Friday, November 2, 2007

What else can I do for high blood pressure, I get enough exercise at work .........(warehouse/construction/daycare)

When addressing patients for the first time or those that have been taking medicines for a while, I always ask, do you watch your diet and are you exercising. (For those with a large waist to hip ratio it's more of a rhetorical question.) But most will answer they are doing or have tried to do alot of exertion in the form of walking. Most will think of exercise as a form of walking. That is soooo 90's. Most of the articles on introducing exercise into a life style would safely say, try walking first. This was meant to be an intro for the first 6-8 weeks with the idea of progressing on if you didnt suffer and injury or drop of a heart attack. When I see a couple in jogging suits, both with grey hair smiling on a neighborhood trail, I think that is great, I can't wait till retirement! For a 30-40 year old, we should be thinking of "smoking" that speed walking couple but fact is that most of the construction workers, warehouse workers or moms chasing after 2 generations of children would run out of gas in 5 minutes. Remeber the tortois and the hare? The rabbit in this story enventually goes for angioplasty and gets placed on 2 medicines with a blood thinner. This is the threat I give to most of my 30-40 year/olds that are too busy to worry about a little blood pressure issue or slightly elevated cholesterol. True, its easier to take a pill than make a major lifestyle change and cut back on hours at work....but that way of thinking doesnt prepare for the next medical issue that comes then the next one after that. So like most people, someone comes in for a regular check up and without symptoms ends up on 2-3 medicines with medical problems and problem lists that would dwarf the 10 commandments. I always touch on the current life style of high pressure, fast food, poor family communication and lack of proper preventive medicine.

Just that title alone is a misnomer now a days. Preventive Medicine is supposed to be what primary care doctors are teaching in the community but most of the family practice docs, internists I know are finding medical problems and managing them but no one has time to teach exercise, diet, lifestyle modification. Its usually after the diagnosis and after the first or second pill that we highly suggest cutting back hours or sending to a dietician since the sugars are not responding to first line meds. We also have steps in place to check at intervals to find when the changes are going to occur but that is usually the only contact. "Ok Mr Smith, come back in a year and we'll check if the diabetes has begun. Or, keep on checking that blood pressure, 3 random times in a comfortable environment and when they all are above 120/80, I'll start you on something. I would like to develop a branch of medicine to establish nutrition based changes in addition to supplement design that would integrate into current hierarchy of modern medicine. Insurance would probably not pay for this but patients have already showed they would pay for it out of pocket. Imagine, after paying the 400-1000 per month for insurance just in case you get sick, paying even more money to prevent needing to use the insurance plan your dishing out monthly mortgage payments to. Medicine is so screwed up! Sorry, I am trying to redirect my anger and frustration into constructive development of something good for everyone.

Back to hypertension, exercise is supposed to be in the form of 20-30 minutes of any activity that would keep the heart rate in the 140-160 range,(personally I shoot for 160-170 but can only do this 1 time a week for 20 minutes, the rest of the week is standard 150 beats per minute for 60 minutes all preceded by yoga.) One is supposed to repeat this regime 5 times a week. For those on a limited timetable, more bang for the buck with yoga or tai chi. Most people have heard of yoga, a limited amount know tai chi but these two forms of exercise don't get the credit they need. I have had a handfull of patients able to get off medicines running, yoga and tai chi were the only ways. Some did it through fast aggressive weight loss but this was dietary directed with some form of cardio.

There are studies out that have reported stress control throughout the day with 10 minutes of yoga/meditation in the morning. Same with daily tai chi. Eastern philosophy will show if one is well "grounded" that the body is healthier and will repsond to daily stress and infection better. The chakras or meridias of the body communicate and flow better so to make the external layers of the body impenetrable to the environment. In more western terms, someone at peace will be harder to coax into a fight than someone already on the 3rd cup of coffee and running 10 minutes behind to get to the first appointment. This also can be achieved in the form of prayer. If we could all start the day like Bob Marley says; "don't worry"! we may do better in rush hour. Most people I would see in the office with high blood pressure would say "I just ran up a flight of steps for the appointment" or "I was stressed in the waiting room." My come back is if that is what happens in a waiting room, can you imagine what happens to you throughout the day several times a day with confrontations and problems? Bottom line is the heart and brain don't like the high pressure fronts placed on them and soon will suffer with blood vessel damage, muscle enlargement and ischemia. For the rare person that says I'm ready to die, I say the hospital will probably save your life and you will live, being cared for by your family, unable to work, with no medical insurance. Not a pretty picture but I believe it's the job of a doctor and a friend to help see the worst case scenario.

