Healthy and Affordable Shopping

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Grocery shopping can seem overwhelming especially as you are getting used to eating and preparing foods in a new way. It can be especially difficult on a budget. My belief is that investing in healthy food is investing in your health. I recently shared some tips with my patients at our R-Health Cherry Hill Healthy Shopping on a Budget event. Here are some of my favorite pieces of advice.

First let’s broadly define “healthy” as there are many controversies.  However, let’s focus on key elements of agreement.  They are: eating whole unprocessed foods, especially fruits, vegetables, nuts and seeds, avoiding empty carbohydrates such as those in sweets and refined flours, avoiding additives including chemicals and added sugar and salt, avoiding pesticides, antibiotics and hormones and getting adequate amounts of healthy fat, protein, and fiber.

Reading labels is empowering! It takes extra time at first, but once you know the products that are right for you, shopping will get faster again.  Not all food labels are helpful in making decisions.  For example, “natural” does not have a clear definition that is regulated by the FDA.  Companies can label their food natural and it still contain high fructose corn syrup for example. Also, beware of Heart-healthy statements as well as they can have plenty of refined carbohydrates that raise your blood sugar and trigger inflammation.  A few things to think about food labels in general.

  • Ingredient list: QUICK HINT – look for names you can pronounce and foods you have in your own kitchen.
  • MANY OF THE BEST CHOICES WILL NOT HAVE A LABEL – Think the produce section!
  • Calories: Not all calories are created equal – don’t worry so much about the calorie count, when you are able to get rid of processed foods usually you can trust your body to tell you when you have had enough.
    • Your body processes a Twinkie much differently and with different metabolic effects than a handful of nuts even though they have the same amount of calories.
  • Check the portion size. (Sodium content can be misleading when that tiny can of soup has 2.5 servings!)
  • Watch for fats
    • Buy healthy fats – nuts, seeds, olive oil, etc. and avoid trans fats
    • Foods can be labeled as having 0 gm of fat or trans fats if they have ½ gram or less.
  • Fiber is good for your body, especially for healthy gut bacteria
  • Watch for additives especially sugar and salts
    • New guidelines now ensure labels now contain “added sugars”
    • Try to avoid concentrated natural sugar in high quantities too (e.g. fruit juice or dried fruit)
    • Work on sticking to the recommended limits of no more than 6 tsp of added sugar for women and children and 9 tsp for men per day
    • For salts, much of the sodium and added sugar comes from salts and sugar added to processed foods. This helps the food industry to make the food more addictive. Read labels carefully and cook home-made meals whenever possible.
    • Look for chemical additives or artificial flavors/colors. You might be surprised when you first start reading labels to find how much more is in your can of beans, tomato sauce, or yogurt than you thought.

Saving money on anything usually requires planning ahead.  Look at circulars for sales and make a meal plan for the week.  Look online and in magazines for great ideas for your palate and budget.  Try searching “clean eating on a budget.”  On our grocery trip we toured Aldi.  Not only does this grocery store offer healthy natural (their Simply Nature labels are verified by a third party) and organic options, but surveys show Aldi’s prices on average contain 20% more savings than larger retail stores.  Remember to bring a quarter and your own shopping bags.

Other cost saving tips:  If you have the time, avoid pre-cut servings.  Stock up on nonperishable and frozen items when on sale, and shop frequently for perishable items so they don’t spoil before you can use them.  Try looking above and below eye level, compare store brands, and of course not shopping while hungry are other cost saving tips.

Also know when to invest in organic produce and when to save on conventionally grown produce. According to the Environmental Working Group’s 2017 list below are products to look for.

  • DIRTY DOZEN – Fruits and Vegetables with the most pesticides (Shop organic when possible for these!)
    • Strawberries
    • Apples
    • Peaches
    • Pears
    • Spinach
    • Tomatoes
    • Celery
    • Potatoes
    • Sweet bell peppers
  • CLEAN 15 – Fruits and Vegetables with the least pesticides (Okay to buy conventionally grown produce for these!)
    • Pineapples
    • Mangoes
    • Papayas
    • Honeydew Melon
    • Kiwi
    • Cauliflower
    • Eggplant
    • Sweet Corn
    • Cabbage
    • Avocadoes

Hopefully this is a good start for your next grocery store trip.  Please feel free to reach out to your R-Health doctor for more information and if you have specific medical conditions for your doctor to get you on the best health and nutrition plan.

