sources, it is best to eat a variety of iron-rich plant foods daily and combine this with a good source of vitamin C. Vitamin C (found in citrus, dark green leafy vegetables, broccoli, bell peppers, strawberries, tomatoes, etc.) increases the body’s absorption of iron from food. As an example, you can squeeze some lemon juice over your leafy green salad to increase the amount of iron you absorb. Beta carotene can also increase the absorption of iron. It’s responsible for the red, yellow and orange coloration of some fruits and vegetables. It’s found in foods such as carrots, sweet potatoes, cantaloupe, and squash.

Food Sources of Heme Iron:

Chicken or Beef Liver

Beef, Chicken, Turkey, Pork

Shellfish such as Clams, Oysters, Mussels, Shrimp

Veal or Lamb


Fish such as Halibut, Haddock, Perch, Salmon, Tuna, Sardines

Food Sources of Non-Heme Iron:

Legumes (such as lima beans, chili beans, lentils, peas, soybeans and peanuts)

Vegetables (such as spinach, broccoli, asparagus, kale, chard, collards, brussel sprouts, string beans, mushrooms, potatoes, tomato sauce, and sauerkraut)

Fruits (such as prune juice, prunes, figs, dates, raisins, dried apricots and peaches)

Pumpkin, Sunflower or Sesame Seeds

Nuts (such as almonds, pistachios, pecans, walnuts, and cashews)

Fortified Cereals, Brown Rice, Wheat and Oats

What About Iron Supplements?

Although iron is widely available in food, there are certain groups of people that may need more iron. Infants and toddlers have a greater need as do adolescent girls and women, 19 to 50 years of age. This is also important for women who are pregnant. If you feel that your iron is low check with your doctor before taking any supplement. It is good to take vitamin C with the iron supplementation for both better absorption and to reduce any constipation that may be caused by the iron supplements. Your health care provider will assess your status and recommend any necessary dietary changes or supplements.

-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, Suite A, Atlantis FL 33462.  Phone: (561) 432-8935, Visit and Follow us on Facebook

Foods linked to better brainpower

Just as there is no magic pill to prevent cognitive decline, no single almighty brain food can ensure a sharp brain as you age. Nutritionists emphasize that the most important strategy is to follow a healthy dietary pattern that includes a lot of fruits, vegetables, legumes, and whole grains. Try to get protein from plant sources and fish and choose healthy fats, such as olive oil or canola, rather than saturated fats.

That said, certain foods in this overall scheme are particularly rich in healthful components like omega-3 fatty acids, B vitamins, and antioxidants, which are known to support brain health and often referred to as foods. Incorporating many of these foods into a healthy diet on a regular basis can improve the health of your brain, which could translate into better mental function.

Research shows that the best brain foods are the same ones that protect your heart and blood vessels, including the following:

  • Green, leafy vegetables. Leafy greens such as kale, spinach, collards, and broccoli are rich in brain-healthy nutrients like vitamin K, lutein, folate, and beta carotene. Research suggests these plant-based foods may help slow cognitive decline.
  • Fatty fish. Fatty fish are abundant sources of omega-3 fatty acids, healthy unsaturated fats that have been linked to lower blood levels of beta-amyloid—the protein that forms damaging clumps in the brains of people with Alzheimer’s disease. Try to eat fish at least twice a week, but choose varieties that are low in mercury, such as salmon, cod, canned light tuna, and pollack. If you’re not a fan of fish, ask your doctor about taking an omega-3 supplement, or choose terrestrial omega-3 sources such as flaxseeds, avocados, and walnuts.
  • Berries. Flavonoids, the natural plant pigments that give berries their brilliant hues, also help improve memory, research shows. In a 2012 study published in Annals of Neurology, researchers at Harvard’s Brigham and Women’s Hospital found that women who consumed two or more servings of strawberries and blueberries each week delayed memory decline by up to two-and-a-half years.
  • Tea and coffee. The caffeine in your morning cup of coffee or tea might offer more than just a short-term concentration boost. In a 2014 study published in The Journal of Nutrition, participants with higher caffeine consumption scored better on tests of mental function. Caffeine might also help solidify new memories, according to other research. Investigators at Johns Hopkins University asked participants to study a series of images and then take either a placebo or a 200-milligram caffeine tablet. More members of the caffeine group were able to correctly identify the images on the following day.
  • Walnuts. Nuts are excellent sources of protein and healthy fats, and one type of nut in particular might also improve memory. A 2015 study from UCLA linked higher walnut consumption to improved cognitive test scores. Walnuts are high in a type of omega-3 fatty acid called alpha-linolenic acid (ALA), which helps lower blood pressure and protects arteries. That’s good for both the heart and brain.

