Family Dynamics In The Age Of COVID-19

No doubt you are feeling some stress from the COVID-19 situation. While doing our best to make the virus disappear with social distancing, hand washing etc., it has changed our day-to-day dynamics and routines. One area that has come up repeatedly, is the panic in parents’ voices about how unprepared they are to have the schools unexpectedly closed. Unfortunately, society has “evolved” to a point where families are socially distant. School, work, activities, homework, housework, sports, our days have become whirlwinds of activity but not much communication. One of the tenets of Lifestyle Medicine is building strong relationships. Rather than feeling “trapped’ by upcoming restrictions, look at it as a time to reconnect as a family. Get to know your kids as individuals and learn their personalities. To this end, I asked my friend, teacher, and mom, Heather Cudworth, to write a guest blog that will hopefully help you achieve this goal.

Family Together Time by Heather Cudworth

As a public school teacher, turned stay-at-home mom, turned homeschool mom, if there’s one thing I learned about managing children, it’s the power of having some sort of schedule to keep the day flowing along and allow for together time and alone time, active time and quiet time. What you’ll want to do depends upon your circumstances and your children’s ages, but I’d suggest something along these lines:

1. Quiet reading or play in their rooms
2. Get dressed and have breakfast
3. Do schoolwork if they’re assigned any, or you can assign some from the links below (which is more fun, because you can do the activities with them!)
4. Play break, outside on the lawn if possible so that they can run!
5. Lunch
6. Read a book together aloud. If they’re old enough, pick a chapter book to read aloud together or to listen to on Audible. If they’re little, have a couple of story books.
7. Quiet Time — Naps for the little ones and quiet reading/writing/art or finishing schoolwork for the big ones. Break time for the parent to accomplish other things!
8. Play break — active play encouraged.
9. Clean up and help get supper ready.
10. Supper
11. Family fun time — Play a game, build something, do an art project, watch a video together, go for a walk, etc.
12. Get ready for bed.

Once you get them used to the routine, it should go fairly smoothly, and the more you’re really involved in their activities, the better things will flow. This is not the time to be on your phone or computer unless you absolutely have to be. Children, even teens, really need their parents and crave their attention, as much as they pretend not to. If you use this opportunity well, you may build some of the best memories of your children’s lives, and make your biggest impact upon who they grow up to be, in these weeks together at home.
Here are a few links:

100 Ideas for Family Fun at Home (mainly non-electronic)

If your children’s schools aren’t providing assignments right now, here are a few resources:

This site was thrown together quickly to allow people to educate Preschool and up for free and since it was put together so quickly there are some spelling errors etc. that the content creator acknowledges: A Better Way to Homeschool

Tons of idea links on the internet

Printable workbooks to keep them busy

Free educational websites for kids 

Chocolate Berry Crisp

Valentine’s day is almost here and with it thoughts of Chocolate! It is so easy to over-indulge in sweets this time a year, I wanted to find a way to have your cake and eat it too, so to speak. So, what will please chocolate lovers but still bring some health benefits? Since not everyone is at the same place in their health journey and since I don’t want to alienate milk chocolate lovers, it needed to be versatile. First thought was the classic pairing of dark chocolate with some beautiful strawberries. At a $1.00 a berry in the store, they won’t go far. Make at home? Berries are out of season and tempering chocolate is not common cooking skill, but it did give me an idea. Chocolate Berry Crisp!
Since everyone’s taste is not the same, at the end of the recipe, I share some ideas for swapping out ingredients to adjust it to your taste so keep reading to the end. This dish is about melding different flavors with less emphasis on sweetness.

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Start with mixed berries, an antioxidant powerhouse. These can be fresh or frozen, but keep in mind the cooking time will vary between the two. Select a mixture of berries for best flavor. Put into your 9×9 pan.

Next chocolate. Dark chocolate without milk may lower blood pressurIMGP1007e and provides antioxidants. Since this dish was made for Valentines, ½ of the chocolate was distributed in with the berries and the other spread on top. To make this easier, all the chips can be put in with the berries. Alternatively, after the crisp is baked, you can put all the chips on top. After they warm up for a few minutes, they will become soft/melted and you can spread them over the surface of the crisp. While this is an extra step, I do think that it provides more chocolate flavor to the dessert.

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Flour or corn starch is sprinkled over the fruit to help thicken the juices while it is cooking. If you don’t mind the juices being thin when you serve it, then this step may be omitted.

Assemble your dry ingredients and mix together:
Oats — Heart healthy fiber. IMGP1010 (3)
Nuts  — Heart protection.
Cinnamon — Trace minerals and antioxidants.

Ready for the wet ingredients. If you add the vanilla to the syrup, it will distribute better when poured into the dry ingredients. Add the following to the bowl:
Applesauce — fiber. It acts as a binder for the dry ingredients to eliminate the oil traditionally used. These newer pouches with a lid allow you to use part of the package and store the rest in the fridge until later.
100% Maple syrup (please note this is not maple flavored pancake syrup) — Vitamins and minerals. It adds a nice depth of flavor.
Vanilla extract (not artificial flavor) — antioxidants.

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Mix until crumbly. Spread across the top of the berries and pop the pan into the oven.
With fresh berries it will take about 30 min for the top to become brown and the berries to bubble. Frozen will need 10-15 minutes more. If you find that the top is getting too brown, cover with foil.

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For this picture, I laid out the chocolate chips in a heart pattern. When they had melted, 3-4 minutes, then I smoothed them into the heart shape. When I discovered the heart-shape did not show up well in pictures, I decided to outline the heart with white chocolate chips. White chocolate is basically cocoa butter and sugar with no real nutritional value. It is also difficult to melt which is why I left them as chips.  They are not an essential part of the recipe.