Everyday Tips to Relieve Constipation

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There comes a point where almost everyone goes through it – constipation. A period of infrequent bowel movements or hard stools.   Constipation can be a very uncomfortable state, especially the longer it lasts. Though not severe, if not taken care of, constipation can cause damage to the veins and skin in your anus, in addition to significant damage to intestines.  Chronic constipation is also a risk factor for colorectal cancer.

Per the Mayo Clinic, there are a few risk factors that may increase your risk of constipation:

  • Older age
  • Women
  • Dehydration
  • Low fiber diet
  • Little to no physical activity
  • Blood pressure medications/treatments
  • Mental health conditions

Luckily our R-Health doctor, Julia Snyder, MD, offers tools to prevent and relieve constipation.

  • Eat a whole foods, high-fiber diet
    • Eat foods in their unprocessed forms without additives (i.e. sugar, salt, flavorings or preservatives)
    • Consider a trial of dairy and gluten free (two food groups that are likely to cause constipation for people)
  • Try adding 2 tablespoons of ground flax seeds to your daily diet for extra fiber
    • Grind the flax yourself every 2 days for an extra healthy fat boost
  • Eat more good fats and try coconut oil
    • g. – wild fatty fish like sardines and salmon, avocados, and olive oil (which lubricates the digestive system)
  • Supplement with magnesium, vitamin C and probiotics
    • Use 200 mg to 1,000 mg of magnesium citrate daily. Gradually increase the dose until you go once or twice a day. If you take too much, you will get loose stools. If that happens, back off a bit.
    • Vitamin C – you can take 2,000 to 4,000 mg in divided doses two or three a day, along with magnesium supplementation. The same principle applies here: If you begin to get loose stools, just back off a bit.
    • Many people who struggle with constipation are often deficient in healthy gut bacteria, so adding probiotics can help – try adding them for one month. The increased fiber in your diet will give them food to eat and they will be happy to stay.  Also add fermented foods/drinks to your diet.  (Fermented vegetables are found in the refrigerated section)
  • Drink about half your weight in ounces of water each day (add more for hot weather or exercise)
    • Try starting off your day with water and lemon (room temperature to warm)
    • Cold drinks slow down the bowels.
    • Try coffee or tea with an apple and walnuts/pecans/almonds for breakfast
  • Exercise regularly
    • Get up and move – just 10-15 minutes of walking a few times a day will make a big difference
    • Try Yoga – the combination of relaxation and movement aids in triggering the bowels to release
  • Give yourself time to go and listen to mother nature’s call!
    • Schedule time in to your morning – just like potty training your little ones!
  • Position yourself correctly
    • Put your feet up on a stool to mimic a squatting position. This allows the muscles to relax and the stool to exit more easily.

 

 

Following these suggestions are sure aids in constipation prevention and management. However, if you have questions, or have frequent constipation, notice blood in your stool, and have severe pain in your bowel and/or experiencing weight loss, be sure to reach out to your R-Health doctor for assistance.

Why do we react to foods?

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Why do we react to foods? The most immediately serious reason is true food allergy.  A food allergy is mediated by the fast-responding antibody IgE. It might result in an immediate and intense reaction, such as anaphylaxis.  The most common symptoms include: tingling or itching in the mouth; hives; itching; and swelling of lips, face, tongue and throat or other parts of the body, among others. Treatment usually involves avoiding the culprit foods, using medications for reactions as needed, and possibly, desensitization through allergy shots.

Food sensitivities are less understood, but are thought to be a chronic, low-level reaction which can have a delayed response of one to three days after eating a triggering food. The most commonly associated symptoms are arthritis, IBS, migraines, asthma, eczema, and chronic fatigue.  If you have symptoms, IgG/IgA testing or other immune response testing can be useful for confirmation, and can be the basis for an elimination diet that could improve your symptoms.

Cross-reactivity to environmental allergens involves foods with similar proteins as outdoor allergens.  For example, if you have ragweed allergy you may also react to eating the melon family.

Celiac disease is an autoimmune response to gluten (found in wheat barley and rye).  Treatment is a lifelong gluten-free diet.

Reactive hypoglycemia and post-prandial syndrome happen when insulin levels rise after a meal and trigger symptoms.  Eating a balanced diet rich in protein, healthy fat and fiber, while avoiding high carb foods-especially refined carbohydrates or sugary drinks are first-line management.