Standard cardio work outs are great. They give the all the organs, the heart in particular, great blood flow, more efficient muscle with millions of hard working mitochondria. When the heart is more efficient with its beating and contraction, it doesnt have to work as hard throughout the day. Lungs work better at extracting oxygen from air, liver gets blood flow so it can get rid of toxins and run it's multistep break down of things that would normally kill us. Even cells will be able to absorb glucose better and in many cases without the need of insulin when exercise excedes a certain level. The endorphin and enkephalin release post exercise is something only an avid exerciser can relate to. One of the reasons we get "bitten" by exercise. It is addictive due to the hypothalamus being stimulated by the hormone release. This would be the same spot morphine works on. Finally, during the 60-120 minutes after exercise, there is usually a blood pressure drop that occurs like after and orgasm. Yes, exercise can be fun. Something a doctor or therapist or personal trainer can do would be to figure which kind of exercise would be appealing enough to catch the attention of a particular individual. If that person can make it through the first 8-12 weeks without injury, they are probably on their way. The enthusiasm drops rapidly with failure to progress or injury. With the diversity of jobs and hours and facilities and paychecks, an advisor has to be well versed with what is available or at least what has worked for others in the same predicament.

From 5K's to rock climbing to martial arts to dance, find what fits the schedule, what is economically feasable and what sounds like fun. The "Saguil Approach" says working a 5 pound sledge hammer 8 hours a day is something a regular person can't do and I am impressed the muscles will tolerate that but that type of exercise is not what the heart considers relaxing and helpful, if anything, that form of exercise can induce a heart attack. Exercise should be prescribed, and I believe it should be paid for (hopefully soon a health savings account will allow this). Activity should be part of anyones rehab and treatment program for staying healthy. Even if you are already "active" and hypertension is found, you may still have to rethink what has to be done to avoid the pills or more urgently, "avoid the knife".

cut and paste to see the ACSM's stance on exercise:
http://www.acsm.org/AM/Template.cfm?Section=Home_Page&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=7764#Under_65

Thursday, October 25, 2007

What do I look out for in getting MRSA infections?

Here in Illinois (specifically DuPage county) there have been reports of MRSA. This acronym stands for methicillin resistant staphylococcus aureus. This bacteria has been around for about 30 years but wasn't so prevalent. When I was a resident working at West Suburban Hospital in Oak Park, we would occasionally get it in chronic ventilator patients. These unfortunate people would be on a ventilator for multiple reasons and of course on a ton of medicines. One note is they would most likely be immunocompromised due to multiple reasons.

There are medicines for MRSA but they are limited. Once a patient was found to be cultured with this bacteria, they would usually be placed in isolation for fear the visitors (nurses family and doctors) would spread the bacteria to other patients (kinda like TB in the 60's). Patients would stay in the hospital for multiple antibiotics till infection was showing improvement. Then they would usually be sent to a chronic care facility in the same restricted form of contact.

Now we are emperically treating patients with antibiotics (usually 2 or three at the same time) and sending them home hoping they clean up after themselves at home and work. Now as a review, the reason the staph became resistant was most likely due to overprescription of antibiotics a while back and now we are hitting every little bug that doesn't seem to respond to standard antibiotics with doubles and triples till the follow up visits with their docs and the cultures come back. God help us in the next few years when no antibiotic will touch certain strains of staph or any other bacteria due to this years' MRSA scare.

What people don't realize is that MRSA is a bacteria like any other. If the individual doesn't care for themselves properly in hand washing, showering and using soap and water on new cuts and scrapes, not sharing towels or clothing from others then any bacteria, not just MRSA, will cause an infection. That infection will need to be drained or blasted with antibiotics. Standard infections go away in 10 days, MRSA gets worse in 2-3 days. The front line tactic for MRSA still is the same for any infection: hygiene, rest, eat properly and exercise.

Poor hygiene, a stressed out body, poor nutrition, obesity, lack of exercise, poor sleep will lead to a body that can't fight the initial battle of infection. This is usually exposure to a bacteria and break down of the body barrier.

