Dr. Poonam Singh, MD

Dr. Amar Singh, MD

Harbin Clinic

Amar Singh, MD and Poonam Singh, MD 2/3/21 Amar Singh, MD and Poonam Singh, MD 2/3/21

How To Curb Sugar Craving

Do you have a sweet tooth? Most of us will overindulge at times. But the more sugar we consume, the more we want. If you crave sugary foods, you're not alone. Studies estimate that up to 90% of the adult population may experience food cravings. These cravings are often for sugary foods. Desire to improve mood drives cravings for carbohydrates and other sugary foods since consuming sweet treats increases serotonin levels in your brain. Many of us turn to sugar when we are happy and when we are sad or stressed. It is a ‘crutch’ for many.

Sugar is one of the most over-consumed substances in the standard American diet. According to the American Heart Association, American adults consume an average of 77 grams of sugar per day, more than three times the recommended amount for women. That is up to 60 pounds of added sugar annually. The numbers are even worse for American children who consume 81 grams per day, equaling over 65 pounds of added sugar per year. Children are drinking over 30 gallons of added sugars from beverages alone. The American Heart Association’s sugar intake recommendations: men should consume no more than nine teaspoons (36 grams or 150 calories) of added sugar per day and women six teaspoons (25 grams or 100 calories) per day. To put that in perspective, one 12-ounce can of soda contains eight teaspoons (32 grams) of added sugar! Sugar cravings are a formidable opponent to anyone trying to stay on a nutritious path.

The first step in controlling the sugar cravings is figuring out why you have the cravings. Craving and hunger are not the same. Hunger is your body calling for energy, while craving is your brain calling for something that releases a lot of dopamine in the reward system. When you get a craving while you’re hungry, the feeling is difficult to resist.

Insulin signals fat cells to accumulate fat while telling the other cells in our body to burn carbohydrates for fuel. That is why these carbohydrates are uniquely fattening. Since insulin levels after meals are determined largely by the carbohydrates we eat — particularly easily digestible grains and starches, known as high glycemic index carbohydrates, as well as sugars like sucrose and high-fructose corn syrup — diets based on this approach (Glycemic Index Diet) specifically target these carbohydrates. This effect of insulin on fat and carbohydrate metabolism offers an explanation for why these same carbohydrates are typically the foods we crave most.

Here are a few things to consider to overcome this challenge.

Eat a Healthy and Filling Meal

When you experience a craving and hunger simultaneously, have a healthy meal rather than junk food. Eat whole food. Simply put, whole foods are foods that are either not processed at all, or processed minimally. Examples include whole grains, legumes, fresh fruits, and vegetables. Think foods that don't need labels listing countless different unpronounceable ingredients.

Evaluate Your Protein Intake

The initial rush of sugar is quickly followed by a crash, resulting in low energy levels and poor mood. This cycle of highs and lows puts your health at risk. Protein-rich foods, such as beans, nuts, eggs, quinoa, broccoli, and pastured meat, provide a more balanced and steady energy source. You will feel more satisfied, reducing the effects of brain chemicals that cause you to seek food, even when you're not hungry. Sometimes the right way to kick your sugar cravings to the curb is to eat more protein. Protein reduces the speed with which your body processes sugars and helps you need lower amounts to experience that reward. So, get protein in to quench that yearn for sugar.

Avoid Nonnutritive Sweeteners

Replacing sugar with low- or no-calorie sweeteners can help cut calories, but the jury is out regarding the safety of regularly consuming these artificial sweeteners. Weight control is much more complex than the, now debunked, notion of eating fewer calories and spending more to achieve a negative caloric balance. Weight gain happens with artificial sweeteners, despite the reduced calorie count. Artificial sweeteners may encourage eating behaviors that increase cravings for sweets and food in general. They can affect the gut microbiome, which triggers inflammation. Inflammation is the mother of all health problems.

Studies of artificial sweeteners are mixed, indicating that people eat fewer calories and lose weight or maintain a stable weight. However, in several studies, artificial sweeteners were associated with weight gain, which might increase the risk of developing insulin resistance—a condition in which body cells do not respond properly to insulin and thus cannot easily absorb glucose from the blood-stream.