For more on staying sharp as you age, read A Guide to Cognitive Fitness, a Special Health Report from Harvard Medical School.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

26 Weight Loss Tips That Are Actually Evidence-Based

The weight loss industry is full of myths.

People are often advised to do all sorts of crazy things, most of which have no evidence behind them.

However, over the years, scientists have found a number of strategies that seem to be effective.

Here are 26 weight loss tips that are actually evidence-based.

1. Drink Water, Especially Before Meals

Weight Loss Tips

It is often claimed that drinking water can help with weight loss — and that’s true.

Drinking water can boost metabolism by 24–30% over a period of 1–1.5 hours, helping you burn off a few more calories (1Trusted Sourcetarget=”_blank”2Trusted Source).

One study showed that drinking a half-liter (17 ounces) of water about half an hour before meals helped dieters eat fewer calories and lose 44% more weight, compared to those who didn’t drink the water (3Trusted Source).

2. Eat Eggs For Breakfast

Eating whole eggs can have all sorts of benefits, including helping you lose weight.

Studies show that replacing a grain-based breakfast with eggs can help you eat fewer calories for the next 36 hours as well as lose more weight and body fat (4Trusted Source5Trusted Source).

If you don’t eat eggs, that’s fine. Any source of quality protein for breakfast should do the trick.

3. Drink Coffee (Preferably Black)

Coffee has been unfairly demonized. Quality coffee is loaded with antioxidants and can have numerous health benefits.

Studies show that the caffeine in coffee can boost metabolism by 3–11% and increase fat burning by up to 10–29% (6Trusted Source7Trusted Source8Trusted Source).

Just make sure not to add a bunch of sugar or other high-calorie ingredients to your coffee. That will completely negate any benefits.

Shop for coffee online.

4. Drink Green Tea

Like coffee, green tea also has many benefits, one of them being weight loss.

Though green tea contains small amounts of caffeine, it is loaded with powerful antioxidants called catechins, which are believed to work synergistically with caffeine to enhance fat burning (910Trusted Source).

Although the evidence is mixed, many studies show that green tea (either as a beverage or a green tea extract supplement) can help you lose weight (11Trusted Source12Trusted Source).

Purchase green tea online.

5. Try Intermittent Fasting

Intermittent fasting is a popular eating pattern in which people cycle between periods of fasting and eating.

Short-term studies suggest intermittent fasting is as effective for weight loss as continuous calorie restriction (13Trusted Source).

Additionally, it may reduce the loss of muscle mass typically associated with low-calorie diets. However, higher-quality studies are needed before any stronger claims can be made (14Trusted Source).

6. Take a Glucomannan Supplement

A fiber called glucomannan has been linked to weight loss in several studies.

This type of fiber absorbs water and sits in your gut for a while, making you feel more full and helping you eat fewer calories (15).

Studies show that people who supplement with glucomannan lose a bit more weight than those who don’t (16Trusted Source).

Find glucomannan supplements online.

7. Cut Back on Added Sugar

Added sugar is one of the worst ingredients in the modern diet. Most people consume way too much.