Skin is the first barrier: well hydrated and moisturized, nothing should get through. Unfortunately, nobody that works 8-10 hours a day likes to drink water since it results in having to urinate soon after. Not the best for a driver, outdoor worker, telephone operator, computer user. (I remember watching the movie "Pursuit of Happiness" with Will Smith playing a stock broker and he stated in the biography, he wouldn't put the phone down in the cradle or drink water cause it would give him an extra few cold calls at the end of the day.) I am also guilty of this, in seeing a day full of patients, I would not want to eat or drink since it may slow me down for 10-15 minutes and that would cost me one patient visit to put me behind and I would be playing catch-up for the entire day. (See my first blog on The Adventures of Dr Saguil for info on the 10 minute visit as paid for by medical insurance.)

Second barrier would be hydration. If well hydrated, the skin would react by producing thin protective oils to keep the outer layers tensile and unbroken. When dry, outer layers are parched, single cells are separated from each other and flaking occurs which further hampers pore function by blocking the skin pore from making sweat and oil to trap bacteria and prevent further deeper invasion. Being well hydrated also produces a very effective vascular volume. More blood to the skin brings more white blood cells to fight invading organism.

Third barrier would be a properly functioning white blood cells. Tobacco, poor nutrition, lack of multivitamins and supplements, or uncontrolled medical disease states (like diabetes) will hamper the way white blood cells work. Lets consider white blood cells to be policemen. Even if we have a large police force in a city, if they don't know how to arrest or pursue, a crime will still occur. Considering that 50% or more of the US population is overweight and eating poorly, this alone will decrease body defense. Throw tobacco, alcohol, high fat diets in the mix and one is asking for an infection to invade.

Forth barrier is more of what doctors are doing and what patients are demanding. Many patients go in to see the doc just for a diagnosis. Many aren't satisfied and also want a prescription medicine. This is especially in the pediatric population. Most parents feel better when they leave having an antibiotic for the fever and cough even if the infection is just a virus and will go away on it's own. Remember, more antibiotics cause more drug resistant bacteria in the community.

To piggyback on the forth barrier, most docs don't suggest acidophyllus use during the antibiotic 5-10 days. All antibiotics kill indiscriminantly. All those colonies in the throat or chest or urine or sinus' will die for sure. Unfortunately, the good ones in the colon, stomach, small intestine, vagina and skin also die. Our "normal flora" found in the GI tract are there to help with digestion and function. When they are all killed, only the worst and strongest bacteria and fungus will remain. Let's consider the normal flora in the colon being an average classroom of highschool kids. When all the "nice" smart hard working kids are kicked out of school, you are left with the truant, delinquent tough streetwise kids. The resultant class is totally different...get it? So after the "nice" kids are gone, if a large influx of some other nice kids come into school, the bad guys are usually kept quiet just by outnumbering force, and the class continues uninterrupted. This is where probiotics come in handy. Two tablespoonfuls of liquid probiotic or one three capsules of acidopyhyllus/bifido will reboost the stomach, small intesting and colon with good flora. (Usually given 2 hours after the antibiotic is dosed)

So in summary, The Saguil Approach is to do what mom always harped on. Wash your hands, eat vegetables, take your vitamins and go to sleep on time. Translated; good hygiene, good nutrition, decreasing stressors, staying hydrated, taking supplements/probiotics, and avoiding and controlling disease issues. Allow no bacteria to get through the barriers and you won't have to worry about MRSA. Of course getting professional opinions when something starts to look unusual would be important if it has already invaded but most people have the potential to fight off infection without antibiotics. Personally, I hate antibiotics, the last time I took one for a self diagnosed sinus infection, I got Pseudomebranous colitis after one pill of zithromax and remember thinking to myself.....this has got to be a ruptured appendix as I tried my hardest to stick acupunture needles everywhere I could to treat nastiest pain in my life. That was about 5 years ago and haven't used anything since while living through Chicago's winters and hundreds of patient encounters with infections of their own. Although I do use some herbals to boost immunity...next blog. (5 bucks to anyone who finds I don't wash with soap or use antiseptic gel after I examine them!)

