Steven Piriano, MD

Mindset: The Swap Challenge

Leon Ardho/pexels.com

Mindset is essential in everything you do. You will likely excel at whatever you do if you have the correct mindset or attitude. This same truth applies to living a healthy lifestyle. For instance, some people say that becoming healthy is a major chore. That is not the right mindset. Healthy behaviors such as eating wholesome foods and being physically active should not be considered burdens. Instead, people performing such behaviors should feel energetic, focused, and fantastic because that is how you feel when you’re healthy.

Some people may think that to be healthy, they must give up all their favorite foods. Again, this is the wrong mindset. Individuals trying to be healthy shouldn’t feel like they have to give up anything. What they can do is find healthy foods that they also love and substitute them for those they currently eat that may not be the best thing to put into their bodies. So, don’t ever feel as though something is being taken away. You should instead feel that some other mouthwatering food is being added. You are simply swapping out the delicious and unhealthy for the delicious and healthy. Moreover, a tremendous number of healthy recipes are available on the internet and phone apps—and many are free. I would encourage you to take advantage of them.

For example, take macaroni and cheese. That’s right—good old mac n’ cheese. We found a plant-based version of this classic that is much healthier. My wife prepares it, and—wow, it is just delectable! Bonus—I feel great about eating it because I know it benefits my body.

That is a great place to start. If you are trying to eat healthier foods, I encourage you to search the web or phone apps for a healthy recipe and swap it out for one that is not as healthy. Actually, how about a challenge? If you like, I challenge you to swap out an unhealthy meal for a healthy meal once each week for the next four weeks. Just one swap each week. Are you up for it?

If you are—that’s terrific! I would love to know what meal you prepared, how you liked it, and how you felt about it. Feel free to leave comments every week and let me and others know how you are doing. You may just be an inspiration to others!

Note: I will create a post each week for the next four weeks referencing this challenge where you may comment on your own swaps and how it’s going for you.

Reversing Diabetes: Medications and Lifestyle

Nataliya Vaitkevich/pexels.com

Reversing Diabetes: Medications and Lifestyle

According to the CDC, more than 37 million people in the United States have diabetes, and most diagnosed cases (90-95%) are type 2 diabetes. Diabetes is a disease in which the body’s ability to use glucose (its primary energy source) is impaired due to a problem with insulin, the hormone produced by the pancreas that allows glucose to move into the body’s cells. Whereas a deficiency of insulin production occurs in type 1 diabetes, typically in children and adolescents, there is no deficit of insulin production in type 2 diabetes. The latter condition develops for several reasons, but one of the primary problems is that the body’s cells become resistant to insulin and are thus unable to utilize it to move glucose into cells. Blood sugar levels will be increased in both conditions. Over time, diabetes can cause serious health problems such as heart disease, kidney disease, vision loss, and amputations. Definitely not an illness you’d want to get if you can prevent it. The good news is that you can prevent it, at least the type 2 version.

The reason type 2 diabetes is preventable is that it, like many other chronic conditions, is a disease of lifestyle. That’s correct—type 2 diabetes develops due to an unhealthy lifestyle. There are several studies showing that making healthy lifestyle changes can prevent this condition. Moreover, one group of researchers wanted to examine both a lifestyle-intervention program and a prescription diabetes medication called metformin and their effects on preventing or delaying the development of this disease.

Their article appeared in the New England Journal of Medicine (N Engl J Med 2002; 346:393-403). They performed a study in which they enrolled 3234 participants that did not have diabetes and split them into three groups. One group was given metformin; the second group was the lifestyle-intervention group, and the third group was assigned a placebo pill. The individuals in the lifestyle-intervention group consumed a healthy, low-calorie, low-fat diet to maintain a weight reduction of 7 percent and performed moderate-intensity exercise for at least 150 minutes per week.

The results of the study were fascinating. Compared to the placebo group, the incidence of diabetes was 31 percent less in the metformin group. However, the really captivating part was that the incidence of diabetes in the lifestyle-intervention group was 58 percent less than in the placebo group. So, a healthy lifestyle was better at preventing type 2 diabetes than a commonly prescribed diabetes medication—and without any adverse side effects!