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This desert is great as is. However, there will be those temped to add ice cream or whipped topping.  WIMGP1039 (2)hile not a whole food plant based approved topping, So Delicious Coco Whip topping adds creaminess and a pleasant coconut taste without as many chemicals or fat as the other popular toppings.  Enjoy!

Additional notes:

To reduce fat:
Leave out the chocolate chips and add ¼ cup of cocoa powder to the topping. Reduce the nuts by 2 tablespoons. Since cocoa is bitter, add 2-4 Tablespoons more of sweetener.

Sugar substitutes:
¼ cup of brown sugar or
½ cup coconut sugar or
¼-1/2 cup of date sugar or date paste

Chocolate chips:
You can use equal amounts of semisweet chocolate chips. To preserve the antioxidant activity of the chocolate, it is still recommended to use a dairy-free version. Keep in mind if you use semisweet or milk chocolate, these chips will be sweeter than dark chocolate so be cautious when adding additional sugar.

Chocolate Berry Crisp

Prep Time: 15 minutes

Cook Time: 45 minutes

Total Time: 1 hour

Category: Food

Cuisine: American

Servings: 6 servings

Chocolate Berry Crisp

Ingredients

  • 2 cups of blueberries (fresh or frozen)
  • 2 cups strawberries (fresh or frozen)
  • 2 cups blackberries (fresh or frozen)
  • 6 Tablespoons of 70% or higher dark chocolate chips
  • 2 tablespoons of flour or cornstarch (optional)
  • 1 cup old fashioned oatmeal
  • ½ cup of walnuts or pecans
  • ½ teaspoon of cinnamon
  • ¼ cup maple syrup
  • ½ teaspoon of vanilla extract
  • ¼ cup applesauce
  • White chocolate chips (optional)

Instructions

Place berries in a 9 x 9 baking pan. All the chocolate chips can be added at this time over the berries, or they can be added as a topping after baking. If a less runny filling is desired, sprinkle the berries with flour or cornstarch. Combine dry ingredients. Add the vanilla to the maple syrup for better distribution in the topping. Add the wet ingredients to the dry and mix until moistened. Distribute the topping over the berries. Bake in a 350-degree oven. Check after 20 min to make certain topping is not getting too brown. If the topping starts to get too brown, cover the crisp with foil. For fresh berries cooking time is about 30 minutes. For frozen berries 40-45 minutes. The berries should be bubbling when done. If the chocolate chips were not added with the berries, they can be sprinkled over the topping immediately after removing from the oven. Allow chips to soften from the heat for 3-4 minutes then spread evenly over the surface.

Notes

White chocolate chips were used as decoration to accentuate the heart.  They are an optional ingredient.

https://healthstylesdr.com/2020/02/09/chocolate-berry-crisp/

Doing…Nothing!

Did you know that the average person makes 30,000-45,000 decisions a DAY!  A staggering number. Many “decisions” are part of everyday habits such as teeth brushing and seemingly may not require much thought.   Also, simple, almost mindless tasks can actually take multiple decisions.  For instance, to read this blog you had to decide when to get on the computer, to ignore the ad that popped on the screen, to link to this site and to look specifically at this blog. 

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The Western lifestyle and technology have brought many of these changes.  In 1875 if you wanted a pair of jeans Levi Strauss & Co. was it.  Now there are colors, styles, sizes, fashion and designers to select from.

Some decisions are in the background of our daily lives.  A noise in the house, based on past experience will be “interpreted”. Without thinking too hard, your brain decides if the noise is burglar (call 911), or the cat riding the robotic vacuum…again (go back to sleep).  How amazing our brains make sense of the world to assist our interactions with it.

Unfortunately though,  coping with excessive decision-making can result in fatigue.  Studies have shown that the brain needs to have time to rest.  One way is quality sleep, covered in an earlier blog.  Some people find meditation or prayer to be helpful.  But for some individuals, quiet time is stressed time.  Those moments of quiet forced focusing devolve into lists of undone and forgotten tasks, or past transgressions screaming for attention.  The next option?  Try doing nothing for a few minutes a day. 

This is also known as practicing Mindfulness rather than Mind Fullness.  For examplPIne branche, recently I heard an unidentified noise.  The brain tried to define it as a car, a vacuum, another mechanical device as these are the sounds I hear the most.  What was it?  Wind in a pine tree.  What had happened, that I was so disconnected from the world that I could no longer recognize wind?!?!   I stopped my day for 30 sec and took that time to reacquaint myself with the sound of wind.  The feeling and temperature of the breeze.  It was a peaceful moment that has come back to me several times since renewing that moment of calm I felt. 

It isn’t hard or time consuming.  You simply stop what you are doing for a few seconds to minutes and use your senses to listen, see, taste, smell or feel what is around you.  And the best part, there is no right or wrong way to do nothing.  You can even be doing something and do nothing.  It is just a practice about being mindful.  About beinightskyng present in the moment.

On vacation with 100 sights to see? Take a minute, stop, look out the window at the view.  No view? Look at the sky, at the stars. 

 

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                                                                                                                           What does silence sound like during different times of the day? Hint silence usually isn’t silent. Unidentified noise?  Focus on it a minute and track it down.  Following that advice lead to the discovery of a pileated woodpecker.  

beach

At the beach look at your feet in the water.  Is the water cold or warm? Is the sand shifting or still?  Can you taste the salt? 

 

At night are the sheets rough, warm, heavy, or fragrant? 

