Michael Smith, MD (Host): Welcome to Southwest General Health Talk. I'm Dr. Mike, and with me today is Dr. Rammy Korkor from Southwest General Health Center. Today we're going to be exploring what it truly means to be healthy, and we're going to dive in to all the little nuances of self-care and wellbeing. Dr. Korkor, welcome to the show.

Rammy Korkor, MD: Thanks for having me on Doc.

Host: I wanna start off with relationships. So what role, in your experience, do relationships, family, friends, coworkers, all of that put together, what kind of role does all that play in our overall health and wellbeing?

Rammy Korkor, MD: Absolutely it is a big role, bigger role than we thought. According to the research, it's a very strong correlation between linking sort of your own health, and wellness to the better relationships you have in your family. So small things have been studied even at Harvard University, about staying in touch with old friends or connecting with people outside of just your small circle of family, but with your community. And they have shown benefits across the board for increasing longevity and decreasing illness and living a happier, healthier life. So it's a very important part of the overall picture.

Host: It seems that as we age, those kind of social connections become even more important from what I'm reading and learning?

Rammy Korkor, MD: The stronger relationships are as you age, have been linked to lower stress levels, better mental health. Doing something small like, an act of having lunch with a colleague or a friend or reaching out to an old friend and staying in touch, sharing a meal with a neighbor or a loved one. It has profound health benefits.

Host: Now, you've talked also about spending time in nature, and I love that. What's going on there? Why do you think being outdoors has such an effect on how we feel and our wellbeing?

Rammy Korkor, MD: It's really our true home and it nature just resets us from being in the hustle and bustle of cities and, and the modern day living. There's research showing that lower blood pressure happens when we're around nature. Reduced cortisol levels, which is the stress hormone that causes a lot of anxiety and depression and trauma. It improves mood. Studies have shown being 20 minutes around nature, it goes beyond the data of just like your numbers of your blood pressure and your, but like, if you're spending time in nature, it's going to have a long-term lasting impact according to the research. A walk in the park can sometimes be more powerful than a cholesterol medication in some studies.

Host: That's impressive. And I'm glad you clarified that. So when we say outdoors, I don't have to go and camp for a week straight to be considered outdoors, I can just find a cool little nature trail in my neighborhood, right?

Rammy Korkor, MD: I'm coming to you from northeast Ohio here in the Cleveland suburbs, and we're very lucky. I used to work in downtown Baltimore and I'd ask patients, what does it take to get out and be around nature? And they'd have to explain to me, one taxi to a bus stop and a bus stop to a second bus. Then walk a quarter mile just to get around nature. That's $7 in. Now, most places we're lucky in this country, thanks to Teddy Roosevelt, that we have preserved parks everywhere we go. And so here in northeast Ohio where I think most of the people watching this are from, just in our little area of Brunswick and the Cleveland area, we have these metro parks and Hinkley Hills, and the Cuyahoga State parks that are well known in the hiking communities.

So yeah, being time in nature can be sometimes is just downloading an app called All Trails App and it can show you within a 10 mile radius, five mile radius where all the walking paths in nature can be. So it can be more accessible than people think.

Host: Yeah. No, I love that. I love the idea it could be just a simple walk outside and that can make such an impact. Now movement is a big thing you talk about, you said something once where we want to encourage people to find movement they actually enjoy. Why is that such a key factor, that enjoy part of it?

Rammy Korkor, MD: It is the sustainability part. I mean, it's easy for a young person to have a routine with their uh, studies to have a gym workout and a buddy they work out with. But the moment you start the full-time job, the kids, the responsibilities, the mortgage, the car payments. Like, once you start adding more and more, you've gotta find ways to exercise where it's part of your life and it's enjoyable so that it's sustainable.

So I'll often have patients say that when I ask them about their exercise, they'll say. Well, I do a lot of gardening, but I don't really have a gym membership doc. I know I should do better. I'm like, wait, stop there. Tell me more about your gardening. That can be a great way to get outside in nature, be around nature.

There's been studies where people who do gardening actually just by touching leafy greens of plants, raise serotonin levels in their body, in their bloodstream which is what the mechanism of anti-anxiety pills, anti-depression pills are trying to do also. So, making sure it's sustainable and fun.

Host: I love that idea of doing something that you enjoy and that you can continue to do. You know, a lot of physicians nowadays and other types of healthcare practitioners, they're moving away from the word exercise and they're using, just being active as the replacement. Do you like that, switching that out there?

