Why Doctors Behave the Way They Do

Many doctors are heroes because they save lives every day. So, why are so many of us unhappy with our doctors? 

According to a recent study, 21% of patients were dissatisfied with the care they received from their doctors.

To make matters worse, health issues such as high blood pressure, high cholesterol, diabetes, and obesity are on the increase. 

This, in turn, creates a bigger workload for most doctors, who complain that they don't have enough time to provide the quality of care that most patients expect to receive. 

For example, a disease such as Type 2 diabetes is a very difficult disease for most doctors for several reasons. 

First of all, your doctor doesn't have the time to ask you a lot of questions about what your meal plan and exercise regimen. In most cases, your doctor is running behind schedule, so he/she needs to make a snap decision concerning what to do about your diabetes.

Doctors are trained to provide solutions in the form of prescription medications and, if necessary, surgery -- that's what your doctor and all the other doctors have been taught in medical school. 

So, we should not get upset with our doctor when he/she cannot provide a better alternative (non-drug) solution for your health problem.

Also, that doesn't mean you should totally ignore your doctor and stop seeing him/her. In many cases, it's simply poor communications.

In addition, there are certain things that Western Medicine does very well. So, it would behoove you to take advantage and reap the benefits of Western Medicine and its technology.

If you want to get more out of your appointments, there needs to be better communications. To help you with better communications, it is important for you to understand how your doctor thinks and how to use that to your advantage.

And, even though we may not enjoy our visits to the doctor, we know that it is a necessary practice if we want to be proactive in taking care of our health.

It seems that no matter our age, gender, or position, while we're waiting anxiously in the doctor's office, we feel like we're back in high school, waiting in the principals' office to find out what you did wrong.

Finally, your doctor shows up (usually late) and says something innocuous  like: "Well, how are we doing today?"

We're not sure what to say, so we usually say something just as innocuous, like: "I'm fine."

After reviewing your medical history and your most recent lab work, your doctor pulls out his little notepad, scribbles out a non-readable prescription, and hands it to you, saying something like: "This should take care of your problem. See my secretary on the way out." 

Or, your doctor may say something like: "We need to run some more tests. Please see the nurse on the way out."

You try to say something or ask a question, but, you're either ignored, interrupted or  your doctor says something like "Time's up." as he/she skates out of the room onto the next appointment.

And, that's it! You've just spent anywhere from $50 to $200, depending on the amount of lab-work, the scope of your exam, where you live, and whether or not you have insurance. For a 15-minute appointment, that works out to a nice hourly rate of $200 to $800!

And, more than likely, you're not happy with the appointment. But, who's fault is it that things didn't go the way you wanted? 

It's easy to blame it on the doctor, but, in most cases, it's our own fault for not getting prepared before the appointment. We try to "wing it", but winging it just never works.

Instead, you should do a little planning before the appointment, i.e. write down 1 or 2 questions that you want to ask, carry a little notepad with you -- that will show the nurse and the doctor that you're taking responsibility and accountability for your health. Refer to the previous blog post (Doctor Appointments & Tips) for more ideas about what to do before your next doctor's appointment.

We want to trust our doctors and believe they are superb at what they do. The alternative is too unnerving to consider. Yet the thriving medical malpractice industry proves that our doctors don't always deserve our devotion. 

Sometimes they disappoint us, endanger us, treat us like children, and ignore our input. Or do they? Maybe the problem is with us. Maybe we just don't know how to talk to them. 

Whoever is to blame for the miscommunication, both sides pay dearly in health and money: 70 percent of all medical malpractice suits are filed not because of technical negligence but because the patient misunderstood the doctor.

Medical schools have been paying more attention to this problem lately, and the new generation of doctors is supposedly trained to listen, be empathetic, and look beyond the most obvious diagnosis to see if a patient's problems might be more complex. But while doctors are trying to improve their bedside manner, reality is undermining them.

Doctors today have far less time to spend with patients than they did twenty years ago, mostly because of the paperwork demanded by HMOs and insurance companies and the patient load required to make ends meet. In the typical practice, a visit with the doctor lasts 7 to 15 minutes—and is interrupted within the first 27 seconds by a nurse or a telephone call.

And, if you’re diabetic with a bunch of blood glucose readings, you find that your doctor doesn’t have the time to really pay attention to your data and your health concerns. This can be a little disconcerting, since your doctor was the one who told you to collect the data in the first place!

Meanwhile, doctors who think they are improving their communication skills are often mistaken. One study asked physicians how much time they spent educating their patients. "Nine to ten minutes" was the most likely response. 

In reality, it was about one minute. And patients clearly need the education. Another study highlighted the sorry state of patients' "medical literacy": more than 40 percent of patients couldn't understand instructions that indicated they should take a certain medication on an empty stomach.

Even the most well-meaning doctors regularly fail their patients by overestimating their knowledge of medical terminology and rushing through the exam. Patients complain that doctors don't ask their opinion, don't explain the side effects of drugs, don't take an adequate medical history, don't warn them properly about the difficulty of recovery, don't take their pain seriously, and discourage questions—and that's just a short list of grievances.

Complaining is useless. Waiting for your doctor to change is futile. Your only choice when it comes to dealing with doctors is to change your own behavior in order to influence theirs.  Again, refer to the previous post for a list of specific things that you can do to get more out of your appointment.

Behind the Scenes: They're Not Gods, They're Overworked Humans with Godlike Powers

As a group, doctors don't inspire much sympathy, yet in order to get the best treatment you must be able to see things from their point of view. Like all of us, doctors have feelings and fears that influence their work.

First, consider your doctor's mission: to heal you. If he can do it, he is a success. If he cannot, he thinks he is a failure—and doctors hate to fail. You may feel powerless in his presence, but in fact his self-esteem depends on you. 

Will you heed his advice or ignore it? Will you refuse his treatment? Lie to him about your symptoms? Snub him for another doctor? 

Occasionally, even if you follow the doctor's instructions, you won't get well. His skills will fail you and so will the medications. This is a doctor's greatest fear and a source of constant anxiety – especially when it comes to a disease like diabetes.