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Get up 5 minutes early and have your coffee outside at sunrise or at least at home rather than traveling in the car.  How is it?  Too warm, too cold, too sweet? Just right? 

Stop and taste your food.  If you are going to eat something unhealthy at least you owe it to yourself to stop long enough to enjoy it.  

You get the point.  Just try taking a couple of minutes a day and think about how that moment tastes, looks, feels, smells or sounds.  You may just find that a piece of mindfulness brings a bit of peacefulness to your day.

Lifestyle Medicine vs. Cancer

An illness may result in the loss of something of greatest value, namely some aspect of one’s health.  When considering cancer, you may think “I am at risk of losing my health and there is nothing to be done about it.”  But, is this really true?  According to research by Mingyang Song, MD, ScD and Edward Giovannucci, MD, ScD, “about 20-40% of cancer cases and about half of cancer deaths can be potentially prevented through lifestyle modification.”1  Yet, individuals continue to believe there is nothing preventative to be done under the mistaken notion that cancer is about non-modifiable—“nothing I can do about them”–risk factors such as genetics, age, or race.

Enter the good news, Lifestyle Medicine has evidence-based information on modifiable risk factors and the actions you can take to help counter them:

What you put in or on your body, and what you do for your body.

Someone is already thinking, “If that were true, then why do picture-of-heath individuals get cancer”?  Generally speaking, information about disease and its etiology, complications, etc., fill medical school libraries and is profoundly beyond the scope of this article.  Further, certain details of an individual’s life, e.g., childhood and workplace environmental exposures, may never be known and therefore impossible to factor into the individual’s equation.   However, it is generally agreed that 40% of cancer diagnoses are preventable with changes to lifestyle.  Before you write off lifestyle consider the following: 

EXPOSURE

Smoking has long been linked to lung cancer, sun exposure to melanoma, radiation to thyroid cancer, and Human Papilloma Virus (HPV) to cervical and other cancers.  And, have you seen the legal advertisements on TV with regard to asbestos exposure and Mesothelioma?  Most of us are aware of at least some cancer/exposure links.  Lesser known associations include alcohol’s link with six different kinds of cancer.  Another is Diethylstilbestrol (DES), a synthetic estrogen used during pregnancy between 1940-1971, which resulted in cancer in some of these women and their offspring.  Studies are now ongoing in their grandchildren.  So, the message here is avoidance of exposure to limit your risks.

IMMUNITY

White Blood Cells Attacking an Invader

Think of the immune system as your body’s own little army of “soldiers.”  A “foreign invader” such as bacteria, a virus, or even an abnormal cell forming inside the body sends the “soldiers” into action to prevent invasion, replication and dispersion.  But, as with certain illnesses like HIV/AIDS, impairment of the immune system can occur.  Transplant recipients require immunosuppressive medication to prevent the “soldier” cells from mistakenly attacking the new organ.  These “soldiers” also may not be able to destroy unrelated cancer-causing infections or cancer cells, hence the restrictions placed upon these patients regarding crowd exposure, etc.

INFLAMMATION

When an injury occurs, the body’s immune system sends white blood cells and chemicals to heal the area.  This will present as a warm, red area around the wound.  However, sometimes after the injury is healed, the inflammation remains.  It is even possible to have inflammation without an injury or infection; this chronic inflammation can damage healthy cells and weaken the immune system, leading to development and growth of cancer cells.

EXAMPLES FROM EACH OF THREE AREAS

Viruses, bacteria, and parasites are all part of the problem.  By exposure, they enter the body.  Some disrupt the cell communications; others weaken the immune system, decreasing the body’s ability to defend itself against other cancer-causing infections; and a few lead to chronic inflammation.  Some like H. pylori (best known as causing stomach ulcers) and Hepatitis C have treatments available.  Others such as Hepatitis B and HPV have vaccines available for prevention before exposure.  Your doctor will guide you regarding appropriateness of vaccines for yourself and your family.  When traveling, educate yourself about the geographic area and the preventive measures you can take to reduce exposure to pathogens.

SO, HOW TO AFFECT THESE AREAS

Every time you eat, it is an opportunity to put something into your body to make it function better.  Does this mean supplements?  No, real food!  Blueberries for example, are showing amazing potential in studies to not only prevent cancer from forming but to assist in cancer therapy by making the cancer cell more susceptible to treatment.  To see other ways foods can positively affect your health refer to the “The Nutrition Rainbow2.

So, what else can I do?  Shown below are other activities you can incorporate and their cancer-busting potential.

Hopefully, this article has given you a brief introduction to the relationship between lifestyle changes and their ability to perhaps lessen potential cancer risks, all presented in a way that is understandable to those not seated at the science nerd table.  Or, maybe you are still caught up in the “this is too much trouble; this is too unlikely; this is not do-able in a family of five; this isn’t going to mitigate the strong history of “x” cancer in my family,” etc. But, you read the article…all the way to the end.

In a nutshell, Motivational Interviewing, a counseling technique, defines five stages of change:

  • Pre-contemplation—“Leave me alone.”
  • Contemplation—“I’m thinking about it, but on the fence.”
  • Preparation—“I’m going to do it.”
  • Action—Do it.
  • Maintenance—Ongoing monitoring.

Remember, you read the article…all the way to the end, so you may well be at Stage 2 or even 3.  Continue to digest the information and maybe even look up some additional sources online or chat with your primary care doctor or Lifestyle Medicine physician.  Should you undertake to make changes, remember perfection isn’t expected or being broadcast on social media.  Any change, however small, you undertake to promote better health can only help.