To get a better idea of how artificial sweeteners affect a person's metabolism, researchers have conducted studies in which people drink artificially sweetened beverages and then undergo a glucose tolerance test to measure how efficiently the body uses sugar. Two recent studies have found that beverages containing sucralose (Splenda) and acesulfame potassium (Sunett, Sweet One) increased insulin levels, while drinking water didn't. Neither study lasted long enough to determine whether drinking artificially sweetened beverages would eventually result in weight gain or insulin resistance. But the results suggest that artificial sweeteners may have some of the same adverse effects on insulin and weight as sugar does. It will be some time before the full impact of sucralose, acesulfame potassium, and other sugar substitutes are identified. In the meantime, it's a good idea to limit your use of them, just as you would natural sugar, and to rely on fresh fruit to satisfy your sweet tooth. Artificial sweeteners might momentarily satisfy that sweet craving, but they trick your body into thinking it’s getting fuel when it’s not. Your body soon goes looking for more calories in the form of, you guessed it, sugar, and you’re right back where you started.

Drink Water: Hydrate Yourself

It is common to mistake thirst for sugar cravings. We know that we want something fresh and cold, and we usually identify that with sugary drinks. When our bodies have a deficiency in fluids, they can’t efficiently breakdown glycogen, which causes the urge to consume something sugary. Drink water and observe how you feel before you reach for sugar.

Sports drinks can often be mistaken as a healthy choice for those who exercise. However, sports drinks are designed to hydrate and fuel trained athletes during prolonged, intense periods of exercise. For this reason, they contain high amounts of added sugars that can be quickly absorbed and used for energy. A standard 20-ounce (591-mL) bottle of a sports drink will contain 37.9 grams of added sugar and 198 calories. This is equivalent to 9.5 teaspoons of sugar. Sports drinks are therefore categorized as sugary drinks. Like soda and fruit juice, they’ve also been linked to obesity and metabolic disease. Unless you’re a marathon runner or elite athlete, you should probably just stick to water while exercising. It’s by far the best choice for most of us.

Vitaminwater is marketed as a healthy drink that contains added vitamins and minerals. However, like many other “health drinks,” Vitaminwater comes with a large amount of added sugar. In fact, a bottle of regular Vitaminwater typically contains around 100 calories and 30 grams of sugar. As such, despite all the health claims, it’s wise to avoid Vitaminwater as much as possible.

Rethink Social Habits That Drive You Towards Sugar

Many of us have social rituals during our day that help us de-stress amidst countless tasks and meetings. Suppose you have a standing tradition with a friend or coworker to eat a cookie after lunch every day or run to the corner coffee shop to get a sugary, caffeinated iced drink. In that case, rethink those social behaviors. Try to put something else in place that is healthy but rewarding. Cookies and cupcakes are tempting, but avoid consuming sweet at every celebratory event.

Try to Decrease Your Sugar Intake Gradually

Sugar fuels every cell in the brain. Our bodies view sugar as a reward. But too much of a good thing is never good. Overindulgence in sugar consumption reinforces your body’s need for that reward, essentially becoming addicted to it. But like many addictions, it is not a reasonable or sustainable strategy to quit cold turkey. If you feel as though you are out of control or moody without your first soft drink of the day or until you have a piece of chocolate, you need to consider slowly weaning your system off sugar. It’s those small, consistent changes you make in your daily diet that will work the best. Avoid processed food and sugar-sweetened beverages. The common culprits are breakfast cereals, flavored yogurt, and sauces. Ketchup is 25% sugar by volume. Per tablespoon, ketchup contains 4 grams of sugar and 190 milligrams of sodium. Although 4 grams of sugar doesn't seem like a lot, much of it comes from added sugar instead of natural sugar. The breakfast cereal aisle at the grocery store is loaded with colorful boxes featuring cute characters to attract kids. They are also tagged with claims such as "whole grains" or "reduced sugar" to reassure adults. Many of them are still just puffed candy in a box, with a few vitamins added to make them seem healthful. It isn’t very clear. Even cereals that promote themselves as part of a healthy breakfast can be made up of more than 50% sugar by weight. Sugary breakfast cereals can lead to an inevitable sugar rush and slump, which will increase your sugar craving for the rest of the day. Avoid cereals with more than 10 grams of sugar per serving and choose one with as much fiber as possible to stick with a healthy lifestyle. Research has shown that a diet with reduced sugar and increased fiber can lead to weight loss and improved insulin function. Watch your serving size. A serving ranges from 3/4 to 1 cup of cereal. Using bigger bowl results in eating more, as does eating a calorie-dense cereal such as granola. And replacing sugar with artificial sweeteners is like jumping from the frying pan to fire. They adversely affect our body, albeit without calories, just like simple sugars do.