Keeping Your Heart Healthy – The Importance of Blood Pressure Screenings

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While February may be best known for Valentine’s Day, it’s also American Heart Month. This is a period geared towards spreading awareness of cardiovascular disease, and encouraging your family and friends to be proactive in monitoring their heart health. One of the best ways to do that is getting a heart health screening.

There are many screenings available – Fasting Lipoprotein Profile (cholesterol), Body Weight, Blood Glucose, Smoking/Physical Activity/Diet – but chief among them may be the blood pressure screening. According to the American Heart Association, this is one of the most important screenings because there are typically no symptoms for high blood pressure (HBP). If you have HBP you are at a much higher risk of:

  • Heart failure
  • Heart attack
  • Stroke
  • Chronic kidney disease

It’s important to check your blood pressure regularly, especially if it’s outside the range of 120/80 mm Hg. If so, it’s recommended you get this screening at least every two years. While your blood pressure levels may be affected by short-term factors such as emotion, stress, pain, and caffeine use, there are many other risk factors that can contribute to the rise of HBP:

  • Age
  • Race
  • Family History
  • Obesity
  • Tobacco Use
  • Low levels of Potassium/Vitamin D

While there may be many risk factors, the CDC believes there are many things you can do to take control of your blood pressure, and most importantly, developing healthy habits.

  1. Healthy Diet – A balanced diet, individualized for your health needs, can be crafted by your R-Health doctor.
  2. Maintain a Healthy Weight – Additionally, your R-Health doctor can work with you to determine a healthy weight range.
  3. Physical Activity – Physical activities not only help maintain healthy weight, but keep your heart active and healthy.
  4. Do Not Smoke
  5. Limited Alcohol Use

Though there are healthy habits to follow, and risks factors that may increase chances, the best first step is to get a blood pressure screening. With no true signs or symptoms, this screening is a vital step in preventing cardiovascular disease and a first step towards making lifestyle changes. In addition, your R-Health physician can help you decide upon individual lifestyle adjustments to keep your heart and your body healthy and happy.

Recipes for Success

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Part of having a good team is having great team members, and our R-Health doctors are exactly that. Not only are our doctors always accessible to their members, but they constantly share insightful and intriguing information unrelated to medicine that our team and our members certainly enjoy. We asked Dr. Miller, our doctor at R-Health Voorhees, if she had any recommendations for our members, and she shared with us both a book and a delicious recipe.

For her book, Dr. Miller recommended Small Great Things by Jodi Picoult. Debuting #1 as a New York Times bestseller, the story follows a nurse who gets sued while battling the ever-present challenges of our time such as prejudice, justice, and race. Garnering great success since its debut, Small Great Things was recently added to the National Network of State Teacher of the Year’s (NNSTOY) booklist in 2017.

Furthermore, if you’re looking for a healthy meal, look no further than Dr. Miller. An R-Health doctor by day and amateur chef by night (we think), Dr. Miller loves to cook. She shared her recipe for Kale Soup below.

Dr. Miller’s Kale Soup

Ingredients:

  • Green Pepper Diced
  • Red Pepper Diced
  • Medium Onion
  • Turkey Kielbasa
  • Red Kidney Beans
  • 16 oz. Stewed Tomatoes
  • 32 oz. Beef Stock
  • 28-32 oz. Chicken Stock, Low Sodium
  • 2 Carrots, Peeled and Chopped
  • 2-3 Potatoes (other than white is healthier), Peeled and Diced
  • Frozen Package of Kale (10 oz.)

Recipe

  1. Sauté red pepper, onion and green pepper in olive oil
  2. Add it to the beef and chicken stock that has 2 tbsp. of adobo and 1 tbsp. of dried jerk simmering
  3. Sauté the kielbasa to brown and add to the pot
  4. Add diced potatoes and sliced carrots cook until tender – take some out and mash then add back to thicken the soup
  5. Add the stewed tomatoes
  6. Add the kidney beans
  7. Add the frozen kale and simmer for a couple of hours
  8. Serve it with sourdough or garlic bread

 

As you can see, our doctors are multifaceted but above all, are experts in primary care. Be sure to schedule your appointment with your R-Health doctor, and with all the time you have with them, maybe you can swap books and recipes too.