References:

  1. Song M and Giovannucci E. JAMA Oncol. 2016;doi:10.1001/jamaoncol.2016.0843.
  2. “The Nutrition Rainbow” by The Physician’s Committee for Responsible Medicine. Link

A Study of Studies

Photo by Pixabay on Pexels.com

“Butter is Bad.” “Butter is Back, Baby.”  “Red Meat is Bad.” “Red Meat=Beneficial Nutrients.”You get the point.  

In our 24-hour news cycle, anything can be touted for “clicks” and “likes.”  From time to time, studies which support writers’ personal biases are sought out. And, perhaps most importantly, today we are overwhelmed with the magnitude of available information, leaving one to scratch his or her head while it spins in confusion.

So, how do we narrow down all this info to make it meaningful? Consider going back to the source of the information and evaluate the studies yourself. Not a scientist? You can still find useful needles from the haystack by keeping in mind a few ideas:

1. Am I willing to invest the necessary time? Plan to read the entire study, not just the abstract (summary) of the paper. It will take some time. Have a notepad handy to jot down any ideas or questions the study prompts.

2. What kind of study is it?
a. A double-blind, random, controlled study (where neither participant nor researcher knows to what group the participant is assigned) is considered the best experimental model.  
b. Observational studies typically observe a controlled environment, but results can be influenced by the participants’ awareness of the groups to which they are assigned. Conclusions in this case may be inferred but not necessarily proven.  
c. Metanalysis examines multiple studies to look for consistent results.

3. Who funded the study? If the Widget Council funded a positive study on widgets, it may be a good study…or, it may be one good study among several unpublished ones that did not support their product.  What about a study sponsored by American Gadget Association? A look at the sponsors may reveal funding for the study from the Widget Council.  (A list of any researcher’s conflicts of interest should be listed.)

4. Where was the study published?  In some journals the author can pay to have a study included regardless of the quality.  Look for academic, peer-reviewed journals.

5. What are the researchers’ credentials?  A neurobiologist with several advanced degrees and 15 years’ work experience studying the microscopic changes of a nerve probably has a great deal of credibility.  An English major’s biology paper written to satisfy a graduation requirement might not contain the best criteria upon which to base a life-changing decision.

6. What is the study trying to prove?  This information should be found in the Abstract or Introduction.  A recent news article cited a study in the fats vs. carbs weight loss debate. However, the study’s Abstract revealed that the study topic regarded metabolism not weight loss.  

7. How large is the study?  A study of 10,000 participants will control for many more variables than a study of 100.  Keep in mind though, under rare conditions ten participants may be a large sample size.

8. How many participants did the study start and end with? Suppose a study started with (a very reasonable) 1,200 screened participants, yet only 300 eventually participated. What was the elimination criteria? Was this a drug trial and participants quit taking the medicine due to side effects? Was it a diet that was too hard to follow?  Did the scientists only include results that support one viewpoint?

9. How long did a study last?  Two years for a chronic disease drug trial rather than a week could provide considerably more useful information. Conversely, the deaths of 10% of the sample within 5 days of study commencement is very telling.

10. Was this a cell culture, an animal or human study?  

11. Do the results answer the question the researchers set out to prove?  Can you think of any alternate reasons for why these results were obtained?  Do the authors look at alternate reasons for the results they obtain? Don’t forget reader bias; are you willing to change your mind if the evidence is strong enough?

12. Good at statistics?  Run the numbers.  If not, then look for study critiques.  Many journals have other researchers that will evaluate the study and explain the numbers as well as the study design, sometimes with different conclusions.  Compare to other similar studies. Look at the references.  They can shed new light on how the scientist is approaching the problem.

Like any other skill, learning to read this type of material takes time and patience. But the more you read the more you will learn, and this may help you to sort the wheat from the chaff the next time a new blockbuster study is rolled out in the media.  For a more detailed study plan with additional questions to guide you, click here.

Whole Food Plant-Based

Becoming Plant Powered

It is exciting to run into people who haven’t seen you for a while who comment “you look great; what are you doing”?  The problem? How to describe a plant powered lifestyle in just a few words.

Vegan? Vegetarian? Plant Strong?  While a little wordy, Whole Food Plant Based really describes what we do and what I promote.  It is not a diet but a lifestyle. So how does it differ from other approaches?

Vegetarian — plant based meals which may include eggs and/or milk.

Vegan — eschews the use of all animal products.  If it has a face or a mother it will not be consumed or used.  For many vegans, this way of life is as much or even more about animal and environmental concerns. 

Keep in mind that your diet may still be unhealthy with either of these approaches.  If you subsisted on chocolate cream cookies and beer it would be vegan, but would it be good for you?  NO!!!

How Does WFPB Set Itself Apart?

Start with the first part – Whole Foods.  Eating food in its least processed form.  It does not have to be raw; some foods are more nutritious cooked, but try to minimize processing.  Examples:

Most processed:  Apple juice lacks fiber and other substances which blunt the quick absorption of the sugar.

Better, less processed:  Apple sauce without the peeling contains only about ½ of the fiber and polyphenols.

Best:  The whole apple contains all the available polyphenols and fiber.

Plant-Based.  Someone invariably jokes that cows eat plants so beef is plant-based.  It always gets a chuckle from the group until we discuss how multiple large studies link red meat as a cause of colon cancer.  Another point is how meat-based proteins (but not plant-based proteins) cause stress to the kidneys in renal failure patients.  This potentially means meat is stressful to healthy kidneys as well.  So, plant-based means just that—it comes directly from the plant. 

Frequently, someone says “I don’t like vegetables.”  The plant world is much more varied than people believe.  Take a look at this non-exhaustive list of items we can find in stores and farmers’ markets in the North Alabama area.   Most people can find something on each list that they like. The items may not be listed botanically, but rather in how they nourish the body.