Friday, October 12, 2007

My allergy medicines aren't working anymore

I was walking through my favorite store that I will keep anonymous, they sell a wide variety or supplements, cooked and whole food. Was talking to a rep for one of the companies that makes omega 3 and couldn't help but notice he had a very nasal sounding voice, a reddish hue to the center of his face and most of all he was set up so the aromatherapy and incense was directly across the aisle from him. I did spend some time inquiring about his product and he answered well, (I usually like to listen intently on how a rep sells his/her product and what basic knowledge they have before I tell them I am a physician and that I use herbal products for myself and my patients). All during this time I try not to focus on his nose but my mind automatically pictures me checking his nostrils in the office with a nasal speculum.......(sometimes this triggered response I have to ordinary situations scares me). I will be talking to someone at a party or chance meeting and while conversing, my mind wanders about a working diagnosis for what I see before me. Anyway, after he is finished and gives me some samples and a dvd (love freebies!) I point to the elderberry in my basket and say to him, "you may need some of this for the rest of the week". He acknowledges and states he is already on Zyrtec (an antihistamine that some how states it is the best thing for cats, cigarette smoke and plant allergie;, although it isn't the substance exposed to, but more the person that is having the histamine reaction we must try to control) and nasonex (A steroid nasal spray that controls local response in the nose only). He had some cat fur on his sweater and after I asked, wouldn't you guess....he has 3 cats that supposedly didnt go in his room at night. Wouldn't that be great if pet dander, pollen and dust mites would stay in areas of the house where they are supposed to stay! When I was in practice, patients with nasal symptoms who had all the classic signs of allergies would usually tell me they were tested and the allergist stated they have no problems with cats, dogs or milk. I still believe that several small allergens all together at the same time will still have the body act in the same way as one big exposure to a single allergen. So with this person, same theory in the "Saguil Approach" goes; if placed on a medicine, it would be as a temporary measure at best. These folks are placed on meds and not told to do much with the environment around them or their diet. Just like echinacea is supposed to be used for short term only, the perscription medicines should be used short term only.
Other herbal medicines are stinging nettles (a favorite or Dr Weil) and butterbur. If things progress over the allergy line and into the infection stage.....all the above continue and then I like andrographis (paniculata), garlic, quercetin, mushroom extract(reishi, cordyceps, shitake) elderberry is a great alternative for kids. Many times in the ER we see kids that are sick but all tests and evaluations yeild nothing to treat so we say go home and wait....well this is where I think alternative medicine excels.

For extinguishing allergic response, there are the typical shots we give to desensitize the patients over a course of a few months. Essentially giving the patients micro amounts of what they are allergic to every week to have the white blood cells(eosinophils) take a little at a time and hopefully learn that the compound is not irritating. Increasing the amount every few weeks will "desensitize" the patient after a while. Immunologists say they have great response but I guess I see a different portion of the population, most of the "average joes" that come into the office are obviously sick and allergic and still getting shots. (Sometimes I see patients that have been getting shots for years!) Usually, these kids have been taken off gluten, casein and wheat already-god bless those parents for being so tolerant to the problem. I have found homeopathy is great at allergies especially since their concept is based on slow exposure to a substance in order to change an eventual reaction the body manifests.

In summary, "Saguil Approach"-
take care of the environment around you
change the pets diet (possibly to human grade meat)
change the pet
vacuum and dust sunday and thursday
allergen central air filter (3M)
alot of fluid for you
spray the nose with saline douche 3-4 times a day
echinacea or stinging nettels- 1 month before allergy season
zyrtec, clarinex, claritin, allegra, asteline if above doesnt work
avoid direct contact with sick people -hand shakes,hugs,kisses,pens
cut down animal protein, no dairy (but take a calcium/vit d3 pill)
add garlic and ginger
elderberry, andrographis, quercetin, mushroom extract
homeopathy drops to desensitize, doctor to look into leaky gut
allergist to test and consider shots and try to avoid long term steroid!

oh...puffs plus or tissue with moisturizer added to prevent abrasion to the nose.

Friday, October 5, 2007

Should I be on a certain diet when my joint is so inflammed?

I like the way Andrew Weil makes choices for dietary restrictions in those with inflammation. This is usually asked of me when a patient is going through a sprain or strain of a body part and I am putting them on the trifecta of:

1 an antiinflammatory
2 a muscle relaxant
3 a pain reducer

We can sometimes get by without this "cocktail" but people present in extremes and the discofort is agonizing to the point of the patient and family being desperate for immediate change. I had mentioned in the post on "which protein powder is good for gaining muscle" that white willow bark, turmeric, boswelia and ginger are good for antiinflamatory properties. I have tried New Chapter's Zyflamend and Natures Sunshine's IF relief. Both had great results with nostomach upset. There should be limitations to duration used and in some with true joint disease a compound with glucosamine sulfate would also be useful. (As an aside, I was using glucoasamine in the mid 90's with my patients using European studies as a basis for trying it. Also my older patients were developing ulcers and reflux with typical NSAIDs used for joint arthritis. Only a few years later did I see some of the orthopedic surgeons trying the same for teh arthritic patients we sent them. This was one or two "pods" in Wheaton Illinois. You can imagine the thrill I had when Whole Foods was built behind my office and this was the first I heard of this concept.)