Doctors assume that the medication is going to work. That's what they were taught in medical school. If the medication doesn't work, the first thing that the doctor thinks is that you didn't follow the instructions, not that there was a problem with the medication.

When the doctor looks at your lab work, he/she quickly surmises that you need a medication for something -- usually for high blood pressure, high cholesterol, or high blood glucose.

Although you brought your blood glucose readings data with you, your doctor doesn't have time to review your blood glucose readings. In this particular scenario, the diabetic patient has more data than the doctor! Doctors are not used to this! This makes them uncomfortable, so they tend to ignore your data -- because they've already determined what medication to put you on or whether to increase the dosage, or switch you to a new medication. 

And, because diet is so important to diabetics, this is also unnerving to most doctors. Why? Because most doctors know very little if anything about diets and nutrition. In medical school, most doctors end up taking at the most a 3-hour course in nutrition – a course that most of the doctors skip or ignore.

Doctors are schooled to diagnose illnesses and prescribe some kind of pharmaceutical treatment as quickly as possible. With most internists logging about 150,000 office visits in their careers, speed and accuracy are highly valued. Being right is important, but being fast is the mark of a real pro. 

In surveys, medical literature, and interviews, doctors repeatedly admit to diagnosing the typical patient within just 30 seconds of walking in the examining room. "It is subsequently quite easy to go on autopilot," writes Victoria Maizes, M.D., in American Family Physician. 

Instant diagnoses, followed by formulaic, half-interested questions, thus become their normal mode of operation. Maybe it's not the way Marcus Welby would have done it, but it effectively propels them through their overpacked days.

The doctor is primarily focused on your symptoms so that he can quickly map your symptoms to a specific prescription drug. 

As a result, most diabetic patients end up on at least 2-3 medications: a drug for the diabetes, i.e. metformin (Glucophage), glipizide, glucotrol; a drug for the high blood pressure, i.e. Lisinopril, hydrochlora-thalizide; and a drug for their high cholesterol, a statin such as Liptor, Zocor or Crestor.

Another more troubling aspect of doctors' training is the well-known desensitization that takes place in medical school and during a physician's internship. It is a grueling trial by fire as the student is thrust into a world of pain, suffering, and death with very little emotional support. Barbara M. Korsch, M.D., who has devoted much of her career to studying doctor-patient communication, wrote a book on the topic: The Intelligent Patient's Guide to the Doctor-Patient Relationship (Oxford University Press, 1997). 

In her book she explains that in medical school the emphasis is on anatomy, chemistry, and other hard sciences, with little or no attention paid to the human aspect of attending to the ill. "When third-year students have their first intense encounter with real patients, they are faced with sickness and death in very large doses." 

As the years of training continue, "students' inner conflicts with facing illness and death become more and more acute. Their role models, the attending physicians, often behave toward them (and their patients!) in ways that are not very human....One of the goals in the education of physicians is to 'professionalize' them, to toughen them up."

When the training is finally over, relatively few doctors emerge with their empathetic equipment intact. Korsch says that doctors "turn away from emotion. They are not trained to deal with feelings." This detachment is very hard to unlearn. 

It doesn't have anything to do with a doctor's talent, but it does affect the way he treats his patients and the success of his practice. On the one hand, doctors with lousy people skills have trouble keeping clients and attract more lawsuits; on the other, doctors who aren't emotionally tough are likely to burn out and become unable to function.

Today's physicians, then, are constantly grappling with opposing forces. They want to solve your problem but must do it quickly, which automatically increases the likelihood that they will make a mistake. They depend on your compliance but you can defy them at will, which undermines their chances of success. 

Theirs is a people-oriented profession, yet they learn few social skills and have much of their natural empathy squeezed out during medical school. They must operate within ever-shrinking time and money constraints, even as patients are becoming more proactive and demanding more attention. They are expected to take control but are constantly being second-guessed by insurance companies, HMOs, and the patients themselves.

The result is that doctors are under a lot of stress. The power, respect, and money that once compensated for the tensions of the job are eroding. They spend more on insurance and keep less for themselves than they once did. Some doctors are even forced to change specialties because they can't afford the malpractice insurance. 

These healers, who at one time held themselves above the fray of commerce, are now neck-deep in it—resentful, frustrated, and concerned about the level of care they are able to provide their patients. So when the doctor walks into the examining room and you're laid out on the table like a piece of pastry, remember: underneath the trappings of power, he too may feel anxious and vulnerable.

Patient, Know Thyself

Physicians constantly complain that patients don't share crucial information about their symptoms and lifestyle. This is ironic, since patients' number-one complaint is that doctors don't seek their opinion. It seems as if patients are forever waiting for the doctor to ask just the right questions, while doctors are waiting for their patients to go ahead and spit out the facts already. 

It is up to you to break the impasse and start speaking up in the doctor's office whether or not he asks you the right questions. In fact, speaking up is the single most powerful thing you can do for your health. About 70 percent of correct diagnoses depend solely on information the patient tells the doctor, according to an analysis done by the American Society of Internal Medicine.

Talking to Your Doctor

Once you understand the mind-set of doctors, you can choose behaviors that will put them at ease while you draw information out of them. The most important strategy is to keep your voice steady and calm. Doctors are afraid of emotion, so the less you show, the more comfortable they will feel. 

Barbara Korsch explains: "If you put drama in your voice, it will turn the doctor off. Be quantitative and objective instead of saying how you feel. This is unfortunate; doctors shouldn't be that way, but in my studies we've learned that they are." 

When you seem desperate or panicky, when your voice is trembling with anxiety, the doctor's first reaction will be to try to tone it down. "Your emotional reactions engage doctors less than describing what it is you're reacting to," says Korsch. 

In addition to using a neutral tone of voice, the following words and deeds will keep you in the doctor's good graces.

Use neutral words to describe feelings. Be concerned instead of scared. Be apprehensive instead of a nervous wreck. In everyday life we tend to exaggerate to get results, but with doctors you have to go to the opposite extreme. Even if you are in agony, try not to use those words. Instead say, "I have a lot of discomfort." 

