PlayPlay Podcast downloadDownload Podcast Take Post TestTake Post Test

Transcription:

Melanie Cole (Host): Healthcare providers are taught about how to treat illness, but not necessarily taught to effectively help patients and themselves to prevent and reverse chronic disease through lifestyle. Welcome to UAB Med Cast. I'm Melanie Cole and today we're discussing lifestyle medicine for women. Joining me is Dr. Ksenia Blinnikova. She's an Assistant Professor and a Family Medicine Physician at UAB Medicine. Dr. Blinnikova, I love this topic. Welcome. I'm so glad you could join us. So, as we get going, tell us a little bit about how disease relates to unhealthy behaviors for other providers. Kind of give us a little bit of a summary of why we're talking about lifestyle medicine and specifically lifestyle medicine for women today.

Ksenia Blinnikova, MD (Guest): Thank you, Melanie. I'm very excited to be here today and speak on this very important topic. Lifestyle medicine is a foundation of conventional medicine and unfortunately it has not been utilized as much as it should. It, ideally, this should be integrated in the daily practice. There are no contraindications to it. One of the most important vital signs, we usually think about blood pressure or heart rate, oxygen saturations, but exercise and diet should be also integrated into the vital signs checkup for any patient that comes through our doors. And this is something that we need to counsel our patients on, on a daily basis, diet, exercise, stress levels, sleep, alcohol and tobacco use, should be ideally assessed at average visit. Smart S-M-A-R-T or specific measurable attainable timely recommendations should be provided based on those assessments that we do.

It's not a secret that about 80% or more of healthcare spendings in the United States are tied to the treatment of the conditions that are preventable. To name a few, hypertension, diabetes type two, heart disease, obesity are all preventable and are related to unhealthier lifestyle choices.

Host: Well, that's certainly true and the American College of Sports Medicine said years ago, exercise is medicine and should be considered a vital sign and discussed with doctors at every visit. So, tell us a little bit about how it's typically practiced now. Do you feel that it's being used in the mainstream? Have you noticed healthcare providers asking about these types of lifestyles and behaviors?

Dr. Blinnikova: I do notice that in our clinic, we try to emphasize lifestyle changes more and more. We did integrate exercise into the questionnaire for vital signs and once provider goes into the room and reviews the vital signs section, there will be the exercise, and right away, provider can counsel patient on that particular vital sign.

Dieticians, a nutritionist, behavioral specialists are more and more integrated into their practices. And, that goes again to a more comprehensive approach to a person not trying to treat disease as a separate condition, but, comprehensively evaluating person and treating them as a whole.

Host: Such an important aspect of what we're talking about here today. So, why is lifestyle medicine essential, as we're saying to sustainable health and to the healthcare industry in general?

Dr. Blinnikova: I was listening to one of the lectures not that long ago. And they had a wonderful site by Michelle Obama who said communities and countries and ultimately the whole world are only as strong as the health of their women. It is really important to keep that in mind that we are providing advice and consult patients on healthy lifestyles. Food and nutrition is a very important component of the lifestyle medicine. We are all aware about our recommendations to eat five servings of fruits and vegetables a day. And, recently some authors were recommending to go up to 10 servings of fruits and vegetables a day, but our patients might not know that.

So it's a really important to get that information to them. Vegetables, green leafy vegetables, berries they all show to you decrease the rates of cardiovascular disease, certain cancers, walnuts, for example, have there a strong association with healthy aging, healthy fats, such as monosaturated and polysaturated fats are an important component of everyday diet.

And for women, for example, we do not recommend to go below 20% of fat intake per day. Fish has good amount of Omega three fatty acids though for pregnant women, we should keep in mind that mercury and other toxins can be found in fish and a good resource that I recommend my patients to check on that is Monterey Bay Aquarium Seafood Watch tool. I can continue with some other recommendations if that's okay.

Host: Well, I would like you to stay on the nutrition aspect of this and we'll get into the exercise and even the toxins, but let's stick with the nutrition right now because food is also medicine and can harm or help. Right? Why don't you speak about protein, fiber and even supplements because you've got some good guidelines and recommendations for amounts for providers to be recommending and counseling their patients.