Studies show that sugar (and high-fructose corn syrup) consumption is strongly associated with an increased risk of obesity, as well as conditions including type 2 diabetes and heart disease (17Trusted Source18Trusted Source19Trusted Source).

If you want to lose weight, cut back on added sugar. Just make sure to read labels, because even so-called health foods can be loaded with sugar.

8. Eat Less Refined Carbs

Refined carbohydrates include sugar and grains that have been stripped of their fibrous, nutritious parts. These include white bread and pasta.

Studies show that refined carbs can spike blood sugar rapidly, leading to hunger, cravings and increased food intake a few hours later. Eating refined carbs is strongly linked to obesity (20Trusted Source21Trusted Source22).

If you’re going to eat carbs, make sure to eat them with their natural fiber.

9. Go on a Low-Carb Diet

If you want to get all the benefits of carb restriction, then consider going all the way and committing to a low-carb diet.

Numerous studies show that such a regimen can help you lose 2–3 times as much weight as a standard low-fat diet while also improving your health (2324Trusted Source25Trusted Source).

10. Use Smaller Plates

Using smaller plates has been shown to help some people automatically eat fewer calories (26Trusted Source).

However, the plate-size effect doesn’t appear to affect everyone. Those who are overweightseem to be more affected (27Trusted Source28Trusted Source).

11. Exercise Portion Control or Count Calories

Portion control — simply eating less — or counting calories can be very useful, for obvious reasons (29Trusted Source).

Some studies show that keeping a food diary or taking pictures of your meals can help you lose weight (30Trusted Source31).

Anything that increases your awareness of what you are eating is likely to be beneficial.

12. Keep Healthy Food Around in Case You Get Hungry

Keeping healthy food nearby can help prevent you from eating something unhealthy if you become excessively hungry.

Snacks that are easily portable and simple to prepare include whole fruits, nuts, baby carrots, yogurt and hard-boiled eggs.

13. Take Probiotic Supplements

Taking probiotic supplements containing bacteria of the Lactobacillus subfamily have been shown to reduce fat mass (32Trusted Source33Trusted Source).

However, the same doesn’t apply to all Lactobacillus species. Some studies have linked L. acidophilus with weight gain (34).

Shop for probiotic supplements online.

14. Eat Spicy Foods

Chili peppers contain capsaicin, a spicy compound that can boost metabolism and reduce your appetite slightly (35Trusted Source36Trusted Source).

However, people may develop tolerance to the effects of capsaicin over time, which may limit its long-term effectiveness (37Trusted Source).

15. Do Aerobic Exercise

Doing aerobic exercise (cardio) is an excellent way to burn calories and improve your physical and mental health.

It appears to be particularly effective for losing belly fat, the unhealthy fat that tends to build up around your organs and cause metabolic disease (38Trusted Source39Trusted Source).

16. Lift Weights

One of the worst side effects of dieting is that it tends to cause muscle loss and metabolic slowdown, often referred to as starvation mode (40Trusted Source41Trusted Source).

The best way to prevent this is to do some sort of resistance exercise such as lifting weights. Studies show that weight lifting can help keep your metabolism high and prevent you from losing precious muscle mass (42Trusted Source43Trusted Source).

Of course, it’s important not just to lose fat — you also want to build muscle. Resistance exercise is critical for a toned body.

17. Eat More Fiber

Fiber is often recommended for weight loss.

Although the evidence is mixed, some studies show that fiber (especially viscous fiber) can increase satiety and help you control your weight over the long term (44Trusted Source45Trusted Source).

18. Eat More Vegetables and Fruits

Vegetables and fruits have several properties that make them effective for weight loss.

They contain few calories but a lot of fiber. Their high water content gives them low energy density, making them very filling.

Studies show that people who eat vegetables and fruits tend to weigh less (46Trusted Source).

These foods are also very nutritious, so eating them is important for your health.

19. Chew More Slowly

Your brain may take a while to register that you’ve had enough to eat. Some studies show that chewing more slowly can help you eat fewer calories and increase the production of hormones linked to weight loss (47Trusted Source48Trusted Source).