Use specific words to describe symptoms. "I haven't slept a wink," doesn't tell a doctor much. Instead say, "I've been averaging only four hours of sleep a night, and I usually get seven. I've been waking up every hour or so, and it takes me at least 20 minutes to fall asleep again."  

Talk about the most important things first. Doctors are very time-sensitive and will (understandably) be annoyed if you wait until the end of your visit to bring up a problem that requires some time to address. 

Make your expectations clear. At the beginning of the visit, tell the doctor exactly why you are there and what you hope she can do for you.

Acknowledge the doctor's situation. If the office is jam-packed and everyone seems stressed out, let the doctor know you're on his side: "It must be hard for you today, so I'll try to be concise." 

Be clean. Personal hygiene does matter. If you smell bad, the doctor will want to get away from you, just as anyone else would.

Keep in mind that most doctors believe that patients have a lot of misunderstanding about medicine, because their information is based on what they've heard from a friend or read on the Internet. Most doctors are offended when patients start to "play doctor" and provide their own diagnosis.

So, when a patient arrives at the doctor's office armed with information, this can create unnecessary tension especially if the doctor pooh-poohs the information without any rational reason. 

In order for your doctor appointments to be more productive, read our next blog post, which discusses some steps that you can take before, during, and after the appointment. This information is also in Chapter 11 of the Death to Diabetes book.

   

      

Emotional Support for Diabetics

Emotional support is a key component of any wellness program in order for any of us to improve our health and achieve optimum wellness.

Whether you are ill or not, emotional support is important to all of us.

But, if you're ill with a disease like diabetes, emotional support is even more important because this disease and all the things you have to do can be overwhelming.

Author's Perspective About Emotional Support:
When I was in the hospital, I remember the first time when one of the nurses started explaining all the things that I needed to start doing to manage my diabetes. Having to keep track of my meals and blood glucose readings wasn't that bad, but I had to come to grips with having to prick my finger and give myself insulin shots 4 to 5 times a day! Are you kidding me??

Luckily for me, my daughter and mother were there to help me. In fact, my daughter went to the pharmacy to obtain my glucose meter, test strips, insulin syringes, bottles of insulin, and the other drugs that the endocrinologist had prescribed. In addition, she (along with my mother) did the grocery-shopping and prepared my meals.

Every few hours, I had to psyche myself up to prick my finger and measure my blood glucose and write it down. Then, before each meal, I had to psyche myself up again to inject myself with insulin. After the meal, I recorded what I had eaten and about 1-2 hours later, I pricked my finger again to measure and record my blood glucose level.

Initially I didn't have much energy, so I was always tired and sometimes I felt sleepy. But, I forced myself to exercise (by walking) at least twice a day. Grocery-shopping with my mother was torture, but, ironically, all of the walking around the stores helped me in the long run.

Finding out that I had diabetes was a shock. Seeing what I had to do every day just to manage my diabetes was a little overwhelming. Given the large amount of reading information that I had been given by the doctors, nurses and dietitian in such a short amount of time was intimidating and also overwhelming.

Ironically, being an engineer made it easier because a lot of the tasks were similar to what we as engineers do, i.e. recording information, reading, doing research, collecting data, analyzing the data, etc. In many ways, managing my diabetes was a lot like starting an engineering project for myself.

Besides the support I received from my family, I also received support from my Xerox managers, who ran the organization in my absence. This was very important to me although I don't think that I ever thanked my managers. Part of the reason for this was due to the embarrassment I felt that I needed their help.

I also received emotional support from other diabetics, who shared their stories with me. This was a little uncomfortable at first because I thought that talking about one's health was a little too personal to share with other people.

While trying to come up to speed on diabetes management and incorporating it into your life, it's perfectly natural to go through some emotional upheaval. You may feel some anxiety, anger, depression, sadness, and other emotions. Consequently, you will need some time to adjust and some support from your family and friends.

Discuss your feelings with your doctor or a diabetes educator; or, join a local diabetes support group. If you are having a hard time getting through your day because of depression, anxiety or other overwhelming feelings, you may need to see a counselor or other mental health professional. It's okay to seek professional help to assist you through this difficult time.

Emotional support comes in many forms from a variety of people including your family, friends, co-workers, doctors, dietitian, health coach, support group, counselor, organizations, church, pastor, etc.

How to Handle Your Emotions

The tendency to dwell on anger, resentment and other uncomfortable feelings can negatively affect your health, including increasing your blood glucose levels. So it’s important to listen to your emotions and then take steps to let them go. Here are some things that you can do:

Understand Your Emotions: Look within and try to pinpoint the situations that are creating the stress and negative emotions in your life. Negative emotions can come from a triggering event; for example, feeling overwhelmed with your diabetes, or feeling angry about being diabetic. Negative emotions are also the result of our thoughts surrounding being diabetic; the way we interpret being diabetic and whether or not it causes stress. The key job of your emotions is to get you to see the problem, so you can make necessary changes.

Change What You Can: Only focus on what you can change. Don't dwell on what you can't change. Cut down on your stress triggers, and you’ll find yourself feeling negative emotions less frequently. This could include learning more about diabetes, taking a walk during lunch with a co-worker, joining a diabetes support group, avoiding stopping by the pizza place on the way home from work, bringing your lunch to work instead of going out to lunch, cutting down on job stress, and eating healthier meals more often.

Find An Outlet: Making changes in your life can cut down on negative emotions, but it won’t eliminate your stress triggers entirely. As you make changes in your life to bring about less frustration, you will also need to find healthful outlets for dealing with these emotions. Regular exercise can provide an emotional lift as well as an outlet for negative emotions. Meditation can help you find some inner "space" to work with, so your emotions don’t feel so overwhelming. Finding opportunities for having fun and getting more laughter in your life can also change your perspective and relieve stress. Find a few of these outlets, and you’ll feel less overwhelmed when negative emotions do arise.

Take a Break: If you're feeling stressed out, take a break! If you're under a lot of pressure at your job, talk to your manager about leaving early for the day; or, maybe take a half-day vacation. Don't continue to overwhelm yourself -- that's only going to drive your blood glucose higher!