Always remember that treating your body well and providing it with healthy foods will significantly lower your risk of developing lifestyle-related diseases.

Health Habits

Taryn Elliot/pexels.com

Is there any health behavior that you have ever considered changing?

Perhaps you have been thinking about your diet or the amount of physical activity you give yourself.

Have you ever felt that your current health habits may not be the best for you, but you never really have “gotten around to” changing things?

Just a question to reflect upon. Believe me; I understand how busy we can be and how often life can get in the way of, well, life.

When you are ready, remember that it doesn’t have to take drastic changes. Simply making one slight adjustment a few times a week and then building upon that can have tremendous positive effects over time. For example, add a single serving of fresh fruit to your day three times each week for two weeks. Or perhaps replace your afternoon candy bar with an apple three times a week and slowly increase over time.

When you are ready, give it a try.

Let me know how it goes for you.

Genes are not Destiny

Let’s shatter a myth.

Over the years, I have heard many people express a belief that is not only false but also dangerous.

I’ve heard it conveyed in many forms:

“I know I’m going to get a heart attack someday. Everyone in my family has heart disease.”

“I am so afraid of getting cancer. So many of my relatives have cancer.”

“There’s nothing I can do about my diabetes. It runs in my genes.”

These are disempowering beliefs. However—they are NOT TRUE. That’s right. These beliefs are incorrect.

To further explain, how about a quick lesson on genetics?

Deoxyribonucleic acid, or DNA (much easier to say, right?), is the molecule that contains our genes. Our genes, in turn, encode for proteins that determine our physical characteristics, such as our height, eye color, hair color, skin color, etc. Moreover, our genes can predispose us to develop many diseases. That part is true.

However, many times these disease-causing genes need to be activated in order to actually create a disease. There are “gene switches” that work to turn genes “on” and “off.” The question then becomes, “What determines whether a gene will become active?” The answer is the internal environment of the body. The next logical question is: “What determines the internal environment of a person’s body?” The answer to this question is the key to maintaining good health—lifestyle.

Yes, lifestyle, which is defined by the foods we eat, the amount of physical activity we give ourselves, how well we sleep, how we manage stress, the strength of our relationships, and whether or not we use risky substances such as tobacco. These factors will define a person’s internal environment and, thus, what types of genes will be activated. In fact, it is thought that genes themselves account for only 10% of a person’s overall degree of health, whereas “gene switches” account for 70-90% of a person’s overall degree of health.

To illustrate using an example:

Let’s say that you have a strong family history of heart disease. Your parents, one of your siblings, and several aunts and uncles have all suffered heart attacks. It is very likely that you also have the genes that will lead to the development of heart disease. However, given this genetic predisposition to heart disease, there are two possible health scenarios.

Scenario #1:

You eat a lot of fatty and processed foods and not many fruits, vegetables, or whole grains. You are relatively sedentary, have a stressful job, and don’t get adequate sleep. The chances are good that the heart disease genes will be turned on, and you will develop heart disease.

Scenario #2:

Your diet consists primarily of fruits, vegetables, legumes, and whole grains. You are a physically active person and exercise regularly. You handle your job stress well, sleep well every night, and have a happy family life. In addition, you don’t engage in risky behaviors such as tobacco use. The chances are pretty good that the heart disease genes in your cells will not be activated and that you will not develop heart disease.

This is empowering information! Always remember that it is you that has control of your own health.

The Magic Penny

Olichel/pixabay.com

Let’s say that a billionaire came up to you and offered you a choice: $500,000 given to you today or the sum of a penny doubled every day for 31 days. Which would you choose? Half a million dollars today is undoubtedly tempting. However, if you do the math, you will realize that the meager penny doubled every day for one month is by far the better deal.