I will usually involve my patients immediately in some form of movement (physical therapy, yoga, tai chi) and a diet. The diet is more of a restriction diet. The American culture is based on fast cars, fast money, fast food and built into this is a very poorly calculated diet rich in milk, sweetners, fat and salt. Everything to make you release serotonin and feel great after eating. The normal post prandial wave or parasmpathetic hormone release that occurs after a meal is increased with the ingestion of simple carbs that have a very high glycemic index and fill the blood stream with immediate glucose for that tsunami of hormone to be released from the gut and stimulate the brain cells. Well, the average american is eating to set him or herself up for inflammation whether in the form of poor tolerance to exertion and resultant muscle soreness or that deadly inflammatory response that occurs in the blood vessels laden with cholesterol plaques called CAD (coronary artery disease).

"The Saguil Approach" to an antiinflammatory diet:

No dairy
Change animal protein to plant protein-switch from red fatty meats to soybean, tofu soymilk or lean cuts
Avoid processed meats (nitrites cause inflammation)
Multiple colors of fruits and veggies daily(shoot for 5)-(Berries are great)
Start cooking with ginger and turmeric (try indian dishes)
Start preparing cold water fish dishes (SLASH-M see omega 3 post in the herbal411review blog)
...or take omega 3 fish oil
Use extra virgin olive oil as the main fat and eliminate anything that is deep fried containing transfatty acids.
Avoid Nightshade family?
Increasing fluid intake is mandatory

Reinforcement of goals achieved if very useful. The person suffering from acute or chronic inflammation has 24 hours of pain they experience so any applause that they have made it through to a first or second goal is helpful. When under duress, concentration is lost and sometimes the one in pain forgets they are actually able to move a joint now or walk with less limp. Our ER is built on determining if the treatment is successful by lowering the pain scale from 10/10 to a lower number. Problem with this mentality is a patient will keep on saying it's a 10 until mental faculties and so distorted that either they are asleep or slurring their speech.(oh but they are still a 10/10 because the pain is still in the same place-remember, we didnt fix the inflammation, we only dulled the brains' interpretation of it so even if they are now drunk, the joint or body part still aint moving and is still as hell.) Occasionally we do win and that patient states the headache or back pain is better but these are also the patients that are moving the extremity and pumping the muscle to the previously guarded area....maybe more blood flow, less lactic acid or just the golgi tendon organs in the muscle are getting a massage?

So next time the doc whips out a script of three different medicines for that pain.....try adding this diet to the next 1-2 weeks and see if it gets better faster.....maybe you might like the diet and save your heart too!

How do I carb up for a race?

When I was the team physician for University of Central Florida,the trainers for the endurance sports usually came to the weekly clinic with one or two athletes that were eating "weird" before a competition. Most notorious were the mens soccer player. Great group of guys and excellent training staff but some of the guys were scholarship athletes from different countries so not only was there a language barrier, there was also a difference in food preferences. The soccer team as an example had a very deep bench and coach could call on substitutes frequently so top players didn't "hit the wall". (a term used for running out of energy during a work out or competition). Ask any distance runner or cardio athlete and they can tell you one time they just had no more gas to continue and just felt lousywith huge performance losses. Most non-cardio aggressive sports will be able to rest and conserve energy so as not to "bonk out".

When I asked about how these athletes would prepare for a saturday match, Greg (the mens soccer trainer) would respond they hit the cafeteria and try to choose high carb foods for the dinner friday night. This is basicly correct but it can be tweeked. I like the old way which was draining down 2-3 days before the event with a low carb diet (20% of total diet being carbs) thendoinga high aerobic exercise 1-2 days before and loading with a high carb diet the day before the event when the work out is light. This is the way it was done in my day when John Travolta did the Saturday Night Fever thing (the 70's). Newer versions cameout in the time of PearlJam (the 80's) where an athlete didnt have to dwindle glycogen stores down before the load and just started to load with a gentler amount of carbs in the diet 3 days or so before the event. (70% carbs) Being an herbalist, I always like the concept of clearing out the liver before a big event anyway. (Those unseen toxins and free radicals do accumulate somewhere....but thats another post!)