Note: Read our future post or DTD web page about stress for more detailed information concerning stress.

Get Help if Depressed: Depression and diabetes are two conditions that can sometimes go hand-in-hand. First, diabetes can increase the risk of depression, according to a growing body of research. In fact, having diabetes doubles the risk of depression, compared to people who don't have the disease. Conversely, depression also can increase the risk of Type 2 diabetes, research shows.

It's often a vicious cycle. Depression can get worse as the complications of diabetes get worse, and being depressed can stop people from managing their diabetes as effectively as they need to, which can lead to increased incidence of long-term complications such as retinopathy, neuropathy or nephropathy.

The key is to get your diabetes under control and seek professional help for your depression, if necessary. Getting help for your depression not only improves your quality of life, but, it also can help you manage your diabetes better by giving you a more hopeful outlook.

How Stress Impacts Your Health

It is estimated that 90% of diseases are caused by stress. If we can get a handle on the stress that affects our lives, we might be able to live longer, healthier, happier lives.

Merriam-Webster defines stress as: "a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation; a state resulting from a stress: one of bodily or mental tension resulting from factors that tend to alter an existent equilibrium".

Stress can be a positive force that keeps us alert, ready to avoid or handle danger or meet deadlines. It can also enhance our emotional intelligence and creative capabilities. 

But, stress can also be a negative force that weakens our immune system and makes us susceptible for multiple diseases and health problems.

Stress can come from your external environment, your inner thoughts and your body itself.

During a 'fight or flight' instance, the body releases stress hormones to allow a burst of strength and endurance. For example, your heart speeds up, your breathing quickens, your muscles tense, digestion stops, and blood flow to your muscles and brain increase up to 400%.

When you are under stress, the 'fight or flight' hormones still flood your system, and after repeated instances, this reaction can harm your physical, mental and emotional health.

Stress is known to build up and when symptoms start to surface, it's the body's way of getting our attention to do something about it.

Stress can impact almost any part of your body, depending on which part of your body is the weakest and the most susceptible to disease.

Constant stress over a long period of time can break down your body and weaken your immune system. This, in turn, can create major biochemical/hormonal imbalances and cause damage to major organs, making you susceptible to a variety of diseases and health issues, i.e. headaches, indigestion, allergies, high blood pressure, weight gain, heart attacks, strokes, diabetes, heart disease, cancer, depression, and autoimmune diseases.

In addition to the physical and biochemical impacts, stress can impact you emotionally. If you're under a lot of stress, this can cause you to be more impatient with others, more angry, more unhappy, more anxious, more negative about life, etc. And, these negative emotions trigger your body to release stress hormones like cortisol and norepinephrine, which, in turn, can negatively affect your health.

Stress Indicators
You may notice one or more of these signs when your body is under a lot of stress:

• Anger
• Anxiety disorders (OCD, panic attacks)
• Arthritis
• Asthma
• Cancer
• Chemical dependence (drugs, alcohol, nicotine)
• Chest pain
• Chronic fatigue
• Circulatory system problems (feeling cold, or hot and sweating)
• Cold / flu
• Depression
• Diabetes (High blood sugar levels)
• Dizziness, light-headedness
• Eating disorders
• Exhaustion
• Hair loss
• Headaches / migraines
• Heart disease (heart attack, stroke)
• High blood pressure
• Hormonal changes
• Immune system disorders (a compromised immune system can lead to the majority of all diseases - the immune system is the most important factor in overall health)
• Infertility
• Interleukin-6 (high levels of this immune system protein have been associated with diseases such as cancer, diabetes, infections, heart disease, osteoporosis and rheumatoid arthritis).
• Loss of energy and motivation
• Memory lapses
• Menstrual irregularity
• Mood swings
• Muscle aches and pains
• Nervous system
• Nightmares
• Post traumatic stress disorder (flashbacks, re-living traumatic events)
• Sexual dysfunction
• Skin conditions (breakouts, rashes, cold sores)
• Sleep disturbances
• Speaking and swallowing difficulty
• Stomach distress (nausea, indigestion, ulcers, constipation, diarrhea)
• TMJ (Temporomandibular joint and muscle disorders are problems or symptoms of the chewing muscles and joints that connect your lower jaw to your skull).
• Weight gain /obesity
• Weight loss (unwanted)

Note: How to manage stress will be discussed in a future post.

How to Protect Your Kidneys

Sometimes we forget how important our kidneys are until they begin to fail -- usually due to one or more of the following risk factors: high blood pressure, diabetes, heart disease, frequent UTIs, obesity, overuse of OTC/prescription drugs, an autoimmune disorder.

The good news is that there are a lot of simple things that we can do to protect our kidneys.

But, don't wait until you find out that you have protein leaking in your urine or that you have to go on kidney dialysis before you decide to do something about your kidneys!

Your Kidneys

Each of your kidneys is about 4 to 5 inches long and about 1 inch thick, weighing in at about 4.5 to 5 ounces. To put it into easy-to-visualize terms, each of your kidneys is a bit larger than a deck of cards. 

Although your kidneys make up less than 0.5 percent of your total body weight, they receive close to 25 percent of the total amount of blood that your heart pumps while you're resting. 

Also, your kidneys use up about 20 to 25 percent of your body’s supply of oxygen.

Although your kidneys are small organs (each about the size of a deck of cards), they receive so much of your blood and oxygen because they are responsible for five critical functions:

1. Your kidneys keep your blood clean by filtering it of waste products and eliminating these waste products from your body as urine.
2. Your kidneys help maintain a proper balance of fluids throughout your body.
3. Your kidneys secrete a hormone called erythropoietin, which is responsible for stimulating the production of red blood cells in your bone marrow.
4. Your kidneys produce an enzyme called renin, which is needed to help maintain your blood pressure.
5. Your kidneys convert vitamin D to its most active form.

How to Keep Your Kidneys Healthy

Recent studies indicate that 26 million American adults suffer from chronic kidney disease (CKD) and that the number is likely to rise unless Americans get serious about prevention. Primary risks include: diabetes; heart disease; high blood pressure; a family history of kidney failure; and age 60-plus. 