Many of you may have heard of the magic penny. This is what happens to a penny if you double its value every day. At first glance, it doesn’t sound like it would amount to much. So let’s take a closer look. The first ten days would look like this: $0.01, $0.02, $0.04, $0.08, $0.16, $0.32, $0.64, $1.28, $2.56, $5.12. On day 10, all you would have is $5.12. On day 20, you would have $5,242. On day 25—$167,772. A nice chunk of change—but not filthy rich. And certainly nowhere close to that $500,000 that you could have had right up front. But then, on day 30—$5.37 million. And finally, on day 31—$10.74 million. Now you are a millionaire!

For me, the story of the magic penny holds two lessons. First, consistency is essential. To see results for any objective you have set for yourself, you must take action on a consistent basis. Consistency is critical when it comes to accomplishing goals. The second piece of wisdom I have gathered from this magical piece of copper and zinc is that, even with consistent action, it may take time to start seeing substantial results in the quest to reach your goal. As exemplified by the penny, there were barely significant results on day ten and only modest results on day 20. However, the final two days were when the real magic occurred.

If you have set a worthwhile goal, be consistent in your efforts towards attaining it. Appreciate that you may only notice regular, yet small, steps of progress on your journey. By all means, enjoy the journey. Stay consistent, and know that the real magic may take some time to occur.

The Question

Leeloo Thefirst/pexels.com

I have a question for you. But first, a brief introduction.

Imagine that you have a brand-new, shiny, high-performance sports car, and let’s say you have two choices as fuel to fill its gas tank.

Option #1: High-octane, premium gasoline

Option #2: A bucket filled with soapy water

Which option would you choose?

I know; the answer is obvious (I hope): the premium gasoline, of course. Your car will run really well with that as fuel.

How well will your car run with soapy water in its gas tank? Not well at all. Actually, not at all. Moreover, you’re likely going to cause some engine damage.

I’d like you to take this example with the fuel comparisons and use it as an analogy for your body. Yes, your body is with you 24/7 and, like your car, gets you everywhere you need to be.

Here is the question:

What type of fuel (food) do you need to feed your body every day so that it will run in its most optimum state?

I would love to hear your answers to this question.

Which types of food should you eat each day to help keep your body fit and healthy?

Please send me a message via email or the contact page of this website.

Let me know your thoughts and, if you like, why you feel the way you do.

Let’s stir up some conversations.

Is Your Food a Risk Factor?

In my last post, I spoke about how coronary artery disease can be considered a food-borne illness. I discussed how the modern Western diet, filled with fried foods, processed foods, meats, oils, and dairy, contributes so much to the development of heart disease. Moreover, there is an abundance of data demonstrating this connection. For me, even though the data is there, I don’t need it to appreciate that the foods we eat are harming us. I see this demonstrated every day I go to work. I care for many people suffering from diabetes, hypertension, heart disease, cancer, and stroke. Maybe you do as well. Do you have family or friends living with one or more of these illnesses? They are indeed diseases of lifestyle.

Reflecting on my work as an Emergency Medicine physician, I began thinking about how I evaluate a patient with chest pain. In the Emergency Department, we certainly try to make a diagnosis whenever we can with the resources at our disposal. At a minimum, however, we need to do our best to ensure that no immediate life or limb-threatening process is occurring in a patient, and the questions we ask a patient are often a critical part of our evaluation.

Getting back to the patient with chest pain, there are several conditions that we need to assess for, including coronary artery disease, which may be causing an acute decrease in blood flow to part of the heart. While interviewing the patient, we ask many questions about their symptoms as well as their risk factors for heart disease. Typical risk factors include diabetes, hypertension, high cholesterol, cigarette smoking, and obesity. Then I began to ask myself: why don’t we ask about a person’s diet? It is clear that what a person eats can either contribute to or protect from heart disease. Perhaps in the future, a person’s diet should be officially added to the list of heart disease risk factors. Moreover, raising the subject of diet may allow us to create awareness and educate our patients on this essential component of health and wellness.