There were studies to prove that athletes did run out of glycogen stores in the liver by end of the 1st half. Muscle biopsies were done on the athlete begining midway and at the end of a soccer match (who on earth would allow someone to poke a needle into a calf muscle and study tissue fibers while playing soccer...I guess thats the payback for paying a scholarship). Results showed glycogen stores were close to 90% depleted by second half. That leaves an entire half game played with no energy stores. Most division I athletes can continue to execute technique but overall prefomance will suffer. Remember Micheal Jordan returning to his first game after retiring the 1st time and he still had technique but younger players were running all over him and stealing balls. Of two equally matched teams in talent, the one with higher nutrition levels in their player will be able to take advantage of the players on the other team running out of gas. In the real world of 50 hour work weeks, child care and limited time to compete, we dont often compete with others but performance decreases will be seen in fatigue and aches lasting the days after a routine work out or work performance and concentration being effected days following a hard work out. Worse case is that we may open ourselves to infection due to the immune system being stressed from excessive glycogen store depleation and poor rest when we need protection from the bacteria our kids bring home from school. (Same concept as a diabetic being more at risk for infection, white blood cells are supposed to fight and gobble up bacteria but if the glucose molecule cant get into the WBC for energy creation, it wont function properly to track and kill bacteria.)

The real world approach to carb loading still exists for the division I II or III athlete, regarding the specific types of carbs to go to the store and look for, I have been requested to write a blog on spcific shopping.....keep posted on a new blog! If you are not in competition for a 5K, triathalon, marathon or
endurance sport, still consider hitting the high carb intake within 2 hours of an aggressive work out to at least prepare for the rebuilding phase of muscle or the next work out. Many of the average joes that consult me are working out to gain muscle and lose weight and dont consider themselves athletes but I warn you that there will still be a bonk out or hit the wall point where health will suffer, it just may not be as sudden as the competitive athlete. The two hour rule is the golden hour as I call it when muscle membrane and glyconeogenesis in the liver is peaked to form high stores. After that the hormones that are circulating in the body arent as keen on taking carbs/glucose into the liver or muscle cell and convert to glycogen. (Think of glucose floating in the blood stream as electricity from an outlet and electrical cord; glycogen as stored energy in a battery.) In a game, theres no electrical outlet to connect to and we rely on the battery. On the bench we can "plug in with gatorade or power gel". -Not necessarily the best but most US schools are sponsored by gatorade. The proper ratio of carb to protein ratio is 3carbs to 1 protein within 15 min and up to 2 hours. Simple carbs are better, those with a higher glycemic index, since they get absorbed rapidly. Here is a nice table from www.gssi.com:

GLYCEMIC INDEXES OF COMMON FOODS

Breads & Grains
waffle - 76
doughnut - 76
bagel - 72
wheat bread, white - 70
bread, whole wheat - 69
cornmeal - 68
bran muffin - 60
rice, white - 56
rice, instant - 91
rice, brown - 55
bulgur - 48
spaghetti, white - 41
whole wheat - 37
wheat kernels - 41
barley - 25

Cereals
Rice Krispies - 82
Grape Nuts Flakes - 80
corn Flakes - 77
Cheerios - 74
shredded wheat - 69
Grape Nuts 67
Life - 66
oatmeal - 61
All Bran - 42
Fruits
watermelon - 72
pineapple - 66
raisins - 64
banana - 53
grapes - 52
orange - 43
pear - 36
apple - 36

Starchy Vegetables
potatoes, baked - 83
potatoes, instant - 83
potatoes, mashed - 73
carrots - 71
sweet potatoes - 54
green peas - 48

Legumes
baked beans - 48
chick peas - 33
butter beans - 31
lentils - 29
kidney beans - 27
soy beans - 18

Dairy
ice cream - 61
yogurt, sweetened - 33
milk, full fat - 27
milk, skim - 32

Snacks
rice cakes - 82
jelly beans - 80
graham crackers - 74
corn chips - 73
life savers - 70
angel food cake - 67
wheat crackers - 67
popcorn - 55
oatmeal cookies - 55
potato chips - 54
chocolate - 49
banana cake - 47
peanuts - 14

Sugars
honey - 73
sucrose - 65
lactose - 46
fructose - 23

Beverages
soft drinks - 68
orange juice - 57
apple juice - 41

Foods listed from highest to lowest glycemic index within category. Glycemic index was calculated using glucose as the reference with GI of 100. Modified from Foster-Powell and Brand Miller (1995).