WHOLE Grains:  brown rice, oats, wheat, corn, farro, quinoa, amaranth, barley, rye, buckwheat, bulger, millet, sorghum, spelt, triticale

Nuts, Nut Butters, Seeds and Seed Butter:  walnuts, pecans, almonds, pistachios, sunflower seeds, peanuts, hazelnuts, pine nuts, cashews, flax seeds chia seeds, pepitas (pumpkin seeds), sesame seeds

Vegetables:      

Greens/Cruciferous:  lettuces, kale, collards, bok choy, Swiss chard, turnips, spinach, arugula,  broccoli, cauliflower, brussel sprouts, cabbage, broccoli rabe, Chinese cabbage, kohlrabi, mustard greens, radish greens, rutabaga, tatsoi, watercress

Tubers/Roots:  potatoes, sweet potatoes, yams, carrots, beets, onions, parsnips, turnips roots, radish roots, rutabaga, jicama, taro, Jerusalem artichoke, leeks, garlic

Other:  asparagus, celery, rhubarb, sweet and hot peppers, cucumbers, eggplant, okra, pumpkin, squash, snap peas, green beans, tomatoes, zucchini, mushrooms, bean sprouts,

Fruits:  cantaloupe, watermelon apples, pineapple, oranges, grapes, bananas, raisins, plumes, prunes apricots, peaches, cherries, avocado, kiwi, clementine, dates, figs, grapefruit, honeydew, jackfruit, kumquat, lemon, limes, mango, olives, nectarine, papaya, pear, persimmons, pomegranate, paw paw, quince, tangerine

Berries:  blueberries, blackberries, cranberries, mulberries, raspberries, strawberries, currents, grapes, muscadines, scuppernongs

Beans:  English peas, black beans, black-eyed peas, field peas, purple hulls, crowder peas, broad beans, lima beans, chickpeas, kidney beans, lentils, navy beans, pinto beans, split peas, soy beans

Spices and Herbs:  Too numerous to name, but wonderful sources of additional plant benefits

Returning to the claim of not liking vegetables, I would ask have you tried every plant fixed every conceivable way?  Those with children can relate to the expression, “eat your food, it is good for you” and “how do you know you don’t like it, you haven’t tried it.”  So often as adults we fall into a trap of saying “I am an adult and I don’t have to eat it since I don’t like it!”  But you really need to think about your health.  Try new items.  Try old items fixed new ways.  One client disliked cooked kale, but tried kale as a salad and enjoyed it.  One person loved the consistency and flavor of our cornbread but almost spit it out upon finding it had her hated food group BEANS in it.  She overcame the mental obstacle toward eating them and asked for the recipe to make for her family.

Look at this as a food adventure and see what you can do to add more plant-based foods to your diet!

Lifestyle Medicine

Reprint of my article as printed in Inside Medicine magazine August 2018 edition.

The old expression–”there is nothing new under the sun”— may indeed be true.   But, old ideas sometimes can be explained in a new way.

Many people are already aware that their habits can affect their health.  The news is full of “don’t eat this,” or a new study on exercise.  And, yet, we as a nation appear to be getting sicker.  It is difficult for doctors to discuss health given our current illness-based insurance model.  With genuinely caring physicians having such limited time with each patient, the recommendation for a one-size-fits-all diet and exercise approach is often the norm.

Fortunately, out of established research a new branch of medicine has emerged with the focus on helping people improve their health and prevent chronic diseases.  Based on improving six areas of health, Lifestyle Medicine uses many non-drug modalities to treat, improve, and sometimes even reverse chronic health conditions. Medication, while still used, becomes the supplement to these lifestyle changes.

These six areas are:

  1. Nutrition—getting vitamins, minerals, protein, fiber, phytonutrients, etc., from a predominately whole-food, plant-based diet
  2. Movement—consistent daily movement that works all the muscles, including the heart
  3. Sleep—improving the quality of rest
  4. Substance use—eliminating the use of tobacco and other potentially harmful substances
  5. Relationships—establishing and nurturing supportive social connections
  6. Stress management—leading to improved health and productivity

Why focus on so many things? In addition to the fact that individually each of these areas can produce health issues (e.g., tobacco and cancer), they also can affect each other. Improved sleep may assist in weight loss.  Moving may reduce stress. And, if you don’t fuel your body with a good quality diet, it’s little wonder you don’t feel like getting off the couch.

Would you like to feel better about your health? The process starts by deciding what your goal is and perhaps even writing it down.  Maybe you would like to run a 5K or simply be able to play on the floor with your grandchildren.  Next is to identify areas you are willing to change.  Maybe the coffee creamer will not be eliminated, but you will eat an extra serving of a green vegetable each day.   An earlier bedtime is not feasible, but you are willing to encourage deeper sleep by turning off your phone and leaving it in the kitchen overnight. Successes are celebrated and failures are put to good use as you learnto analyze, re-adjust, and overcome.

So, while the message is not new—your mother may have told you to eat your vegetables and get plenty of sleep—life has a way of intervening and sending us down another path.  Now is the time to learn how to manage that stress, get some quality rest, develop a strong emotional support system, avoid substance use, and become active while being mindful of your food choices.  It may just be exactly what the doctor ordered!

Elizabeth McCleskey, DO Board Certified Family and Lifestyle Medicine; Member, American College of Lifestyle Medicine; HealthStylesDr.com

You Are Getting Sleepy…NOT!!

