Healthier in 2011: Part 3 – Inspired by Recipes

This New Year, I will be cooking more. (Notice I did not say “I plan to” or “I would like to.” It’s best to be committed to making it happen). I used to cook so much more in the past, but my current commuting habits have made it difficult. Soon, I will be changing practice locations and saving a couple hours of driving time a day, and I have full intention on getting back to being in control of what is on my plate, at least most of the time. I found some inspiration in the January issue of Bon Appétit magazine.

In it, cookbook author Mark Bittman writes about changing his diet.

At a point in his life, Bittman was faced with the facts of his poor health and had to make a decision about how to turn it around – similar to many of the patients I see day after day. The best line in his article is “I didn’t want to eat like an Okinawan for the rest of my life.” [Okinawans are known for their longevity, which is attributed partly to their low-calorie, low-fat, mostly plant based diet].  I suspect that a lot of people cringe when a doctor recommends a healthier diet, envisioning rice cakes and salad after salad and other boring foods.  Bittman created a set of smart and simple rules for himself, with a specific motto: “Think plants first.” I alluded to this in my previous post ( ) .  He practices this by being  “vegan until six” or “less meatarian.”  While the mere idea of veganism is daunting to many, his 5 rules should not:

  1. “Go (mostly) vegan.” I personally would modify this for myself by trying to eat mostly vegetarian. (I do like skim milk in my cereal).
  2. “Minimize the meat.” Eat smaller portions of it than you typically do.
  3. “Weigh it out.” When you see your weight creeping up, be a little more strict with the diet. That being said….
  4. “Cut yourself some slack.” Do not berate yourself for slipping up in a day or a meal. Most importantly, don’t give up on your new pattern of eating. It is easy to give in to old habits when you are frustrated with yourself. Just try your best the next day.
  5. “Make it your own.” Bittman’s rules can be used as a guideline for your own smart simple approach.

As far as Bittman’s recipes, I am looking forward to trying the Multi-Grain Pasta with Butternut Squash, Ground Lamb, and Kasseri (a type of cheese). It has 9.5 grams of fiber per serving! Also deliciously photographed is the Pear-Cranberry Turnover. It has 309 calories per serving, which is about 80 calories more than a particular ice cream in my freezer, but so much More nutritious.

Also in the magazine was a response by restaurant editor Andrew Knowlton to a question posed by a reader asking, basically, how he doesn’t get fat. (I am paraphrasing). Imagine having dish after dish of finest and richest foods served to you day and night. This is a recipe (ahem) for obesity. What was his secret? He says, “It took several years of dining out to realize that I did not have to clean my plate, no matter what my momma told me. I can still do my job without finishing the drumstick and breast in my fried chicken basket.”

Words to live by.

Healthier in 2011: Part 2 – Using Mind Games to Eat Better

Mindful eating is a great concept. There is even a center devoted to it. It involves thinking purposefully about what you ingest and why. However, when you are busy, it is easy to slip into old patterns.

Sometimes, having a few tricks under your sleeve can help. Some of these are like mind games. But the more often you do it, it will become habit.

  • Eat on a smaller plate. I use my salad plate as a dinner plate.


  • Make food very hard to get. For example, if you want a second serving, you should have to go back up to the kitchen to get it.


  • Take a sip of water after every bite.


  • Talk more if you are with a group. It will slow down the pace.


  • When eating out, tell the waiter to box half of the dish prior to bringing out the meal.  Economical. It will be tomorrow’s lunch.


  • Order a kids-sized meal whenever possible. (This is generally cheaper, too. If there is a toy involved, I hide it and save it to pacify a little one later).


  • Redefine dessert (a little fruit will do just fine) and do not make it a necessary part of dinner. If we do this regularly in our families, our children will grow up to expect it.


  • When presented with a meal, look at the vegetables as the main course, then the meat, then the carbohydrates. Note that this is the reverse of what we normally do.  


  • At a buffet, do a variation of #5: serve yourself vegetables first and save the richer and carbohydrate-laden foods for last.


  • Stash healthy snacks at work so that you are not tempted by the snack machine. Unsalted almonds, yogurt, peanut butter on a slice of bread, dried fruit with just a sprinkling of dark chocolate chips.


  • Avoid saying “I can’t eat” this or that food unless you have an allergy to it or it interacts with a medication you are taking. Deprivation feeds longing and future binging.


  • If you are inclined to have juice, water it down with 50% water.  (Saving money again)


  •  When making a carb-laden dish (like pasta) load it with veggies and lean protein. You’ll eat less carbs per serving that way.


  • Don’t tell yourself or anyone else that you are “on a diet,” which implies there is a beginning and an end. Remove the word from your brain.  

Healthier in 2011: Part 1 – my story

New Year’s Day is almost assuredly a time to start losing weight, evidenced by the yearly increase in gym memberships in January. But now, during this week after Christmas, is a great time to plan your strategy. Sometimes it takes inspiration and a few helpful hints to get going so I am devoting this week’s blog posts to both formulate my own plan – yes, I need to tune up my own diet/exercise routine – and to inspire you, the reader.