Secondary risks include: obesity; autoimmune diseases; urinary tract infections and systemic infections. Exercising regularly and controlling weight are just two of the ten ways keep your kidneys healthy.

Here are three important ways to protect your kidneys from prematurely breaking down:

1. Don't drink too much water.

Given the work that your kidneys are forced to undertake to filter your blood and produce urine, drinking large amounts of water when you’re not thirsty is a good recipe for prematurely wearing down your kidneys as you age. 

Your body is not like a plumbing tube that gets cleaner by flushing large amounts of water through it. A number of your organs, including your kidneys, are designed to keep your body clean by continuously eliminating waste materials. If you want to prevent illness as you age, a top priority should be to prevent unnecessary burden to your kidneys and other waste-eliminating organs.

2. Don’t eat too much protein, especially animal protein.

Eating more protein than you need leads to a greater workload on your kidneys, which must filter a by-product of protein metabolism called blood urea nitrogen (BUN) out of your blood. This increased workload can contribute to premature breakdown of the glomeruli in your kidneys.

If you have healthy kidneys, you can safely eat up to half of your body weight (in pounds) in grams per day. For example, if you weigh 150 pounds and are in good health, you can safely eat up to 75 grams* of protein (~ 10 oz.) from minimally processed foods per day. If you have problems with your kidneys, you should decrease this amount to a level that results in a healthy blood urea nitrogen level.

If your current health status is such that you need an objective way to monitor how well your body is responding to the amount of protein that you are eating, ask your doctor about monitoring your BUN level. Whenever you eat protein, your body breaks it down into amino acids that contain nitrogen. Nitrogen separates from amino acids and combines with other molecules to form urea. Urea is eliminated from your body when your kidneys filter it out of your blood and into your urine.

A healthy range for BUN is between 4 to 17 mg/dL. Anywhere between 18 to 21 mg/dL is a sign that you may be eating too much protein, and possibly that your kidneys are under excessive strain. More than 21 mg/dL is a strong sign that you need to significantly reduce your protein intake.

The link between eating too much protein and developing kidney disease is one that is not often talked about by supporters of a high-protein diet. While it is important to keep your blood sugar and insulin at healthy levels by avoiding sugar and other simple carbohydrates, please know that a high-protein diet may poses a danger to your health, especially if most of your protein is animal-based and is cooked at high temperatures. 

Your health is best served by eating mostly plant-based proteins, fats and carbohydrates. If you still prefer animal meat for your protein, eat primarily free-range, organic meats and avoid the antibiotics and growth hormones in most conventional meats.

*Note: There are about 7 g of protein in 1 ounce of cooked meat. So, for example, 4 ounces of raw boneless skinless chicken breast yields about 3 ounces of cooked chicken, or 21 g of protein. Most healthy adults need about 0.8 g of protein per kilogram of body weight. To calculate pounds, divide your weight by 2.2 to convert to kilograms and multiply by 0.8 to find the protein grams recommended for your weight each day. For example, a 175-pound person would need about 64 g of protein each day.

3. Don’t take prescription drugs and over-the-counter pain pills on a regular basis.

As many professional athletes have discovered during the past several years, regular use of prescription anti-inflammatory pain medication like Vioxx, Indocin, and Naprosyn poses even greater danger to kidney health than over-the-counter pain killers.

Non-steroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin are known to cause kidney damage if taken regularly. Acetaminophen (Tylenol and Excedrin) can also cause kidney damage and failure if used regularly. All of these over-the-counter pain medications probably don’t pose significant danger if your kidneys are relatively healthy and you use them for emergencies only.

Here are additional ways to keep your kidneys healthy.

• Follow a healthful plant-based diet
• Don't smoke or abuse alcohol
• Don't overuse over-the-counter painkillers or NSAIDs
• Control weight
• Monitor blood pressure & cholesterol
• Exercise regularly
• Get an annual physical
• Know your family's medical history
• Learn about kidney disease
• Talk to your doctor about getting tested if you're at risk for CKD

Please remember that the best "medicine" for all of your organs, your kidneys included, is eating a plant-based, minimally processed diet, getting enough physical and emotional rest, getting regular exposure to fresh air and sunlight (without getting burned), and being physically active.

Note: For more details about maintaining and improving your kidney health, read Chapters 14 and 15 of the Death to Diabetes book (or ebook).

  

Importance of Dealing with Stress

One of the most important areas that is overlooked when it comes to weight loss or improving one's health is the impact that day-to-day stress has on our lives. Because we learn to live with stress, we fail to realize how stress drains your body's energy all day long -- every day.

Think about it -- if you have to drive to work in a lot of busy traffic every day, that's stressful! Working for boss who you don't like or doesn't like you is stressful! Working two jobs or working for less money than you deserve is stressful. Living paycheck to paycheck is stressful! Worrying about your job security is very stressful! Figuring out what to eat when you get home every night can be stressful.

So, what should we do? Well, unless you're related to Bill Gates or Warren Buffet, you can't quit your job. Given today's job market and the paucity of high paying jobs, it's very difficult finding a job that you like and pays well.

But, again, that doesn't mean we should give up and accept that things can't get better. Instead, you should update your resume and look for other job opportunities; or, look for ways to supplement your income.  We'll discuss this in more detail in a future post.

However, in the meantime, it is important to learn ways to deal with your current job, your environment, and the stress without it negatively impacting your health. 

Oh, by the way, did you know that the Number 1 reason why we eat poorly sometimes is due to the high stress in our lives?! High stress leads to poor decision-making. High stress leads to unnecessary arguments with family, friends, store clerks, etc. that only make you feel worse. And, because we feel worse, we feed our face with a bowl of ice cream or some macaroni 'n cheese -- feeding a vicious cycle of stress and disease!

Do you know what is one of the major reasons why we argue with other people, especially strangers or acquaintances? We feel powerless! We feel that we have to lash out at someone after having had such a bad day. Or, we feel unhappy with our lives; or, we just feel frustrated or hopeless with everything that's going on in our lives.