Well, you have accomplished another busy day. Meals prepared, work completed,

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laundry done, kids ferried, and pets tended. Now, you can’t wait to fall blissfully into bed and drift off to sleep. Until you think of your to-do list while a heat wave moves down your body, your bed partner snores like a chain saw, and the panic sets in about that forgotten urgent task. What is a person to do?

Before you head for a sleeping pill, ask yourself some questions that will help identify causes:

  • • Am I having trouble falling asleep or staying asleep?
  • • Is there physical discomfort such as back pain, indigestion, or achiness or stiffness overall?
  • • Listen to the environment. Was there a noise that woke you up? Examples might include a neighbor leaving to work a night shift or the cat dashing across the bed on a secret errand?
  • • Are you hot or cold?
  • • What did you have to eat or drink that day, especially within a few hours of bedtime?
  • • Do you feel anxious and, if so, why? Was it a nightmare or unfinished task?
  • • Are you tired during the day, as though you haven’t had good sleep?

analysis blackboard board bubble

Now see if your solution is here!

Be Touchy Feely

Pain or daytime fatigue? You spend 7-9 hours with your mattress, and as much as you may love it, it may be time to break up. A broken-down mattress can cause you to sleep hot or wake up achy. As you get older, lose or gain weight, or have a pregnancy, the type of support you need can change. Do you need a traditional, hybrid, foam, or pillow top? A split bed which allows for use of different linens on each side may be the answer. (Note: A split bed can be difficult to make up.) Adjustable beds can be helpful for orthopedic issues, reflux, and even some snoring conditions (especially if you control your snoring partner’s remote). Linens and mattress pads can be made of various materials that impact sleep differently. A helpful (but not all inclusive) chart can be found at https://www.cuddledown.com/ResourceCenter.aspx?article=14.

red and white bed pillows

Pillows should support the head and neck without the chin tucking or raising toward the ceiling. Designed for back, stomach, and side sleepers, they are available in a variety of materials. Leg pillows align your body to relieve lower body pain.

Tackling Temp
Best room temperature has been shown in studies to be 65 degrees F. But try adjusting the temperature to see what is right for you.

For Those Who Sleep Hot                                         

Thread count 200-400                                                
Ice pack                                                                          
Gel cooling pillow                                                        
Dehumidifier                                                               
Iced drink in insulated cup by bed                        
Lightweight, moisture wicking fabrics                 
Blinds drawn during the day to reduce heat      
Ceiling or portable fan                                              
Spray bottle of water to mist body                     
Extra set of PJs or sheets                  

For Those Who Sleep Cold

Thread count 400+ or flannel fabric
Hot pack or heating pad
Socks
Humidifier
Hot drink in a thermos by the bed
Heavier sleepwear and sheeting fabrics
Open blinds during the day to warm the room
Electric blanket to warm the bed

Snoring

This could be due to something as simple as allergies (see below) or something as serious as sleep apnea. Sleep apnea can have potentially serious health implications like heart disease, stroke, or reflux (https://clevemed.com/what-is-sleep-apnea/), but people fear the screening procedure or possible treatment regime. Fortunately, advances such as in-home sleep studies and newly designed masks and quieter machines make this a much more comfortable proposition. If you or a loved one snores, check out this screening questionnaire: https://clevemed.com/what-is-sleep-apnea/patient-sleep-apnea-screener/. Don’t know if you snore? Consider taping yourself while you sleep. (Or, you can check out an app like SnoreLab, but a humorous heads up: A friend of mine told me about this app. She was taping herself over time, and was quite alarmed one morning to listen and find an “odd” sound to her breathing. Turns out, the cat had rested on her chest near the phone overnight and his purring was recorded.)

Allergies                                                  
short red hair woman blowing her nose

  • • Launder bed linens weekly in 130 degree F+ water and use automatic dryer.
    • Dehumidify the room to below 50%.
    • Air out the bed before making it up (dust mites like moisture).
    • Cover mattress and pillows with dust mite covers.
    • Vacuum the mattress monthly, and if desired, sprinkle baking soda on mattress 10 or so minutes before vacuuming to draw out moisture.
    • Vacuum and dust the bedroom weekly, and don’t forget air vents, blinds, and curtains.
    • Consider HEPA air filter.
    • Keep pets out of the bedroom.
    • Keep windows closed to keep pollen outside.

The Light and Dark of the Matter

Light wakes up the brain by affecting hormones the body makes. Unfortunately, the body does not know that light from the TV, smartphone, or streetlamp isn’t day light. Gadgets should be put away 1-2 hours before bedtime, preferably in another room because they still can emit small amounts of light while charging, notification alerts, etc.

macbook air beside notebook and camera
How Not to Sleep

Use window treatments such as blackout curtains to prevent leakage of outside light. Consider a sleep mask (a friend tells me hers makes her feel like a glamourous 1930s film star.) These tips are especially important in shift workers. In the morning, getting outside for 20 minutes of natural sunlight also helps to reset your sleep cycle.