Also consider chewing your food more thoroughly. Studies show that increased chewing may reduce calorie intake at a meal (49Trusted Source).

20. Get Good Sleep

Sleep is highly underrated but may be just as important as eating healthy and exercising.

Studies show that poor sleep is one of the strongest risk factors for obesity, as it’s linked to an 89% increased risk of obesity in children and 55% in adults (50Trusted Source).

21. Beat Your Food Addiction

A recent study found that 19.9% of people in North America and Europe fulfill the criteria for food addiction (51Trusted Source).

If you experience overpowering cravings and can’t seem to curb your eating no matter how hard you try, you may suffer from addiction.

In this case, seek professional help. Trying to lose weight without first combating food addiction is next to impossible.

22. Eat More Protein

Protein is the single most important nutrient for losing weight.

Eating a high-protein diet has been shown to boost metabolism by 80–100 calories per day while shaving 441 calories per day off your diet (52Trusted Source53Trusted Source54Trusted Source).

One study also showed that eating 25% of your daily calories as protein reduced obsessive thoughts about food by 60% while cutting desire for late-night snacking in half (55Trusted Source).

Simply adding protein to your diet is one of the easiest and most effective ways to lose weight.

23. Supplement With Whey Protein

If you struggle to get enough protein in your diet, taking a supplement — such as protein powder — can help.

One study showed that replacing some of your calories with whey protein can cause weight loss of about 8 pounds over time while increasing muscle mass (56Trusted Source).

Purchase whey protein online.

24. Don’t Do Sugary Drinks, Including Soda and Fruit Juice

Sugar is bad, but sugar in liquid form is even worse. Studies show that calories from liquid sugar may be the single most fattening aspect of the modern diet (57Trusted Source).

For example, one study showed that sugar-sweetened beverages are linked to a 60% increased risk of obesity in children for each daily serving (58Trusted Source).

Keep in mind that this applies to fruit juice as well, which contains a similar amount of sugar as a soft drink like Coke (59Trusted Source).

Eat whole fruit, but limit or avoid fruit juice altogether.

25. Eat Whole, Single-Ingredient Foods (Real Food)

If you want to be a leaner, healthier person, then one of the best things you can do for yourself is to eat whole, single-ingredient foods.

These foods are naturally filling, and it’s very difficult to gain weight if the majority of your diet is based on them.

Here are 20 of the most weight loss-friendly foods on earth.

26. Don’t Diet — Eat Healthy Instead

One of the biggest problems with diets is that they rarely work in the long term.

If anything, people who diet tend to gain more weight over time, and studies show that dieting is a consistent predictor of future weight gain (60Trusted Source).

Instead of going on a diet, aim to become a healthier, happier and fitter person. Focus on nourishing your body instead of depriving it.

Weight loss should then follow naturally.

Five Great Reasons to Follow a Mediterranean Diet

The Mediterranean diet reflects the traditional eating habits in the countries that border the Mediterranean Sea. Research has consistently shown that this pattern of eating is connected with good health. The Mediterranean Diet is ranked #1 (in Best Diets Overall) in the 2019 U.S. News Best Diet Rankings. 41 diets were evaluated with input from a panel of health experts. These diets were evaluated on a range of levels, from their heart healthiness to their likelihood to help you lose weight.