Growth: The Expansion of R-Health and Direct Care

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The growth of Direct Care continues to spread across the country as more and more people begin to realize its positive influence on healthcare delivery. As awareness has grown, so too has R-Health – as one of the leaders of the industry, R-Health continues to expand its footprint in New Jersey by not only offering unprecedented relationship-based access to doctors, but curating a model that challenges the episodic, transactional, and volume-maximizing traits that presently exist.

Last year, Hint, a software organization that helps streamline administrative tasks for Direct Care practices, released a study on the practice trends of Direct Care, or Direct Primary Care. Hint reported that the average yearly patient panel growth for Direct Care practices is growing at over 8% per year. With more time with the patients due to the elimination of many administrative tasks, Direct Care is great for both the doctor and the patient.

R-Health follows right along these lines. Not only does R-Health offer individual memberships, but after signing a groundbreaking contract with the State of New Jersey, it is able to offer Direct Care as a benefit to over half a million New Jersey school and state employees and their families, completely free of charge.

With such an historic agreement, R-Health saw major growth over the past year. R-Health expanded to seven locations across New Jersey, three which came during the final quarter of 2017. Just like our approach to healthcare, our sites are committed to quality, excellence, and convenience. With comfortable assessment areas along with some of the latest technology in medicine, our locations offer the convenience of a one-stop-shop for all primary care needs whether you’re a patient or doctor. To see a list of all of locations, please visit our website.

Recognized as game changers, in 2017 R-Health received Philadelphia Business Journal’s Healthcare Innovator award for our efforts to reinvent the healthcare industry. Other news outlets such as the Wall Street Journal, Politico, and NJBIZ were just a few others who graciously acknowledged the hard work and commitment towards the success of this model.

In closing, this past year has been a great year for Direct Care, and an even greater year for R-Health. Now having laid a strong foundation in New Jersey, R-Health is driven to expand to more markets and develop new relationships with other businesses more than ever. As a tight knit group that puts our doctors and patients first, excitement ensues for what’s to come and we hope that more physicians join our clinical team to enjoy it with us.

Well, What?

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What is a well woman visit and why it is important?

 
It is a designated time for you and your health care provider to discuss your reproductive health. It may also include an exam, screening tests, like a pap smear or blood work, and immunizations. If you have breasts, a uterus, and/or a vulva it is important to have this type of visit to check the physical organs, even if you do not identify as a woman.

 
A well woman visit can be important in different ways for different people, depending on their needs and stage of life.  For young women, it may just be a discussion about periods and immunization for prevention of cervical cancer.  For those who are sexually active, contraception and STD prevention will likely be discussed.  Those thinking about starting a family might have a discussion about optimizing their health for conception and pregnancy.  For those 21-65 the Pap test allows cervical cancer to be detected and treated before it causes problems.

 

For women over 40, getting a mammogram can help detect breast cancer earlier. Those approaching or facing menopause might discuss bone health, changes in their body, symptoms, and strategies to protect them from long term health risks. It may not be necessary to have an internal exam or breast exam every year.  You can discuss with your doctor the risks and benefits.

 

A well woman visit is another important way to be proactive about your whole health. From an evolutionary stand point, one of the most important functions of our body is to reproduce.  So, reproductive health can be an indicator for overall health and well-being.

 
It also is an opportunity to continue to build a good, honest relationship with the doctor. With unlimited access to your R-Health doctor, not only are you not pressured with remembering all your questions for a single visit, but no matter what is discussed, you’ll always get the time you need to fully understand and have your input applied to any course of action.

Cervical Health Awareness

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January is Cervical Health Awareness Month. The goal of this month is to raise awareness on how to protect against Human Papillomavirus (HPV) and cervical cancer. HPV is the most common sexually transmitted infection (STIs) in the United States, affecting nearly 80% of women, at least once in their lifetime. According to WomensHealth.gov, though most cases don’t show any symptoms, and usually goes away on its own, if it doesn’t, HPV can lead to:

  • Cervical cancer
  • Other genital cancers (e.g. cancers of the vulva, anus, penis, etc.)
  • Oropharyngeal cancer (i.e. cancer of the back of the throat, affecting tongue and tonsils)
  • Genital warts

However, there is good news. With HPV vaccine shots, regular screenings, and follow-up care, HPV and cervical cancer can often be prevented. This is one of the many reasons why a yearly well-woman visit is important. Other ways to prevent HPV and the risk of cervical cancer include:

  • Get tested – make sure you are your partner are tested for STIs
  • Use condoms – condoms have been linked to lower cervical cancer rates
  • Limit your number of sexual partners – your risk increases with the number of partners you have

As parents, it’s important to understand the benefits of the HPV vaccines, and have them administered to your children, both boys and girls. Though encouraged to get the vaccine during the pre-teen years, teens and young adults are still able to receive the vaccine (boys – up to age 21; girls – up to age 26).