To Sleep, Per Chance to Dream: Sleep Assistance

  • • Start the morning with an exercise routine. Exercise helps to reduce extra energy, but undertaken too late in the evening it may prevent sleep.
    • There is an old adage: “Eat breakfast like a king, lunch like a prince, and dinner like a pauper.” Consuming and expending most of your calories during the day are best; night-time consumption can cause reflux and restlessness.
    • Alcohol and caffeine will disrupt sleep. Cut off the caffeine early in the afternoon, and coffee-cup-working-happy.jpgnever use alcohol to “help” you go to sleep.
    • Keep the bedroom tidy, the bed made, and decorate with comfortable colors and furnishings. Calm surroundings will contribute to calming the mind for drifting off to sleep.
    • Before lights out, commit to paper the to-do list to release it from your mind as you fall asleep.
    • Induce sleep by heating the body with a warm drink or bath then let it cool down.
    • A regular daily bedtime and wake time is important. Lost sleep is just that…lost. Don’t expect to make up several days of sleep deprivation. Unless made up within a few hours, the damage is already done.
    • Noise—
    »Turn the TV off. The frequent volume changes prevent deeper stages of sleep
    »Use white noise such as a fan running or white noise machine which is good at masking noises such as traffic.
    »Try ear plugs.
    »Music with a beat of 60 beats per minute may assist in bringing the heart rate down and causing sleep. BUT put the music on a timer for 30 minutes. Much longer than that and it, too, can wake the brain.
    • Some people swear by lavender or other essential oil scents. While these may be helpful for some, others may experience allergic reactions.  Also be aware that pets can be harmed by them in very low doses.
    • Breathing exercises such as 4-7-8 breathing or focusing on relaxation of each part of the body progressively are often helpful.
    • Should you wake during the night, have a large tablet and pen by the bed to write down in one or two words what is bothering you, preferably without turning on a light. Don’t worry about spelling, grammar, or staying “in the lines.” This is just to get the thought on paper so you don’t focus on it to the detriment of further sleep.
    • Should you wake up and be unable to go back to sleep for 20 minutes, go ahead and get up. Find a quiet activity such as reading to occupy your mind. Sleep cycles take about 90 minutes, so when you start to feel tired, go back to bed.

Sweet Dreams!!  

baby beautiful bed child

Additional information can be found at:
https://sleepfoundation.org/bedroom/index.php

 

Cooking 101

“I need fast” one will say. “Flavor is what is important” says another. “Appetizing look!” “Alas, I don’t know how to cook.” And the ever popular ‘I don’t like ____________ (fill in the blank).” Well you get the picture. Everyone has a perception of what it means to make a “good” meal.
Personally I did not learn to cook until I was an adult. The way my mother (an excellent cook) prepared food was incomprehensible to me. What is a handful or a dash? Cook until done means what exactly? Enter Martha Stewart. Think what you will of her, she provided a framework for cooking that was understandable. It reminded me of chemistry class where everything was precise and the chemical reactions made sense.
Fast forward a few years and now I understand how my mother cooks. Precision is great when you start cooking but variety in taste comes when you become open to experimenting. Don’t believe me? Google a favorite dish and see how many distinct recipes you can find.
So in honor of summer, I am writing about a favorite meal. One that can be changed up in numerous different ways and adapted to meet the need for both fast and flavorful.

Pasta Salad 2.0
4 servings

Basic recipe-remember if you don’t like an ingredient, substitutions will be suggested below.

imgp9468.jpg
1 package of Barilla Ready Pasta – any style
22 oz (2 packages) of frozen California mix vegetables microwave in the bag
2 Tablespoons of Italian dressing

Cook the Barilla as directed on the package. Put ¼ of the bag on each plate. Cook the vegetables as directed, divide into four servings and mix with the pasta on the plates. Add ½ Tablespoon of dressing to each serving. Putting this directly on the plate saves a mixing bowl and will help cool the vegetables and pasta quicker.

For a side dish, while cooking the vegetables wash some fresh berries and serve with plain yogurt. Or to skip the sides, make this dish into 2 servings rather than 4.

It depends on your microwave, but I made this version in 10 minutes start to finish.

imgp9491-2.jpg

Don’t care for this warm, or want to use it for a lunch? Cook earlier in the day. Put the dressing in the bottom of a bowl or Mason jar, then layer the firm vegetables, pasta then soft vegetables like tomatoes (a listed option below) and put in the refrigerator. Stir before serving.

 

Now for some variationsimgp9469.jpg

With no Italian dressing on hand, I used a tablespoon of olive oil and a ½ tablespoon of vinegar. Different vinegar types will work, just remember the stronger the vinegar the less you need. The nice thing about Italian dressing is the spices are already included so there are no extra ingredients. Don’t care for Italian? Check the chart at the end for alternatives.

 

imgp9470.jpg

Vegetables make this dish for me so adding more is always an option. Here I used tomatoes, bell pepper and black olives.

 

 

 

Special tools can help save some time and dishwashing but are not necessary.

I find a corer faster to remove stems from tomatoes and peppers and even the pepper seeds. Food processors quickly chop food, but increase clean-up time. Cutting with a knife is sometimes a bit precarious for me so I invested in a chopper-the manual kind-to quickly coarse-chop items such as olives and bell peppers.

IMGP9476

 

In the bowl they go.

 

imgp9498.jpgNow for added flavor. There is always salt and pepper to taste. Dried herbs are easy to keep around and adding Italian seasoning can work wonders. But you can really kick up the favor with fresh herbs. Yes they can be expensive, but ask around and see if you can find someone who is growing some. Better yet, consider growing some yourself! You can grow a variety all in one planter.

 

Here we have fresh basil, parsley and oregano as well as dried herb options.

imgp9474.jpg

After washing the fresh herbs, here are two quick methods of cutting.
imgp9478.jpg                                           Roll the leaves up into a tight roll and

 

 

imgp9479.jpg
imgp9481.jpg

Chop with a knife-Note the poor hand placement

Or cut with scissors-safer

 

The leaves may turn brown in the cutting process. Just leave this for the last step so the leaves stay green until consumed.

imgp9490.jpg

And there you have it! Total time: 18 min.

But what about those things that you don’t like to eat or don’t have on hand?