At the risk of TMI, here goes:

I have a love of food that started with plain gluttony and emotional over-eating but has evolved into the development of a more refined palate and balanced approach to eating. I think most people who see me think I have always been at my current weight or that I have a different genetic make-up that keeps me at my current weight. Or perhaps they think that I somehow have lots of time to fit in exercise. None of these is true.

I came from a household that frowned upon engaging in sports (avoid injury), did not allow me to play outside of our driveway (fear of abduction), and encouraged schoolwork and piano playing (all sedentary). In addition, in this dual-income household, I could eat what I wanted when I wanted. This meant four meals a day, with frequent snacking and soda drinking. Of course, I ate in front of the TV. You know those candy bars we had to sell as part of fundraising? I ate the majority of my box, grabbing change from my father’s coin jar to pay for it. Hey, I may have been a glutton, but I was not a thief. (The family coin jar was fair game to all, a lesson we didn’t learn in saving).

By the time I went away to college, I was at least 20 pounds heavier than I am now and had poor endurance, which was a little embarrassing.  What’s more, I had the premier meal plan, unlimited cafeteria access. What teenager wouldn’t have wanted waffles with all the works every morning and ice cream or cake every evening? So, I added even more pounds to my already overweight physique.

I found that I was getting shin splints every day and felt short of breath getting to my morning class and that became my wake-up call. I truly believed it was due to my weight. I have to admit, I was also surrounded by and envious of some beautiful, thin people. So I made radical changes in my diet and took up running. The changes were so radical, that I became underweight in the course of a few months. I was not intentionally trying to be thin, per se, but my strict diet and exercise routine would have made anyone underweight.

Well, that’s all fine and dandy, you might say.  You, Dr. Pourmassina, had the will to lose weight through a means that is impossible for me. Well, there is a twist to this story. I became so thin that I stopped having periods for some time. This is a common scenario when women are low in body fat or exercise too much. It is actually unhealthy because it increases the risk of stress fractures.

A doctor I saw told me that I needed to gain weight. Most women who have gotten to this point will refuse to gain weight because of all the effort put into losing it. But for me, it was an excuse to eat poorly again. I had a roommate who was as thin as a rail and always had chocolate and cookies in our dorm room. I never partook when she offered, because I was following my own rules so strictly. However, once I was given the OK to gain weight, I took it as a free pass to eat the way I used to. Well, it was actually worse. Why? After all that time restricting myself, I binged and binged and binged. I was never one for throwing up (like a bulimic), so back came my periods… and my weight.

OK, back to square one.

It took a few years – yes, years – but I finally found a balance. I started eating “good food.” I would go to fancier restaurants, order the cheapest dish (on a student’s budget), and found it much more interesting and complex than the junk I was eating. I was also exposed to better chocolate that was more satisfying. I looked at food as something to be enjoyed. I don’t mean the prior scarfing-down-and-stuffing-yourself kind of enjoyment, but one that leaves my mouth satisfied.

The basic inexpensive American diet is loaded with either sugar or sodium. I clearly remember eating tons of chips and then needing something sweet to balance it out. So I ate a bunch of cheap chocolate, which left me craving salt again. Does this sound familiar? And, to this day, I find drinking soda begets a craving for more soda, so I never purchase it.

Healthy eating takes vigilance, particularly if you have a sweet tooth and a penchant for carbohydrates. This is why I continually seek out food inspirations, whether it be discovering new vegetable recipes or reading magazines with tips on healthy eating. Because of my very conscious efforts, it is unlikely I will slip back into my prior bad habits. Not completely, anyway. I would be a fool to think I have conquered all my issues with food.

Questions to Ask to Make Difficult Treatment Decisions a Little Easier

We live in an era of medicine in America in which patients want to be involved in their healthcare. This is very satisfying to physicians like me, who prefer to educate and engage patients rather than just telling them what to do. Granted, there are some instances when a patient does need to be told what to do (ex: “You have appendicitis. You need surgery.”)

 However, when faced with a tough choice in treatment, it is often difficult to know what questions to ask your doctor. Sometimes, a diagnosis -cancer, in particular – can leave you dumbfounded and unable to absorb any further information.

I recently found out an elderly loved one was diagnosed with cancer. She comes from a generation that let the doctors run the show (paternalistic healthcare). Her son has been very involved and, faced with a decision to undergo chemo or not, they were both unsure of what the appropriate next step would be.

Because I am not a family member and I live far from her, I wanted to help her and her son with upcoming doctor appointments. I compiled a list of questions to ask the oncologist (cancer doctor). Really, though, this set of questions can apply to many situations where you have a difficult treatment decision to make.