No matter where you live you can adopt and enjoy a delicious Mediterranean-style diet.  Choose nutrient-rich foods instead of nutrient-poor foods. The Mediterranean diet is a heart-healthy eating plan that is high in fresh fruits and vegetables (variety of color), lean protein, healthy oils (Extra virgin olive oil), whole grains, beans, nuts and seeds.  Click here for the Mediterranean diet pyramid                                                                  

This healthy diet includes:

  • Eating fish and poultry at least twice per week and limiting red meat to no more than a few times per month. Including foods like eggs, cheese and yogurt in moderation.
  • Using herbs and spices instead of salt to flavor foods.
  • Avoiding hydrogenated oils (trans fats) which are found in fried foods and processed foods such as pies, cookies, pastries, donuts and frozen food.
  • Limiting refined sugars and carbohydrates such as white bread and white rice.
  • Sticking with water as your beverage of choice is best, as there is no benefit to adding sugary drinks. Drinking red wine in moderation (optional).
  • Focusing on whole, natural foods and eating lots of vegetables.
  • For dessert, eating fresh fruit and saving sweets for a special treat or celebration.
  • Taking time to savor your food and enjoy your meals with family and friends. 
  • Incorporating plenty of physical activity and exercise.

The Mediterranean Diet is Rich in Anti-Inflammatory Foods.

Choose an anti-inflammatory diet to reduce levels of inflammation. Inflammation is our body’s way of protecting itself from infection, illness or injury. Chronic (long-term) inflammation can occur inside our body without any noticeable symptoms. This type of inflammation may be a common factor in many diseases. Eating unhealthy foods, stress and a sedentary lifestyle are associated with increased inflammation. Your anti-inflammatory diet should provide a balance of protein, complex carbohydrates and healthy fats at each meal. Boost your intake of whole, antioxidant-rich foods and cut out refined, processed food products.

This Diet Focuses on Healthy Fats.

The fat consumed with a Mediterranean diet is generally from monounsaturated and polyunsaturated fats rather than saturated and trans fats which are common in most processed foods. Researchers believe these healthy fats contribute to the heart-healthy benefits of this diet. Olive oil is recommended as the primary added fat. This oil, which is rich in oleic acid – a monounsaturated fatty acid, and contains large amounts of antioxidants, has a protective role against coronary diseases and other health problems. Foods rich in Omega-3 fatty acids include fish, vegetables, especially leafy greens, and nuts and seeds.

The Mediterranean diet’s health benefits are well studied.

This diet primarily consists of whole foods that contain large amounts of fiber. The monounsaturated fats in olive oil, nuts and fish offer anti-inflammatory health benefits and are good for the brain, helping to preserve memory and prevent cognitive decline.  Based on much research, this diet can protect against the development of heart disease, help lower cholesterol, strengthen bones and help with weight loss. This type of eating pattern can help improve inflammatory conditions such as rheumatoid arthritis and reduce the risk of developing dementia, Alzheimer’s, type-2 diabetes and various types of cancer. It’s never too late to start eating a healthy diet to reap physical and mental health benefits.  

It Promotes Healthy Weight Management.

The Mediterranean diet is low in processed foods and sugar. Physical activity and regular, balanced meals are encouraged. Due to the high-quality protein foods, healthy fat content and the abundance of fiber, this diet is helpful in managing fullness. Simple carbohydrates are replaced with whole grains, vegetables, fruit, nuts, seeds and legumes.  This can be adapted for intermittent fasting, where you eat all your meals within a certain time frame, usually an eight to twelve hour window.  Due to your overall genetic makeup you may lean more toward a paleo, low-carbohydrate or keto diet plan. These offer variations in the percentage of macronutrients (carbohydrates/protein/fat) that are consumed daily. The basic distribution for a healthy Mediterranean diet is a balance of all three. Whatever combination of macronutrients you choose, the underlying principle stands: choose whole, natural foods.

This Way of Eating May Help You Live Longer.

Research studies continue to support the benefits of the Mediterranean dietary pattern to increase life expectancy, reduce the risk of major chronic disease, and improve quality of life and well-being. A diet high in fresh plant foods and healthy fats creates a strong cornerstone for longevity. This diet also encourages daily physical activity, spending time in nature, getting good sleep and enjoying home-cooked meals with family and friends. Embracing the Mediterranean lifestyle can lead to living a longer, healthier life.

-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, Suite A, Atlantis FL 33462.  Phone: (561) 432-8935, Visit and Follow us on Facebook