Here are some helpful additions or substitutions you can use. You may want to increase or decrease the seasonings to your taste. Play with the pasta shapes and ingredients.

For cost savings buy dried pasta and cook yourself. Look for in season and on sale vegetables. Potted vegetable plants require little work and can yield lovely low cost fresh produce.

Now be adventurous and enjoy!

Proteins
Precooked Chicken
Feta cheese
Parmesan cheese
Romero Cheese
Provolone
Hardboiled Eggs
Chickpeas

Vegetables
Cauliflower
Broccoli
Carrots
Tomatoes- Cherry tomatoes may be easier to cut
Celery
Different colored bell peppers
Black or green olives
onion
Zucchini
Artichoke Hearts

Flavorings
Basil 3-4 leaves fresh or ¼ teaspoon dry
Oregano ½ teaspoon of fresh or dried
Parsley 2 Tablespoons fresh or ½ dried
Dried Italian seasoning mix 1 teaspoon
Italian dressing dry mix
Salt
Pepper

Dressings
Italian Dressing 2 Tablespoons
Olive oil 1 Tablespoon with Vinegar ½ Tablespoon
Mayonnaise 1-2 Tablespoons
Another type of dressing such as Panera Poppyseed which is sweeter and less tangy

 

 

 

Farmers’ Market

Ahh…spring, when a young lady’s fancy turns to thoughts of…Farmers’ Markets! Yes, the Markets are open again and I find it amazing the number of people who have never visited one.

So, maybe a littlestrawberry and lettuce primer to help encourage you to explore one of these wonderful places.  The photos have been provided by Kevin Stallings and were taken at the Madison City Farmer’s Market, Madison, AL.

Let’s start with some definitions:

Organic—a farming method that avoids the use of pesticides, herbicides, or man-made fertilizers, any of which may leave a residue on the food. Many farmers employ organic growing techniques but, to avoid raising the costs of their products, do not become certified.

Conventional—methods that employ pesticides, herbicides, or man-made fertilizers resulting in higher yields and potentially lower cost. The advantage over conventional store produce is that it is picked at the peak of freshness, taste, and nutrition and brought right to you.

Raw (Straight out of the cow) Milk—has been neither pasteurized (heated to kill harmful microorganisms) nor homogenized (the cream floats to the top and will need to be shaken for best flavor). In Alabama, the sale of raw milk is legal for farmers with a commercial feed license only for pet consumption.

Unlicensed Kitchen—any kitchen (e.g., one located in a home) that has not been breadinspected or licensed by any agency.

Genetically Modified Organism (GMO)—when the DNA of the organism has been artificially changed.

Grass-finished Meat—results from livestock fed exclusively grass during the last few weeks or months prior to being processed.

Grain-finished Meat—results from livestock fed grains during the last 90-160 days prior to being processed. Resulting in more marbling of the meat, many feel this enhances the flavor aeggs 5nd tenderness but may also be less healthy.

Pasture-raised Livestock—livestock that lives in pastures, or may even forage in woodlands, but have access to shelter. Their diet may be supplemented with grain.

So, now that you know some of the lingo, how do you approach shopping? First, youbird 2 neecatd to understand that this is not the grocery store chore. Think of it as an outing. At our local Market in Madison, AL, you can stroll through the Market or have a seat and listen to the local musicians play while sipping coffee or tea sold by a local vendor. Well behaved, leashed pets are welcome. When they dogare not busy, chat with the vendors about new products, farming methods, food storage, produce selection, or recipes. They love to share their knowledge and will get to know you by name and tastes.

Civility, which seems to be generally in decline, is delightfully present at the Market. Patrons patiently wait for the Market to open and quickly leave at closing. Lines magically form as each person waits to purchase especially popular or scarce items. If someone appears to be contemplating a purchase, it would be very poor form to band 2grab the item without asking. Occasionally, I have selected the last of an item only to find someone behind me came early to purchase that very thing. Handing it over to another just seemed the right thing to do, and yes, this gesture has been reciprocated!

While it is not an uncommon practice to purchase from wholesalers and resell at low cost roadside stands, this is not allowable at most farmers’ markets. Many of today’s local farmers who share their crops at the Market not only farm organically (producing less quantity) and harvest (sometimes by hand) but also transport (requiring time away from the fields) their wares. In my opinion, this produces a better quality product brought to us in a timely way, and prices have to reflect costs of running the business. Vendors areradishes and turnips not used car salesman and do not price their wares expecting to haggle. Happily, you may find they offer a discount for bulk or throw in a new product for you to try. But, if price if an issue, walk around and take a peek at what other vendors have to offer.

If samples are not samples 2available and you really want to try something, don’t grab…ask! Many times it will be provided. Produce is gently handled and never squeezed which may cause bruising preventing a future sale. Instead politely sniff for an enticing aroma, and examine with the eyes for size and spoilage. At the Market, food is usually picked ripe because it is brought to sell within hours, unlike the supermarket offerings which are picked to ripen along the journey across the country or around the world.

While some vendors have credit card processing capacity, start by bringing smaller bills until you get to know the ins and outs of who’s selling how. This will also allow you to move quickly through the Market without having to wait for change. Best variety is at opening with limited items going fast. Regulars know this and will head to these vendors first.

So next Market day, slap on the sunscreen and your wide-brim hat, pick up those reusable shopping bags, and head out to your local Market. I will see you there!

Want a bit more information? Join Dr. McCleskey for Shop-with-a-Doc Farmers’ Market edition at the Madison Farmers’ Market, 1088 Hughes Road 7:45 am May 26, 2018. RSVP 256-280-3990.  We will meet at the east end of the Market.