From a biochemical and hormonal perspective, the high stress triggers the release of cortisol (the stress hormone) which can restrict your arteries and lead to high blood pressure, unwanted weight gain, lower back pain, and sleepless nights (insomnia). In addition, the high stress prevents the release of serotonin (the feel-good hormone).

And, because you don't feel good, you make a poor food choice by grabbing for a comfort food like a bag of potato chips, some pizza, a plate of mac 'n cheese, some fried chicken or a bowl of ice cream. This, of course, leads to more weight gain and/or higher blood glucose levels!

This is an example of the cyclic nature of obesity and weight gain; and, why it's so difficult to lose weight the right way. Sure, you can exercise, drink a green smoothie, and eat a salad, but, if, you have a lot of high stress or emotional issues such as anger, envy, jealousy, or regret, your body will respond by releasing cortisol and other hormones that either trigger weight gain or prevent the body from burning fat!.

Bottom line: You must address how to reduce the level of stress in your life and how to deal with your emotional issues. Some ways include: exercising, talking with a friend, joining a support group, being a community volunteer, getting several good night's sleep, helping others, finding your Purpose in Life, spirituality, meditation, and prayer. We will discuss these ways of how to reduce stress in more detail in future posts.

Doctor-Patient Relationship

Doctor appointments are more enjoyable and helpful, especially if you have had a good relationship with your doctor over the years. But, even a good doctor-patient relationship can turn dysfunctional over time. Doctors may have the best of intentions, but their model of practice may no longer fit what you need.

In any given year about 10% to 15% of patients at least consider switching doctors. In one two-year study, 15 percent of patients moved to different practices because of dissatisfaction with the care they were receiving.

One reason may simply be that patients today have come to expect a higher level of care. Patients tend to be armed with more information about health care, either through news stories or after having researched their condition over the Internet. These more-savvy health care consumers also want doctors whose treatment philosophies are more in tune with their own lifestyles and choices.

More often than not, the reason for patient dissatisfaction comes down to poor communication. Patients don't really know how to evaluate medical skills, but they do know if a doctor interrupts them when they're listing their concerns.

Too much talking, too little listening
Patient-doctor communication can be further hampered by age. Doctors tend to be more egalitarian with younger patients, sharing the decision making with the patient. Plus, many doctors may focus only on physical symptoms, without addressing psychological or social concerns, like whether the patient has the transportation to get to a medical test.

Substandard communication isn't just annoying, though. It also has serious implications for your health. Research shows very clearly that when patients are actively involved in their decision making, and their opinions and perspectives are incorporated into a health care plan, there are much better outcomes.

Despite all this, even patients who are less than pleased with their doctors may be hesitant to leave them. First, there are logistical challenges, such as transferring a long medical history or finding a conveniently located doctor who is covered by the patient's health plan. 

And boomers monitoring the health of their aging parents should know that Americans over 70 often resist changing doctors, mostly because they were raised with a profound respect for authority and don't want to offend.

If you do decide to find a new doctor, try to leave on the best possible terms, because your new doctor may need to consult your old one. Consider sending the old doctor a letter describing the specific reasons you decided to change. It may be hard to write — and also hard to hear as a doctor, but we all learn things from what we've done wrong.

10 Warning Signs That You May Need a New Doctor

So how do you know if your doctor isn't "the one"?

Your gut is often your best guide, experts say. But here are a few warning signs that you might need to give your doctor the boot.

Be wary of a doctor who:

1. Dismisses every complaint, blaming age or your sex.

2. Dismisses the importance of nutrition and other lifestyle changes.

3. Insists that nothing can be done. There is always something to try.

4. Spends too little time with you.

5. Scoffs at your research all the time.

6. Interrupts you frequently, especially if you're a patient with complex, multiple issues.

7. Writes a prescription with minimum discussion.

8. Recommends treatments without considering your lifestyle.

9. Has you taking multiple medications with no improvement in your health.

10. Keeps referring you to more specialists without any improvement.

The 5 "Dead" Foods

There are 5 major "dead" foods that fuel the major diseases and health problems, including high blood pressure, obesity, chronic fatigue, Type 2 diabetes, heart disease, cancer, arthritis, osteoporosis, and other systemic diseases.

When consumed in excess with a sedentary lifestyle, these "dead" foods turn the body acidic, cause inflammation, and slowly damage or kill the body’s cells and create biochemical, neurochemical and hormonal imbalances that trigger unhealthy food cravings.

These chemical imbalances, in turn, devastate your health physically, biochemically, hormonally, emotionally and spiritually. Over a period of years, the body breaks down and becomes susceptible to the aforementioned major diseases and health problems.

 

You must avoid these foods if you want to live a healthier life with less financial woes.

If you're diabetic or overweight, you need to avoid most of these foods like the plague -- unless you like being diabetic, fat and taking a lot of drugs.

For those of you who are familiar with superior nutrition, there should be no surprises with the following list.

1: Refined flour, starches includes all foods made with refined flour or starch such as white bread, enriched bread, wheat bread, white pasta, white potatoes, white rice,  macaroni, cereals, crackers, donuts, pancakes, pastries, biscuits, spaghetti, cakes, pies, and other processed flour-based starchy foods.

Warning: Avoid potatoes, corn, and soybeans, which are the most common genetically-modified (GMO) foods. Other common GMO-foods to avoid include canola oil, vegetable oils, margarine (cottonseed oil), cereals, sugar beets, farmed salmon, other farmed fish, cow's milk, baby formula, and artificial sweeteners (i.e. aspartame). Unfortunately, many processed foods and some restaurant foods are now GMOs, so be careful.

2: Refined sugar includes all foods made with high fructose corn syrup, corn syrup, refined sugar, sucrose, maltose, dextrose, brown sugar, artificial sweeteners, and processed honey.

Some examples of sugar-based foods/beverages include soda, diet soda, bottled juice, soft drinks, candy, jams, jellies, cookies, cakes, pies, pastries, some cereals, and some condiments. Stay way from artificial sweeteners such as aspartame and Splenda!

3: Trans fats include all processed foods made with partially hydrogenated oil, such as stick margarines, French fries, bread, potato chips, pretzels, cookies, fried foods, donuts, crackers, store-bought baked goods, packaged foods, and fast foods.