Rammy Korkor, MD: A hundred percent. Now, technically, if you want to do what's the gold standard studies on preventing heart attacks and dementia and cancer, it's 30 minutes of getting your heart rate up three to four times a week. And you're doing that cardio and some resistance training is good for helping with the muscle breakdown that happens with part of the aging process.

That's true. However, there's a book called The Blue Zones, and it's a bunch of PhDs that looked at who lives the longest. And it was farmers like across the world when they looked at small islands off Japan or Hawaii, didn't matter where they were, it was just the act of getting up to go check on the tomatoes, getting up to go check on the chickens.

Just being active and staying around nature and being active is a good way to preserve and live a nice, long, healthy life.

Host: I think a lot of people are trying to eat healthier. Think people really are trying to make that effort. But it can be difficult. Right. So can you help us kind of build and give us some tips for building a healthier relationship with food and drink?

Rammy Korkor, MD: Right. I talk about this every year with every patient I have. It's usually more than once a year. I encourage patients to focus on addition and not just restriction and adding more colors to their plate. And that's a good way to incorporate more vegetables and fruits and certainly drinking more water.

We have to make sure we're being mindful of wholesome hydration as well. Things like black coffee or tea or water can be helpful to reducing inflammation in the body. But the moment we add sugar to it and artificial sweeteners, we're now corrupting this very healthy thing or electrolytes that are usually unneeded.

And so, that's why some water, coffee, tea, and then more colors on the plate. And then there has to be a slow and gradual waking up process to what it means to eat healthy. I know a lot of my patients that are coming for their college physical year, once a year having breakfast out of a vending machine with Pop-Tarts and they might think that they're doing a healthier thing by now trying to shift towards a protein bar for breakfast.

And so that shows that they have a good wholesome intention. And they have a, they're trying to make steps to eat a more healthy breakfast, but it's still a highly processed packaged food with added sugars and dyes that has a three year shelf life. So I try to encourage them to try to think more creative about incorporating mother nature into their meals.

Something like eggs or oatmeal or some Greek yogurt with some berries on it. That's a better way for mother nature to start our days. And can be just as fiscally responsible and just as quick. So making a slow waking up to what it means to be healthy. It's not overnight, but it is trying to be your own nutritionist and reading more about, what is in the food labels, what do they really mean, and understanding that using resources like Wikipedia and YouTube and free resources where you can get great nutrition counseling for free.

Host: Now if I am doing a better job, I am getting more of my fruits and vegetables, getting more fiber, lean proteins. I'm really trying and doing all that stuff. Boy, I love that one processed sweet thing. Is it okay once in a while to have that?

Rammy Korkor, MD: 100%. There's research to back this up too. So if your standard is eating wholesome and healthy and lean diets like the Mediterranean diet, diets like the Dash diet or the anti-inflammatory diet, those are the three big ones that we've been focusing on a lot in medicine because they're so sustainable and help prevent cancer and autoimmune disease and help prevent heart disease.

But if your baseline is like that and then you go on a trip to the Dominican or a trip to Cancun and you have some fun and splurge on some cheesecake or so, that's not going to affect your health negatively. The problem is if you're not able to sustain healthy diet throughout your normal nine to five and your normal week, then once in a while, eating healthy is not going to correct that. So it goes both directions.

Host: Okay, so I'm going to shift now, because we're talking about just healthy lifestyles, wellness in general here. And there's a lot to talk about. But one thing I wanted to bring up was in today's world, we live in a 24-hour news cycle.

 We are bombarded with constant information. It seems like breaking news is any news now. You talk about wholesome media consumption. What does that mean? What does that look like and how does that overall help me?

Rammy Korkor, MD: According to some recent research, not just in the pediatrics with screen time, but for adults as well; what we consume digitally is just as important as what we consume nutritionally. We're starting to see that more and more with the digital era. And if someone's consistently scrolling through negativity or videos that create this mind process of comparing self to others or just the sensational news as you alluded to; it raises anxiety and it drains energy.

So wholesome media consumption really means being intentional and choosing content that sort of uplifts. Imagine watching a coming of age story and how you would feel after watching that or a romantic comedy around Valentine's Day, like, and you're enjoying that and you feel light and, and then compare that to doom scrolling through media, that's just trying to build negativity and, uh, horror movie you right before you sleep.

What do you think is going to happen to cortisol levels? So just being thoughtful and mindful of consumption of media is very important.