Pick the Right Fruit

There will be times when your sugar craving will be exacerbated by the stress of the day or however many days you’ve gone without consuming it. You may feel like you can have a cheat day. Your best response to a worsening need for sugar is to eat a piece of fruit. If you get to a point where you feel frustrated, instead of eating processed sugar, eat fruit. Fruits are sweet and have natural sugar that can address your sweet tooth without throwing out your entire effort. Whole fruits are better than fruit juices as many of them are devoid of fiber and artificially sweetened. Most whole fruits, with the exception of tropical varieties, are slow-digesting because the sugars are sequestered in the cellular structure of the fruit and it takes time to leach out. It’s very different from juice or soda, where sugars slam into your body, overwhelming the liver and raising insulin too much. Fast-digesting carbs, like potatoes, white bread, and other refined carbohydrates, as well as grapes, papaya, and mango, all have a higher impact on blood sugar, but they still do not pack the same punch as soda and juice.

All fruits contain natural sugars. However, some canned fruits are peeled and preserved in sugary syrup. This processing strips the fruits of their fiber and adds a lot of unnecessary sugar to what should be a healthy snack. The canning process can also destroy heat-sensitive vitamin C, although most other nutrients are well preserved. Whole, fresh fruit is best. If you want to eat canned fruit, look for one that’s been preserved in juice rather than syrup. Juice has a slightly lower amount of sugar.

Cut Back Consumption of Starch

Starches like white rice, white bread, and pasta are complex carbs that the body process as simple carbs. They end up affecting the sugar levels in your body and feeding into your need for sugar as fuel for brain activity and energy. If you have cut out processed sugars but continue to eat an abundance of starches, then your next step is to reduce your consumption of those foods progressively and clean your system of the need for sugars.

Fiber Is Your Friend

Fiber helps clean out your system, and it is processed more slowly by the body. Fiber helps you feel fuller for longer, effectively reducing your craving for mid-meal snacks. Many people will be very deliberate about reducing sugar in their meals but will ultimately cave in when their body needs a snack because many of the snacks we have in our pantry have sugar in them. Fiber and lots of water would help you stay full for more extended periods.

Eat Sour of Fermented Food

Eating foods that are sour and bitter helps to counteract sweet cravings. Daily lemon infused water is beneficial. Fermented food is sour, helping to curve cravings while offering your body additional probiotic support. Be sure to check the nutritional information to ensure there aren't hidden sugars lurking in your bottle of choice.

Avoid Too Much Salt

Eating lots of salty foods can bring on sugar cravings. Salt is useful for seasoning but you should avoid super salty foods. They can trigger a craving for sweet foods, often why dinners out often lead to head straight to the dessert menu. Season food with other spices first before heading to the salt. When you dine out or eat packaged, processed foods, your food has more sodium in it than you probably even realize. This usually remains true even when you’re eating something clean like grilled salmon and sautéed or steamed spinach from your fave “healthy” restaurant. Here’s the kicker: the saltier your food, the bigger your sweet craving. To help avoid sugar crashes and cravings, add spices like cinnamon or clove to your meals and snacks. Try banana, peanut butter, cinnamon on toast, vegetable curry with Indian spices, and baked pear with cinnamon and nutmeg.

85/15

Make sure 85 percent of your meals include innately healthy foods like fresh produce, lean protein, and healthy fats. The other 15 percent can consist of some treats. If you make certain foods forbidden, then you crave them even more. A little treat here and there never hurts.