The process of creating hydrogenated oil destroys the essential fatty acids in the oil and replaces them with deformed trans fatty acids.

4: Saturated fats, which are solid at room temperature, are found in animal meat, organ meats, processed meats, lunch meats, fried foods and some dairy products (cow’s milk,
cheese, butter, and ice cream).

Saturated fats are also found in coconut oil, palm oil and other tropical oils. Some of the Omega-6 poly-unsaturated fats in vegetable oils such as soybean, corn, sunflower and safflower can also be destructive to your health. In addition, canola oil is also unhealthy for you.
Note: Not all saturated fats are unhealthy for you, i..e. extra virgin coconut oil, free-range chicken breast, venison, bison.

5: Drugs include alcohol, tobacco, caffeine, over-the-counter (OTC) drugs, prescription drugs, and recreational drugs. Prescription drugs don't cure anything! They give you a false sense of security as the disease spreads causing more damage, and leading to even more drugs!

Author's Sidebar: The terms "live" and "dead" may sound a little melodramatic, but I believe that they get the point across without having to explain the rationale of each term in detail. In addition, I found these terms to be very effective in making specific points during my lectures and workshops. Also, these terms tie nicely into the book’s title and the photograph on the front cover of the book.

“Live” food (pronounced l i v e as in "I'm alive") helps the body to heal, fight disease and stay alive. “Live” foods are primarily raw, unprocessed, lightly-cooked or partially processed foods that contain most of the seven nutrient factors. The term “live” does not necessarily mean that the food is alive, but it does contain the nutrients that keep the body alive. Coincidentally, these foods are connected with the prevention and reversal of many of the major systemic diseases and ailments.

“Dead” food inhibits the body from healing and leads to disease and early death. “Dead” food is man-made, processed food that lacks most of the seven nutrient factors. Coincidentally, these foods, along with a sedentary lifestyle, are connected with the development of many of the major systemic diseases such as heart disease, diabetes and cancer.

Author's Note: During my recovery, I had come up with a list of about 100 foods and beverages that I had to avoid. Then, based on common attributes, I was able to fit these foods into several categories that I eventually reduced to the above 5 groups.

Note: There is a subset of these 5 "dead" foods that fuels diabetes and heart disease faster than other typical "dead" foods. I refer to these foods as "The Triple-Killers".

Note: For a complete list of "dead" foods (and "live" foods), refer to Chapters 5 and 6 of the Death to Diabetes book.

Website Reference: Death to Diabetes Web Page: The 5 Dead Foods

Exercise Excuses

We all know that exercise is important, but, most of us usually try to find ways to get out of exercising.

Here are some of the more common excuses for skipping exercise along with ways to combat those excuses.

I don’t have time: This is by far one of the most common excuses that people use. People that use this excuse are actually saying that exercise is not enough of a priority to make it on their daily or weekly to-do list. If you fall into this category, then it’s time to review your daily priority list. Certainly there is something less important that you are doing for 10-15 minutes every day that can be replaced with exercise.

After all, exercise is one of the most important things you can do for yourself and your family to ensure that you live a high quality life. Try to increase your daily physical activity and integrate exercise into your daily life.

I’m too fat (or out-of-shape): Unless your doctor has forbidden you to exercise, then it’s very unlikely that this excuse has any validity. If you are extremely out-of-shape, then you simply need to start with baby steps. Walking is always a great place to start. You may have to start with just five minutes. That’s okay. You can gradually add more time each week.

If walking is not an option, then you could try some pool exercises. There are many beneficial strength training exercises you can do while sitting with a resistance band, flex bar, resistance chair or a rowing machine.

I’m too tired: This is a common excuse, especially with diabetics, overweight people and people who have insulin resistance – all because of poor nutrition. Without proper nutrition (fuel), the body cannot produce the necessary energy for exercise, leading to fatigue. This excuse also creates a vicious circle because the more sedentary you are then the more tired you become; and, the more tired you are then the less appealing exercise sounds. Exercise can actually make you feel more revived then a nap because it stimulates your lymphatic, immune, and cardiovascular systems – especially if you provide your body with the proper nutrition. Regular physical activity increases your energy level. In addition, consistent exercise helps you to fall asleep faster and sleep better, which allows you to feel rested every day.

I really don’t like to exercise: This is usually due to the boredom that you feel during exercise or the fact that your body not only feels achy after exercising but the fact that it aches for the next couple days. Many people still have the old “no pain, no gain” mentality and think that in order for exercise to be worthwhile you have to be miserable doing it. This just isn’t true. Some people don’t like to exercise because they don’t like to sweat. Actually, you don’t have to work up a big sweat every time you exercise – it’s all about just getting the body moving. Consider things that you really like to do. If you prefer competitive situations, then consider joining a recreational sports team. If you are a social person, join an exercise group or take an exercise class with your friends. If you enjoy spending time alone, then try yoga or evening walks. And, don’t over do the exercise – that is part of the reason for the sore muscles.

I’ve tried and failed in the past: It’s true that it can be difficult to get motivated to exercise after you’ve failed before, but isn’t your health worth another try? If you’ve been unsuccessful in the past, then re-evaluate what went wrong. Did you try to do too much, too quickly? It’s very common to be overzealous when starting out and end up either burning out or getting injured early on. Did you set unrealistic goals for yourself? Try to establish small goals that are truly achievable, for example, that you will workout three times a week for the next month.

I’m too old to get started: It may sound cliché, but you are never too old to get started. Everyone can benefit from exercising. Even if you are a senior citizen you can reap many rewards from starting an exercise program. Okay, so maybe you won’t be a marathon runner or a bodybuilder, but you’ll be able to carry your groceries, walk the stairs easier, play with your grandchildren, improve your balance, and improve your glucose control if you’re diabetic. And, more importantly, you’ll enjoy your meals because you realize that the meals are providing the extra energy you didn’t have in the past.