So the "Saguil Approach" is if you are in competion for a moderate cardiovascular event increase exercise intensity 1-3 days before the event, decrease carb intake 2-3 days before the event, load with high G.I. foods day before the event. Replenish with high glycemic foods, gels or drinks during the event. Finally, if you just work out but intend to "max out" every 4-6weeks, try to keep a balanced diet at all times, intake a 4/1 ratio of carb to protein within 2 hours of finishing the work out and for the love of Pete, don't be spending on expensive protein mixes or weight gain/slim down powders when not even maintaining a proper diet, sleep regime or vitamin supplement schedule. If you try to cut corners, you may not hit the wall or bonk out as aggressively as my D-I students but at one point you will get hurt or sick and plateau. (Email me or see an approved american dietetic association nutritionist or dietician). Exercise safely and have fun!

Which protein powder is good for gaining muscle?


Since I see have extra training in sportsmedicine, I would usually get this question thrown to me at the end of a physical or as I am about to discharge a patient from an injury we were working on. I come back with asking what weekly calorie intake is and the answer is a grab at the chin and a stare to the heavens. Usually the question comes from a 20-30 year old that is breaking into weight training and paying a trainer or someone with knowledge on exercise. The common problem I find is that most teen-to-20+ year olds will still be eating poorly. I attribute this to a learned behavior from high school. Most teens don't eat breakfast. (I remember my nephew forcefully stating to his parents "why would I want to wake up early just to eat breakfast?") Good question for his age, he probalby gets by with the poor nutrition and can function the whole day with little to no good calorie intake. Most people just "get by".



Building a body like Mr. Olympia, or being able to train to win a triathlon will take more than a cup of coffee for breakfast, sandwich for lunch and plateful of something for dinner. When my 20-30 year olds take massive protein mixes that cost a lot but skimp on basic meals....it's a waste. I always start out with suggesting a good multivitamin with multi B, calcium,D, zinc,selenium biotin and possibly coQ10. Add this to 4-5 meals a day to total about 3500 calories daily with 8 hours of sleep and a month to two month time table. A nice herbal antiinflammatory would help but thats over stepping the first suggestion. (The "saguil approach" suggests easy goals that are attainable over a short time with frequent checking in) Once they stick to the basics and 1-2 months has passed, I would for- sure suggest changing the work out schedule and add an herbal antiinflammatory like tumeric, white willow bark or boswelia. Sometimes a multi-ginseng, cordyceps combo capsule would help push the energy level for those stepping up the intensity of their exercise. The change would be power lifting movements for those trying to gain size; cardio or interval training for those trying to get cut, lose weight or get the heart tuned up and off a medication or two. I then would get start breaking down the amount of proteins, carbs and fats in a 2 week diet diary. I usually wait 2 months because I find good foundations have to be attained before I have them buy expensive protein supplements, energy bars or even talk about old fashion carb loading.

I always liked the way Mr Miagi would pace Daniel-san to do basic chores around the dojo before he would teach martial arts techniques. (Obviously trying to get Daniel to learn discipline and respect for power). Some of my well weathered patient athletes are already into proper health, nutrition and rest so when they ask about supplements, I do go straight for names, companies, brands and amounts. Bottom line is that many over the counter companies that advertise in muscle mags, runners world, triathlete boast many benefits to taking their supplements but they all fall under food supplements and the FDA has no control over the quality of what they place on the shelves. Something to look for would be if the company produces pharmaceutical grade supplements. Those that are bioavailable in the bloodstream at 90+% within 1-3 hours of digesting. Having samples tested by an independant lab would also add credence to company quality assurance. I also give the average athlete the example that a Division I NCAA college athlete on scholarship would usually take a season to improve on a technique, gain strength or shorten a time. This is essentially an olympic level athlete I am describing so if my average patient is wanting to see results of size increase in 2 months, I reset their thinking and give them more attainable goals.