Go for a brisk walk

Going for a brisk walk or running may help reduce cravings. If you are a runner, running will be even better. It will distance you from the food you are craving and release endorphins, or “feel-good” chemicals in your brain, which can help turn the craving off. If you can’t go outside, do a few exhausting sets of body-weight exercises.

Chocolate, Magnesium, Chromium, and Zinc

Craving chocolate is more common among people deficient in the mineral magnesium (ask your doctor to check your levels). Head off cravings by eating plenty of magnesium-rich food like dark leafy greens, tofu, legumes, and nuts. Increase nutrient-dense foods rich in magnesium, chromium, and zinc may help improve your cells' sensitivity to insulin to maximize the amount of sugar your body can metabolize and burn.

Foods high in magnesium are green leafy vegetables, fruit, nuts and seeds, legumes, vegetables, seafood, whole grains, raw cacao, dark chocolate, tofu, chlorella powder.

Foods high in chromium are broccoli, whole grains, wheat germ, brewer's yeast, bran cereal, orange juice, romaine lettuce, raw onions, potatoes, green beans, bananas, apples, raw tomatoes, black pepper, grape juice.

Foods high in zinc are oysters, beef, lamb, spinach, pumpkin seeds, nuts, dark chocolate, pork, chicken, beans, mushrooms.

De-stress

High stress and cortisol levels can also lead to sugar cravings. Try 10 minutes of meditation or deep breathing, go for a walk with a friend or family member, take a hot bath, drink herbal tea, and don't forget to exercise. Combat stress and emotions by exercising regularly. Not only will the exercise improve focus, but it will also boost your energy, which is a significant factor why people look to sugar in the first place.

Spot the Hidden Sugar(s)

Sugar is everywhere. And I am not talking about the obvious ice cream, Frappuccino, and cakes. Refined sugar is in yogurt and ketchup, dressings, and bread. It’s even added in canned beans and applesauce. That’s why learning how to check labels is so important. To keep sugar away from your plate, you need to be well aware of the numerous way sugar hides in our food, with all sorts of different names and shapes (including those artificial sugars like sucralose, saccharin, and aspartame).

Here are the most common processed foods containing refined sugar:

Baked Goods (cookies, cakes, muffins, bars)

Breakfast Cereals (such as granola, corn flakes, rice crisps)

Canned Fruit

Canned Soups and Tomatoes

Condiments (such as dressings, sauces, salsas),

Chocolate Bars (unless they’re above 95%)

Gums and Candies

Yogurts and Ice Creams (not just regular but also plant-based products)

Sweetened Drinks (such as sodas, fruit juices, coffee-based drinks, plant-based milk)

The nutrition facts label is required to inform you how much sugar is in a food. However, the label does not separate the amounts of naturally occurring sugar from added sugar. Sugar is found naturally in many nutritious foods, such as fruits and vegetables. But, you have to be a bit savvier with locating foods that contain added sugar. There are more than 60 names for added sugar.

To identify added sugars, look at the ingredients list. Some major clues that an ingredient is an added sugar include:

it has syrup (examples: corn syrup, rice syrup)

the word ends in “ose” (examples: fructose, sucrose, maltose, dextrose)

“sugar” is in the name (examples: raw sugar, cane sugar, brown sugar, confectionary sugar)

Other examples of added sugar include fruit nectars, concentrates of juices, honey, agave, and molasses.

QUICK FIXES That Will Soothe Your Cravings

Nibble on some frozen fruit: blueberries, grapes. Bananas are the best to blend and quickly whip up a ‘banana ice cream.’
Mix some mashed oven-baked yam or sweet potatoes with pumpkin pie spice. They are deliciously sweet and filling!
Stuff a date or a dried apricot with a piece of 90% dark chocolate and a couple of cashew nuts. It’s so satisfying you will be delighted with it.
Slice a piece of fruit (like peach, apple, or pear) and spread with some almond or hazelnut butter. Sweet, healthy, and extremely tasty!
Combine some unsweetened coconut yogurt with some chopped strawberries and puffed millet, and you have a delicious (and quick) sugar-free dessert bowl ready in seconds.
Healthy Snack Suggestion: Do-It-Yourself Trail Mix

Ingredients

1 cup wheat cereal
1/4 cup dried fruit: raisins, blueberries, cranberries, chopped apricots, plums, or peaches, or a mixture
1/4 cup cashews (1 ounce)

Directions

Mix ingredients, split into two servings and store in sandwich-sized plastic bags. Each serving contains about 192 calories, 5 g protein, 9 g fat, 28 g carbohydrates, 3 g fiber, and 115 mg sodium.