The inconsistent weather makes it difficult, or I don’t have any exercise equipment: Nice try, but you can exercise indoors and get your heart pumping without any fancy exercise equipment. Don’t underestimate what you can do with things that are already in your house. For example, if you have a flight of stairs then you have an awesome way to get your heart rate up by walking or running the stairs. Grab a couple of soup cans to emulate dumbbells for strength training exercises.

I can’t afford a gym membership: You don’t have to spend a single dollar for a gym membership in order to get fitter. Just walking outside is a great place to start. Also, home fitness equipment has become very affordable and accessible. For as little as $35 you can buy some great home equipment that will really challenge your body. A resistance band, a couple of small hand weights and an exercise ball allow you to work every muscle group and even obtain a good cardiovascular workout.

I don’t know what exercises to do: There are literally dozens of ways to learn what exercises will help you. There are hundreds of books, websites, television shows and videos that offer advice and tips. If you have the money, another way to ensure your workouts are most effective is to hire a personal trainer or an online personal trainer. They can guide you every step of the way so that you don’t waste any time doing exercises the wrong way.

Or, just increase your daily physical activities, i.e. take the stairs (instead of the elevator); gardening; mowing the lawn; mall walking while shopping, dancing, cleaning the house, park farther from the store and walk, exercise on a stationary bike while on the phone or watching TV.

I just can’t get motivated or I don’t want to change: Keep in mind that most of us are resistant to change. So, find something that will motivate you to exercise. For me, initially, it was the fear of dying. Later, it was the feeling I got from a good exercise session. For you, it may be your spouse, your children, your grandchildren, the quality of your life, or it may be financial (less expenses for drugs, doctors and hospitals).

To help you get started, set small, short-term goals. Start with a promise to just take the stairs instead of the elevator, for example. Then you might move onto scheduling 10 minutes of activity a couple of times per week. Also, make a list of all the positive benefits exercising has on your life. Your list might include giving you more energy, reducing your health ailments and more. The list should be pretty long. Post it somewhere that you will see it regularly and it can serve as a reminder to you as to why you need to workout.

Another option is to take a yoga or T’ai Chi class. They are two great ways to get the physical activity you need and learn the techniques of proper breathing and relaxation. Yoga is a physical way of life emphasizing the harmony of the body and mind, and a philosophical way of life that is based on Eastern metaphysical beliefs. T’ai Chi is an ancient Chinese art of exercise and self-defense with an emphasis on relaxation, both physical and mental, which leads to developing internal strength. T’ai Chi is classified as a low impact aerobic exercise comparable to walking that is used as a therapeutic exercise for people who are recovering from illness or injury, or for those who are beginning an exercise program.

There are new muscle activation techniques that provide maximum benefits in less time by utilizing a series of sequential movements designed to put the body in proper functional alignment, establishing increased strength and flexibility of the spine, better neuro-kinetic flow, lymphatic function, and an increased metabolic rate. In addition, you can utilize these muscle activation techniques while you are at work, shopping, walking, driving or doing everyday household chores – consequently, reducing the amount of time you need to spend exercising each day. Contact our wellness center for more information.

The Power of Exercise

We all know that exercise is important, but, it seems that we either do not have the desire or the time to exercise.

Other people who are exercising eventually stop exercising after becoming bored, frustrated or discouraged due to the lack of progress in their health, weight loss or other health goal.

Personally, I know that exercise is important. In fact, some experts call it the "Fountain of Youth"! But, even though I know this, I still don't really like to exercise! 

There must be an easier way to deal with exercising, right?
When I was younger, exercise wasn't a problem, because I got my exercise by trying to play basketball and tennis. Today, most of my friends now play golf, but, I could never get the hang of hitting that little white ball. Ugh! 
Plus, is that really exercise?

The following are some tips to get you started with exercise and keep you going for the long term.

Schedule your exercise sessions on your calendar as if they were any other important appointment. This way, you will be able to balance your exercise program with family, work and social activities. 

Again, you will be more successful if you fit exercise into your current lifestyle. A little is always better than none.

If possible, try to build your exercise/physical activity into your daily activities, e.g. walking/bicycling to work, shopping, walking in the mall, house chores, painting, gardening, mowing the lawn, walking up and down the stairs, etc.

Don’t work out too hard or too fast at the beginning. If you do, you will end up sore and uninspired. It’s better to work out 2-3 days a week for life than to work out 6-7 days a week for a couple of weeks. Consistency is the key.

When you feel like skipping a workout, get yourself to do some form of exercise for at least 10 - 15 minutes. Most people struggle during that initial 5 minutes, but once they get past that 5-minute mark, they are actually able to complete their entire workout. (If you don’t, don’t worry about it – 10 minutes is still better than nothing).

When you get bored or unfocused, change your exercise routine a bit by adding a yoga, aerobics, Pilates, swimming or dancing class. If you don’t care to join a gym, there are many wonderful classes at the local recreational centers. Try a new exercise video or machine, or, try an outdoor activity such as bicycling or a beach walk.

Give yourself a little leeway - if you miss a workout or even an entire week, get back on track as soon as possible. Setbacks and challenges are normal. 

The sooner you get back on track, the sooner you will reach your goals. Remember - fitness is not about being perfect, but about a series of healthy choices that you make consistently. It is not an all or nothing proposition.

If possible, work out in the morning. You will feel more energized all day and will avoid “life” getting in the way of achieving your exercise and health goals.

If possible, get in the habit of taking a 5 - 10 minute walk after lunch and/or dinner, especially if the weather is nice. 

Walk with your partner or a friend. You will be amazed how well you feel physically and emotionally.

Keep a pedometer and a fitness journal to chart your progress and accomplishments, and provide motivation.

Try to limit the number of times that you use the weight scale to once a month or once a week at the most. As you get fit, lose fat and gain muscle, you will actually drop inches and pants/dress sizes and not move the scales that much.

Evaluate your progress every 6 - 8 weeks and increase the duration, frequency or intensity of your workouts to stay challenged and inspired.

If you need help, ask a fitness professional or instructor for suggestions and advice on how you can most effectively achieve your goals. There are also a variety of other resources on health and fitness available on the web.

Note: For more information about exercise and how to overcome the excuses, refer to the post about Exercise and Excuses.