Dr. Blinnikova: Absolutely. I'll be happy to do that. For protein, you may want to recommend women to average around 0.8 grams per kilogram of protein per day. It should be increased to one gram per kilogram per day for vegetarians and you can go ahead and add 25 grams per day for lactating and pregnant woman. Fiber is essential for gut health and immune function. Adequate consumption of fiber, benefits stool consistency, constipation. It can help lower cholesterol, decrease risk of diabetes, even decrease risk of colon cancer. For women the average dietary intake is recommended to be 25 grams per day of fiber.

We do see a lot of patients who have low vitamin D levels and vitamin D levels below 20 nanograms per milliliter are sub optimal for skeletal health, which we all know is very important for women. Vitamin D can be found in foods like high fat fish, such as salmon, fortified meals and cereals. Because very few foods contain vitamin D it's usually added to table foods. Sunlight is another source of vitamin D. But usually, adequate levels of vitamin D are synthesized only when large body areas, such as face, arms, back, legs, chest are exposed to the sun between 10:00 AM and 3:00 PM without any sunscreen for at least five to 30 minutes, at least two days a week.

So, that's a lot of sun exposure and on average, we don't really get outside much during that time. So, that might be one of the reasons why vitamin D levels tend to be a little bit lower those days in a lot of patients. A 600 to 800 units of vitamin D2 or D3 daily is usually sufficient dose to maintain normal vitamin D levels. But if vitamin D levels are lower than 20 then, it should be supplemented with a higher dose of vitamin D. Another important element especially for women is iron, because women can get depleted during the heavy menstrual bleeding, irregular menstrual cycles. Ferritin level below 15 nanograms per milliliter is 99% specific for making diagnosis of iron deficiency. So it can be checked along with the routine blood work, CBC and if, H and H is lower and MCV value is low, definitely go ahead and check ferritin levels. If supplements are required to treat iron deficiency, then this can be taken every other day. So, patients have to be consulted on some side effects. The most common of which is constipation. And other important thing is absorption of iron. There are certain foods that improve absorption of iron, such as vitamin C rich foods. On the other hand, tea and coffee will decrease absorption of iron. Animal iron is more readily absorbed and can be found in chicken and beef liver. Plant sources can be spinach, almonds, beans, peas, and peaches.

Host: What a comprehensive list this was. Do you feel that providers should be checking things like vitamin D because not all of them do in those well-visits.

Dr. Blinnikova: I would recommend checking vitamin D levels in most of the patients. A lot of times people will feel fatigued and the reason for that can be a low vitamin D and with good supplementation of vitamin D, the energy level will improve. And, again, it's very important for skeletal health.

Host: Well, it's true. And not all providers, I mean, I know that at my well visits, I have to ask them to please check my vitamin D levels. As I'm sitting behind a microphone all day. As we get ready to wrap up, Dr. Blinnikova, tell us your vision for lifestyle medicine. For other providers, you are giving them your expertise on how they can bring these kinds of initiatives into their own practice, how they can take this and be good role models, practice what they preach, but also how they can counsel their patients on these lifestyle behaviors that can hopefully prevent illness and at least really help with energy levels and all of it put together as a whole body.

So, please tell other providers what you'd like them to know about incorporating lifestyle medicine into their practice.

Dr. Blinnikova: I feel a lot of times we ask questions, but we do not take the next step of addressing certain issues. We, in primary care, we all, I'm pretty sure talk about diet, exercise, stress, anxiety, sleep, alcohol and tobacco consumption. Those are even in the social history, which is obtained on every visit. But it's important to take the next step and if you see something that can be improved or changed, or if a patient needs help with addressing certain issues, that's where our role is the most important. Again, specific, measurable, attainable, timely, recommendations should be given. And the patient might not be ready to make a lot of changes.

So maybe addressing diet on one visit then reevaluating on the next visit, addressing exercise on the third visit, re-evaluating diet and exercise on the fourth visit and so on and so forth. There are a lot of resources available for you, the providers with nutritionists, dieticians, psychologists, behavioral health providers that can assist with evaluating and addressing certain issues that patients may have. So, I would recommend to utilize those too. There a lifestyle medicine specialists, for example, in our clinic, we have Dr. Faben who is lifestyle medicine specialist, and a lot of times, we can refer to her for additional testing, evaluation and help with certain conditions.

Host: Such a great topic and so important for providers to hear so they can incorporate these practices into their own patient group. It's just such an important topic. And thank you so much for joining us today. And a physician can refer a patient to UAB Medicine by calling the mist line at 1-800-UAB-MIST or by visiting our website at uabmedicine.org/physician.

That concludes this episode of UAB Med Cast. I'm Melanie Cole.