Take A Hot Bath or Shower

Anecdotal reports suggest that hot showers or baths for 5-10 minutes may be effective at stopping cravings. It can be invigorating anyway.

Get Your Mouth Busy

Another great way to stave off sugar cravings is to give your mouth another distraction. Whether it's chewing sugar-free gum, drinking a cup of warm herbal tea, or just doing something else, allow the craving to pass. Allow enough time to pass while you drink or wait for the piping hot tea for you to think through the craving: most cravings 30 minutes or less.

Sleep Well

Getting adequate amounts of sleep optimizes energy levels, reduces appetite, and slashes sugar cravings. When you are tired, ghrelin, the hunger hormone, increases, and leptin, the satiety hormone, decreases, leading to a craving for something sugary to give you a quick energy fix.

Create a Backup Plan

If sugar cravings feel uncontrollable, think proactively about what kind of distraction will help you overcome them. Eat a piece of fruit. Go for a walk. Listen to some music. Call or text a friend. Read a fun article. Knowing what we are going to do ahead of time is what makes all the difference.

Talk Therapy and Medication

As a last resort, psychotherapy and medications help curb sugar cravings if all else fails.

Food cravings can feel overwhelming and out of your control. But you’re not in this alone. Conquering your cravings will take time, so don’t hesitate to reach out to an obesity medicine specialist for help and to enlist your friends and family for support.

References

https://www.mdpi.com/600900

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119278

https://pubmed.ncbi.nlm.nih.gov/11237349/

https://www.bmj.com/content/345/bmj.e4737

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515645/

Published 5/31/2020

Updated 2/4/2021

About Us

Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone re-balancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP, for their excellence and contributions to medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients. Their mission is to share simple, effective, and proven strategies that lead to meaningful, sustainable, and long-lasting well-being.

Amar Singh, MD and Poonam Singh, MD 1/25/21 Amar Singh, MD and Poonam Singh, MD 1/25/21

How To Stop Unconscious Overeating?

Have you ever popped a bowl of popcorn, flop down in front of the television, and…poof! Next thing you know, you’re scraping the bottom? Or have you grabbed a bag of cookies, hit play on your tablet streaming your favorite program, commence munching….and munching….and munching. Eventually, come to your senses, realize that you’re left holding a bag of crumbs? Maybe it starts by grabbing a late-night snack, hitting the vending machine at work, or just grazing when you’re bored.

Sounds familiar?

Mindless eating is when we eat with little to no awareness around our food or how full we feel.

On average, you make more than 200 decisions about food each day — but you’re only aware of a small fraction of them. The rest are performed by your unconscious mind and can lead to mindless eating, which may cause you to overeat, promoting weight gain. And usually, it’s followed by a flood of negative emotions, like regret and disappointment, which can stir up some pretty terrible self-talk, like:

Why do I keep doing this?

Why can’t I stop?

I can’t stop myself. Or

I feel like I have zero control.

While most people don't binge with the same abandon, even occasional bouts of unconscious overeating -- also called "eating amnesia" -- can lead to poor nutritional habits and undesirable weight gain. But many people enter the eating amnesia zone without even realizing it. Everyone eats this way to some degree, whether they're snacking in the car, cleaning the crumbs off their kids' plates, or at a cocktail party standing next to the buffet table with their hand stuck in the bowl of nuts. Any time that food is present, and it's not a sit down eating event, there is a tendency for this kind of hand-to-mouth eating without sensing that you're full -- or were even hungry, to begin with.