A Food-Borne Illness

As an Emergency Medicine physician, when I hear the term “food-borne illness,” it immediately conjures images of people with vomiting and diarrhea secondary to consuming undercooked or spoiled food contaminated with bacteria or their toxins. However, I recently learned of a new usage of this term. In his article, “Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?” Dr. Caldwell Esselstyn ascribes a new meaning to the phrase “food-borne illness,” referring to coronary artery disease as this type of illness. According to the CDC, coronary artery disease (CAD) is the most common type of heart disease in the United States. It is the narrowing and blockage of blood vessels supplying blood to the heart, which can eventually lead to heart attacks. The CDC also states that in the United States, over 20 million adults over age 20 have CAD and that someone has a heart attack every 40 seconds.

Those are some pretty frightening statistics. But luckily, doctors have treatments for heart disease. We have an armamentarium of medications as well as procedures such as coronary stents and coronary artery bypass surgeries. These are remarkable advances that are lifesaving for those that are having a heart attack. However, as Dr. Esselstyn states, “…none of the present therapies targets the cause: the Western diet.” Yes, our Western diet—filled with processed foods, fried foods, meats, oils, and dairy. He describes cultures that consume a plant-based diet in which CAD is almost non-existent. Moreover, the converse is also true. When plant-based cultures adopt a Western diet, guess what? Yes, that’s right, they develop CAD. Thus, it seems as though heart disease really is a food-borne illness.

History also teaches us this lesson. Between 1939 and 1945, Norway was occupied by Nazi Germany. During this time, the Germans removed all animal livestock, forcing the population to subsist on whole grains, legumes, fruits, and vegetables. Following this, deaths from heart attacks and strokes fell. When the war ended, and animal products became available again, deaths from these illnesses rose to prewar levels. Thought-provoking, isn’t it?

In his article, Dr. Esselstyn mentions a study he conducted on very ill patients with CAD that he placed on a plant-based diet. These patients have thus far been followed for twenty years, and the results are fascinating. A plant-based diet not only stopped the progression of heart disease but even reversed it! Yes, reversed it. Furthermore, this study and its follow-up showed that people with CAD would stick with dietary changes for decades. If provided with an understanding of the link between diet and disease, I believe that people will want to take control of their own health and give themselves the opportunity to be better.

Running a Mile in Less than 4 Minutes

Lukas Hartmann/pexels.com

I love the story of Roger Bannister. He was a runner that ended up becoming famous. You see, for the centuries that track and field records had been kept, nobody had ever run a mile in four minutes. It was deemed impossible for a human to run so fast for such a distance. It was an obstacle that no person could overcome. That was, until May 6th, 1954. Roger Bannister had resolved to be the first person to run a mile in four minutes, and on that day, he ran a mile in three minutes and fifty-nine seconds, breaking through barriers that had stood for centuries.

However, the truly incredible part of this story is that his record lasted for only forty-six days. Moreover, within the following ten years, 336 other runners had also broken the four-minute mile record.

How could it be that no human could run a four-minute mile for centuries, and then suddenly, over 300 people can do it within ten years? The answer lies in the fact that the barrier was not a physical one—it was a mental one. It existed only in the minds of runners, and it crumbled as soon as Mr. Bannister proved that it could be done.

Often, our own barriers do not exist outside of us but within us.

What Goes Around Comes Around

“What goes around comes around.”

I’ve heard that phrase my whole life. However, it wasn’t until later into adulthood that it took on greater meaning for me.

Some days, I “wake up on the wrong side of the bed.” I don’t give my wife a smile or a good morning kiss. Sensing something amiss, she distances herself. I may be impatient with my boys. As my morning progresses, I can’t seem to find paperwork that I was planning to work on. I try to do some work online and discover that the computer has “frozen.” Other small things seem to go wrong during the course of the day.

Conversely, life seems much easier when I am in a good mood. My day is pleasant when I choose to have feelings of gratitude and cheerfulness towards those around me. I wake up with a smile and take a moment to make coffee for my wife. She smiles and hugs me. My boys laugh with me. Whatever tasks I have planned usually go well. And if they don’t, it’s okay because I’ve already chosen to be happy and thankful.

So, “what goes around” does indeed “come around.” Hostility begets hostility. Kindness begets kindness. What we send out into the world will come back to us.