One Little Thing

I was chatting with my patient, an architect known for her sensitive adaptations that bring old structures to modern expectations. She tells her clients, who spend a great deal of time obsessing over every detail, that they will be surprised by what will give them the most joy. It will always be one little thing: the sunlight coming through a new window, the feel of a doorknob or the delight in a well-placed bookshelf.

How true! One little thing, seemingly trivial to the big picture, will be the most important. One of my patients decided to give up mayonnaise – and lost 10 pounds. Another person decided that there would be no cigarette smoke in his new car – the first step in eliminating cigarettes from his life. No ‘screens’ (computer, telephone, television) after 9 pm could mean a new reading habit and a better night’s sleep.

On newspaper writer vowed not to buy objects made in China and eliminated much of the junk in her life. She has fewer possessions, nicer things and better karma. A small decision with a big impact.

Having good health is a big goal. Instead of worrying about the big picture, try to change one little thing.

This Week in the Office

From the office this week:

1.     I barely recognized my patient when he came in asking to have his cholesterol checked. He had lost 55 lb! The secret to his success: he joined AA. He didn’t know what to do in the evenings since he wouldn’t be polishing off a couple of six-packs while watching the game. His sponsor suggested that he go to the gym and watch the game while working out. The result: new friends, a new body and a 35% reduction in his cholesterol.

2.     Another patient really didn’t want to tell me his concern. Since a picture is worth a thousand words, he took out his phone and showed me a picture of his hemorrhoid! Great photo – I didn’t ask him how he accomplished it. I hope that his phone is not confiscated for any reason before he has a chance to edit his photos.

3.     I recalled a middle-aged lady to review her blood tests. Since she was a two-pack a day smoker, I was very concerned about her elevated cholesterol and future risk of heart disease and stroke. She agreed to start some medication, but objected to my suggestion that she repeat the blood test in 6 weeks and then return so that we could evaluate the treatment. She stated that she could not afford the $30 co-pay for the visit.

4.     It’s been hot and patients are getting dehydrated. Don’t rely on thirst. A better guideline is passing light yellow urine every two hours while awake. 

Tips

From the American College of Physicians:

The following tips can be shared with patients to help them remember to take their medications:

•   Take at the same time each day.

•   Take when you do other routine activities (e.g., eat meals, get ready for bed).

•   Store in a pill container with days of the week.

•   Keep a dose in a purse, briefcase, or pocket.

Create a reminder system for doses that are especially hard to remember—for example, a watch with an alarm clock, an electronic reminder through your computer at work, or a sticky note where you will be sure to see it at the appropriate time.

Fighting Evolution

Fighting obesity means fighting evolution’s urges to gorge, according to David Tichansky, MD. “We’re all genetically programmed to eat as much as we possibly can at every possible opportunity, and when we’re given a choice to select the sweetest-tasting choice.”

We need to learn to distinguish between “brain hunger” and “stomach hunger.” Ways to do that include controlling portion size, eating slowly and waiting thirty minutes before eating something else. People can drink hundreds of calories a day, often mindlessly.

It takes a lot of work to combat genetics, not to mention the additional psychosocial, societal and cultural factors. The TV ads for restaurants (mainly fast food and pasta emporia) are non-stop. Super-size drinks are never a good idea. Comfort food from the old country used to be a rare treat, not a daily event. In the old days, cake was only served on a birthday.

We are also losing sight of what is a good weight. A person will often think that he looks OK, even if his body mass index is well above the upper goal of 25. Clothing manufacturers are using vanity sizing: what used to be a women’s size 8 is now a size 4. Men’s trousers are “full cut,” code words for bigger than advertised.

Everyone should be thinking about maintaining a healthy weight. People with a body mass index (BMI) of 25 to 30 should lose weight with diet and exercise and not wait until they are in trouble with a BMI greater than 30.

Calculate your  BMI.

Sugar Alcohols

Foods that are marked “no sugar added” are not without sweeteners – instead of the usual table sugar (or another sweetener such as honey) the food is made sweet with a sugar alcohol. It’s easy to spot the products: on the ingredient label you will see substances that end with “ol” such as sorbitol, mannitol or xylitol.  These additives are not calorie free! Sugar alcohols contain two calories per gram; regular sugar has four calories per gram.

Many of these sugar alcohols are derived from fruit, but some may be made in the lab.  The chemical structure is a blend of a sugar molecule and an alcohol molecule. The sugar alcohols are listed on the Nutrition Facts label under the sugars line as part of the total carbohydrates. They do count as carbohydrates.

The sugar alcohols are not usually added to ‘regular’ foods – they are found in snack bars, candies, frozen treats and some beverages. In excess, they can have a laxative effect.

I am not a big fan of engineered food. Sugar alcohols can be helpful to diabetics, since they decrease the total carbohydrate content of food. For the average person, eating half a serving of real food will also decrease the carbohydrates in half and will taste much better. Best of all – no nasty side effects.