  1. What would happen if I did nothing?
  2. What is/are the worst case scenario/side effects of the treatment you are recommending?
  3. What is the likelihood the treatment will work?
  4. If it doesn’t work, what next?
  5. Is it possible to “watch and wait?” Perhaps re-evaluate the issue in a few months by re-imaging. (This may help avoid unnecessary treatments).
  6. How soon do I have to make a decision?
  7. What do you think about getting a second opinion? *

*(I personally do not take offense to this question, so don’t feel shy about it if you feel very unsure about what is being recommended. However, it is generally not a good idea to “doctor-shop” or try to find someone who will recommend what you specifically want. While there can be varying ways of treating the same thing, two opinions generally should suffice. There are always exceptions, but your healthcare can get more convoluted and expensive the more opinions you get. Often physicians will order redundant tests if they do not have easy access to the first set of data).

And, most importantly, try to convey to the doctor what your overall goals are. Is it independence? Is it living as long as possible? It might be staying healthy enough for a particular event (like a grandson’s wedding, or a child’s graduation).  I knew a patient who preferred to be in pain from poor circulation rather than undergo leg amputation. Perhaps in your own belief system, you want to do everything possible to stay alive, whether or not it means losing independence. There are myriads of views on personal healthcare and it is often difficult for doctors to know what your personal goals are.

One last tip, when you think you might be faced with a difficult diagnosis or discussion with your doctor, bring one friend or family member with you to be an extra pair of ears for you.

Note to Self: Get More “Beauty Sleep”

I came across an article on the BBC News Health website that revealed results of a study that found that there may be such a thing as “beauty sleep.”

Below is an excerpt:

The authors wrote in their paper published in the British Medical Journal: “Sleep deprived people are perceived as less attractive, less healthy and more tired compared with when they are well rested.”

They say the results may be useful in a medical setting, helping doctors to pick up signs of ill-health in their patients.”

I am entertained by the suggestion that sleep-deprived people – doctors – are going to pick-up on this.  If being sleep-deprived is a sign of ill-health, I had better switch chairs with my patients.

How to Tell Your Story

Have you ever gone to the doctor’s office and forgotten what you were going to say or felt like you didn’t have the answers to any of the doc’s questions? Have you ever gone in to an appointment thinking, “I have pain and I am sure an MRI will show the cause,” but your doctor seems to insist on asking you a million questions about your symptoms and doesn’t order that MRI you thought you needed?

Believe it or not, even though we are in the age of rapid testing and imaging, the most important part of making a diagnosis is your story about your symptoms. We call this the “history.” Getting a good history is integral to practicing good medicine, particularly in primary care. 

Imagine this. A man is walking down the street and witnesses a mugging. He is standing there watching the whole thing, but is unable to get involved because the perpetrator has a gun. After the incident, he calls the cops. Pretend you are a cop. What would you ask the witness?

“Where did the incident happen?”

“What did the suspect look like?”

“What was he wearing?”

“What time did this occur?”

As a police officer, what would you do if the witness said, “I don’t know” to some answers and, “I think…” to others? It would be hard to put together the story or to feel confident about it, wouldn’t it?

The basic ideas of getting the “Who, What, When, Where, Why, and How” are important to any kind of detective work. As a physician, I am generally supposed to answer the “Why” and “How” parts. The rest is up to you. Not to put pressure on you as a patient, but because I am not going to run every test known to man in order to come up with the diagnosis, I rely on the information you give me to figure out the appropriate next step.

Here’s a tip:

Tell your story your way, but include the important details. How do you know what is important? Well, I will tell you and you will likely see that it makes a lot of sense.

Pain is a great example of a symptom that is best evaluated initially with a certain set of questions, rather than jumping to x-rays or other imaging. Let’s say that, for example, you are seeing your doctor next week for a pain in your foot. Try to remember the following for that visit (write it down if you are worried you might forget):

–          Where exactly in the foot is the pain?

–          What makes the pain worse?

–          What makes it better?

–          When did the pain start? (dates, exact or approximate help)

–          How did it happen? (after a night of dancing in heels, for example)

–          Is the pain sharp (like a knife) or dull (like an ache)?

–          How severe is the pain?

–          Is the pain constant or does it come and go?

–          What have you tried to do for it already? (medications or exercises, changing shoes, etc).

The beauty of going through these questions yourself is that it not only helps me figure out what is going on, it might even help you figure it out before you even need to see me. I am not talking about self-diagnosis, necessarily, but it may help you keep the pain from getting worse or perhaps make you realize that a certain pair of shoes is not right for you. In our busy world, we often forget to pay attention to little details. Trust me, I have seen patients come to me for help and then come up with the answer themselves as they are talking to me because it is the first time they sat down and actually thought it through.

No matter how you describe your symptoms, I am still going to do my best to put it together and come up with an accurate diagnosis with as few unnecessary tests as possible. It is my job, after all. But sometimes, how you tell your story can help me help you better .

(BTW, I’d love to know your thoughts on whether this is helpful or totally obvious.)


A Nation (Young and Old) Addresses Dementia

Here we have a novel approach to the challenges that come with a rising population of the elderly with dementia. This video about South Korea’s “War on Dementia” is incredibly inspiring, though misnamed, in my opinion. It is much less a war and more of an embrace and an understanding that dementia is complex and requires education to address the needs of a vulnerable population.

It will be interesting to see the outcome.