Host: Yeah. I, gotta tell you, I think that's a big one for all of us of all ages today. So I want to talk also about having a consistent rhythm to your daily life. Right? And I guess what I mean by that is a consistent sleep cycle, consistent healthy diet, all that kind of stuff. How does that help if I'm following a consistency with those key things in my life?

Rammy Korkor, MD: Right. Yeah. So consistency is huge. We've looked at studies between the spontaneity that we see in some young people with jobs that work different hours and how they're doing the things at different sleep times, different eat times. Unfortunately, it's not good for us. The answer you expect to be true is actually true.

Just like we evolved to have this circadian rhythm and how our melatonin is secreted by our retina telling us to fall asleep when it's dark. And then to wake up when it's light is exactly what we see. Our bodies love rhythm, regular sleep and wake times regulate hormones. They improve energy levels and they protect our mental health.

That's especially important this day and age. So I often see patients with sleep issues, and they dramatically get better just by having consistent bedtime and a consistent eating time and a consistent routine. So consistency is very important for overall wellness.

Host: And maybe not be looking at your smartphone at 1:00 AM in bed right, with that light just hitting you. Right. That has to cause some problems.

Rammy Korkor, MD: Exactly. Bright light suppresses melatonin from the retina, from secreting that exactly. People take supplemental melatonin just because of the bright screen on their phone

Host: Yeah. Just maybe put it away. I do think experts talk about putting your phone away, TV off, what, a couple hours you, you go to bed, right?

Rammy Korkor, MD: They space it out further every time they look at this. Yeah. So they recommend further and further out.

Host: Lots of people, Dr. Korkor are feeling burnout today. It could be job burnout, it could be relationship burnout, it could be just taking care of a family burnout. Right. If I'm feeling burnout about things, what's one thing that maybe I can do that can help to maybe turn that around, or at least start turning it around?

Rammy Korkor, MD: Exactly, and I'm glad you mentioned that one thing because that's sometimes all it takes is like one small thing every couple of weeks that you incorporate to help mitigate the burnout frequency, and unfortunately, burnout is not just what we read about with doctors. It's hitting every medical field, it's hitting every professional field, lawyers, accountants, we're all feeling it.

So, yeah, it starts with one manageable change. It could be something we talked about of 10 minutes walk in nature. Finding a way to squeeze that into a lunch break or before or after work. Or just like we said before, turning off a screen 30 minutes earlier than usual. Maybe practicing some gratitude meditation.

A study was done in the New England Journal of Medicine where they just encouraged people who are experiencing burnout, they asked them to think of three things to be grateful for right before they sleep and right before they wake up and reflect on that. Simple things like being able to breathe room air and not on oxygen, or being able to walk and not be in a wheelchair or maybe being able to like swallow food and eat food and, not have to be fed through a PEG tube or some kind of supplement. So little things like that. Gratitude, meditations, time in nature. Those little transformations start off as small, but then those little small wins add up and that helps you build momentum.

So I tell patients, don't try to underestimate the power of one little shift to help prevent burnout. It's like slowly over time, you're doing better and better.

Host: I like that one thing and that one thing can make a difference. That's awesome. To wrap up, is there anything else that you would like to tell the listening audience about being healthy and healthy living?

Rammy Korkor, MD: Well, yeah, probably that being healthy isn't just about trying to be perfect. It's about sort of creating a life that supports your physical and emotional and spiritual needs. And so my hope is that people will walk away understanding that health is not just sort of a number on a chart, or on a scale but it's how you feel when you wake up, when you connect with others.

How, when you move through the world, how does your body feel? How does your mind feel? And just being thoughtful and mindful about being kind to each organ. Like we talked about, media consumption being kind to your mind. Each different organ, if I'm going to be kind to my stomach or if I'm going to have that extra spicy snack. Just looking at each organ individually. For your skin, am I well hydrated? For your joints, is my BMI, right? Is for your heart is my blood pressure okay. So just taking inventory of your body, one small step over time adds up and then you end up feeling that you, you don't want to go back to those old days of not feeling as healthy and well.

Host: That's fantastic information. Dr. Korkor, thank you so much for coming on the show today.

Rammy Korkor, MD: Of course. Thanks for having me.

Host: That was Dr. Rammy Korkor, an internal medicine physician with Southwest General Health Center. To request an appointment with Dr. Korkor, you can visit swgeneral.com. That's swgeneral.com. If you found this episode helpful, consider sharing it on your social channels and explore our full podcast library for topics of interest to you. This has been Southwest General Health Talk.

I'm Dr. Mike. Thanks for listening.