R-Health gives our members access to vaccines right in the office. If you want to learn more about the HPV vaccine, or want more tips to prevent cervical cancer, call your local R-Health office to get started.

Why Weight?

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Weight loss is always about what is on the end of your fork – it’s about what you are eating.  Exercise is extremely important to stay healthy, but it is a much smaller player in the weight loss journey.  Patients often express frustration with their progress because they feel that they have been going to the gym, or otherwise working out, and not losing weight.  The reason that they are not losing weight is that they are missing the most important piece, which is changing how much they eat and what they eat.

Slow weight loss is always best – 1-2 pounds weekly.  That is the kind of loss that will be maintained.  Rapid loss usually results in rapid gain that often surpasses initial starting weight.

Try to eat within a 12-hour window – begin about 30 minutes after getting up, and complete the last meal about 12 hours later.  People often get into trouble with nibbling after dinner or during the night.

Weigh or measure all food – many people incorrectly estimate how much they are eating.  And, keep track of what you are eating, a convenient app is called “MyFitnessPal.” In fact, I have had patients lose up to 60 pounds in just this way!

Instead of beverages with sugar or artificial sweeteners, make spa water – Fill up a container with water, and add in fruits/veggies/herbs and let sit overnight.  Some of our patients have enjoyed combos like:

  • Cucumbers and fresh mint
  • Ginger and lemon
  • Frozen peaches/strawberries

For healthy snacks, consider:

  • A cheese stick and ½ piece of fruit
  • A small handful of nuts and ½ piece of fruit
  • A small container of hummus or guacamole (individual serving sizes are available at the grocery store) with veggies
  • A 3 ounce can of tuna spread on a rice cake

These are just a few of the countless methods by which you can lose weight. For tips and much more feedback, visit your R-Health doctor and develop the plan that works for you.

Time to Stick With It

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Like clockwork, every year around this time there’s a lot to wrap up – holiday gifts, end of year vacations, or another popular one, New Year’s Resolutions. Thinking about setting your own New Year’s resolution?  Here are some tips to help you set and achieve yours!  What makes a goal more attainable is accountability and proper planning, and HealthAdvocate helps focus on the latter by sharing a few steps that make your health resolutions achievable.

  • Choose something that interests you – Having a clear focus can help drive you towards reaching your goals
  • Choose your resolution as a long-term goal – There’s no quick fix for a long-term plan. Time allows you to better manage your goals, which ultimately brings more success
  • Think simple – Choose something that challenges you, but not taxing that it burdens you
  • Compare your 2018 resolutions with previous years’ – Learn from your mistakes and what worked well to better position yourself moving forward
  • Recognize it may take longer than a year – Some goals take longer to accomplish, but every step towards your resolution is one in the right direction

Breaking down your goals into small pieces can help make large goals more obtainable and more important in your daily life.  For example, if your goal is to lose 20lbs over the course of the year, that cheese steak seems less harmful, than if your goal is to lose 1 lb. that week.  You also get to celebrate more victories along the way!   The American Psychological Association shared these quick tips on how to persevere.

  1. Start small – Whether it’s losing 2 pounds a month, or drinking an extra glass of water a day, starting small makes your resolutions easier to keep
  2. Change one behavior at a time – Healthy behaviors take time to develop, don’t rush
  3. Don’t beat yourself up – Everyday won’t be a win, but make sure to continue your pursuit even when you stumble
  4. Ask for support – Share you experiences and find an outlet that helps support and push you to carry on

Attaining better health, is a common New Year resolution.  Maybe it’s through better food, exercise, improved sleep habits, stress management or a combination.  Maybe it’s finally getting a colonoscopy. Whatever it is, you can always reach out to your R-Health doctor and develop plan to make and meet your 2018 health goals. If you want, get a head start, fill out this worksheet to help you think about why the goal is important to you, what might be barriers and solutions to achieving your goal and bring it along.

Finally, don’t hesitate to share.  We can all learn from one another.  Visit our Facebook page and share your trials and successes during your journey.