In summary, 3000-3500 calories daily, 7-8 hours of sleep per night, multivitamin as stated above, flexibility routine daily, and 2 month goals. A risk factor review is good, hold the caffeine, tobacco, stress, and keep the chatter down in the gym. (I find too much conversation slows a work out down and before you know it, workouts are 2 hours not including travel). This kind of scheduling is a set up for failure. [To explain, average person works 40-50 hours a week, 10 hours a day, one hour of travel, 6 hours of sleep, 2-3 hours of chores and relaxation.] Now add two hours daily of exercise not including travel and that fills up the day. One hour would be better and less likely to end up in frustration and failure when winter holiday comes and days shorten with more responsibility that time of the year. "Fancy" supplements for exercise are whey protein, spirulina, L-arginine and cordyceps.



Before signing off, steroids will always be taboo but alot of people will try them just the same. People have to be made aware of the side effects to these short cuts not to mention getting arrested. In my "heyday" when I won Mr Natural New Jersey and Mr Novice East Coast, I competed against guys who did "roids" and I could see how fast these guys blew up and how synthetic they looked when in competition. I wonder how many had died, (one for sure since 1982 I saw in a local paper), many more I'm sure with other problems. From what I understand, "gym rats" are trying concoctions of herbs even to the point of using a milk thistle to clean out the liver between herbs. Unfortunately, there are too many underground body building pushers and just a couple of people who do what I do. That's ok, if I can change one person at a time, that's plenty.

How can I loose weight in 2 weeks for a wedding?

Fast dieting usually leads to fast loss in a week or so but then fast plateau in the loss thereafter. It is thought in most non-medical circles is mostly loss in "water" weight. Many things will happen hormonally when the body is faced with an acute decrease in circulation glucose levels. Much of the body response is due to release of glucagon by the pancreas leading to the breakdown of glycogen in the liver. This goes fast and within a day, if exercise in also started, the action can dwindle stores to very basal levels. If the body continues this path, fat stores are call on to contribute to the glucose production. The built in mechanism to stimulate the body to hunt for more glucose stores is the symptom of craving. The hypothalamus is stimulated by release of hormones and also from the low glucose stores. This is sometimes noticed in "carb hunting" after drastic low-carb diets.
In theory, if the brain can be fooled into accepting the low glucose concentrations in the blood, the short term fasting will be easier to tolerate. Supposedly, the manufacturers of Hoodia say it works by fooling the hypothalamus (though not enough evidence for effectiveness). The drug Redux had also been studied to release serotonin thus depressing appetite and anxiety. It also was reported to cause primary pulmonary hypertension and nerve damage. Much of the same problem occurred with fenfen and Ma Huang (ephedra) which was pulled off US shelves.

More natural ways to fool the brain indirectly would be to increase the fullness in the digestive tract. Water, fiber, frequent smaller meals. Some have tried aroma therapy to sooth the brain when the hypothalamus is prompting the "hunt" to start. Another trick is to exercise which releases a strong fight or flight stimulus. The sympathetic hormones command more response from the body than the parasymathetic hormones so "anger" wins over "eating". The obvious answer is that it isn't healthy to do fast bursts of weight loss. If it must be done over a short term period, consider calories in and calories burned. Use exercise and wise food choices. Keep schedules busy (don't mistake hunger for boredom) and when hunger does come up, don't have high calorie snacks around to choose from, (junk food, simple carbs, candy). Be weary of any supplements that state appetite suppression. Since the FDA doesn't regulate labeling, three of four bottles on the shelf probably won't even have the ingredient at high enough doses in them. Many of the effects from the new cans of energy/weight loss drinks are from the caffeine component, (again stimulating the fight or flight hormone release of epinephrine and norepinephrin) which elevate blood pressure and decrease sleep.

Here is an FDA post of the recall of Fenfen for heart valve problems....http://www.fda.gov/CDER/news/phen/fenphenpr81597.htm

The "Saguil Approach" is to do things in moderation with easy goals every 4-6weeks. The attention span for an average individual is 20minutes to read one of these blogs and I believe 4-6 weeks to perform a specific routine in exercise, after that, muscle develops engrams to memorize routines and it's not asmuch of a stress anymore thus body gets used to the progam and no further gains noted.....the typical plateau people talk about....(that I term sling shot period since re-adjusting the routine, diet or time of work out will "slingshot" you to the next level.) Plateau is such a terminal decription. Diet safely and be patient...push the cardio because that is essentially the only way to burn up all stored glycogen and start to have the body call on adipose tissue for energy. Burn adipose tissue and fat depots will shrink.