Here are twenty-one science-backed tips to stop mindless eating.

Be Attentive - Unplug

Eating without using your TV, computer, or smartphone may help decrease the amount of food your body needs to feel full and satisfied. It’s hard to pay attention to our food when the kids are bouncing off the wall, the TV is blaring, or our phones won’t stop vibrating. Additionally, our minds are racing with tonight’s plans, what happened at work, and worries about school or family. Simply put, we are buzzing with dozens of thoughts at any given moment. Everything around us is competing for time and attention, and stopping to focus on what and how much we eat gets moved to the back burner.

If you eat while you work or read or watch TV, or do anything in addition to eating, you’re going to eat more. Studies show that people who dine while engaged in social interactions, television shows, or mental tasks eat more than those without distractions. In one study in Paris, forty-one mostly healthy-weight women had lunch in the laboratory under one of four conditions: alone, with a group, while focusing on the food, or while listening to a detective story. When the detective story accompanied the meal, the women took in an average of about 72 more calories than during the silent lunch.

Indeed, distractions don't work the same way for everyone. Much depends on a person's relationship with food. People who generally keep a tight rein on their eating habits, called "restrained eaters" by researchers, are far more likely to overindulge when distracted than "unrestrained eaters."

Sixty female students at Swarthmore College (half identified as restrained eaters; the other half as unrestrained eaters) participated in a UCLA study in which they snacked on M&Ms, nacho chips, and cookies while trying to remember a series of slides. The "restrained" group ate much more during the memory task than when there was no task, but the "unrestrained" eaters ate less when engaged in the task -- apparently because they were busy trying to concentrate.

Eating while you’re distracted can lead you to eat faster, feel less full, and mindlessly eat more. Whether this is watching TV, listening to the radio, or playing a computer game, the type of distraction doesn’t seem to matter much. For instance, people watching television while eating their meals ate 36% more pizza and 71% more macaroni and cheese. Moreover, the longer the show, the more food you’re likely to eat. One study noted that participants watching a 60-minute show ate 28% more popcorn than those enjoying a 30-minute show. However, this effect seems to apply both to nutritious foods and junk foods since participants watching the longer show also ate 11% more carrots. Longer distractions extend the amount of time spent eating, making you more likely to overeat. Besides, eating while distracted may cause you to forget how much you’ve consumed, leading to overeating later in the day.

Indeed, another study observed that participants who played a computer game while eating lunch felt less full and snacked on nearly twice as many biscuits 30 minutes later than their non-distracted counterparts.

By putting your phone away, switching off the TV, and focussing instead on the textures and flavors of your food, you’ll quickly stop eating mindlessly and can instead mindfully enjoy your meal. Smell the roses. Live in the moment. Taste your food.

Make It Difficult

Mindless munching is often a result of easy snack access. To slow yourself down, put in some interruption that can make you think twice about how much you want to snack. If there’s a bowl of candy sitting at your desk, you don’t think twice. It’s there. But if you put barriers in your way, it’ll test how much you want this. There’s proof in the pudding. In a candy dish study, office workers ate 125 calories less when the dish was just 6 feet away from them than when the dish was at arm’s distance. Those seemingly trivial 125 extra calories can add up to a whopping 11 lbs in just one year.

Smaller Portions

The portion sizes of today's foods contribute to unconscious overeating. From 1977 to 1996, average portions of salty snacks, soft drinks, desserts, and fast foods in American increased by about 31% -- equaling about 78 extra calories per snack. And unfortunately, the more food you have in front of you, the more you're likely to eat. In a Penn State study, 51 men and women were treated to once-a-week laboratory lunches of macaroni and cheese in portions varying from 2.5 cups to 5 cups. No matter how much they ate when offered the smallest portion, the participants ate an average of 30% more (162 calories) when offered the largest portion. Most of them were pretty unaware that the portions had changed. Their hunger and fullness were about the same, regardless of the portion size and how much they ate.

Another study by the Penn State researchers looked at whether people compensate for overindulging one day by eating less the next day. For two days in a row, each participant received the same daily allotment of calories, in portions that ranged from 100% to 200% of the recommended daily caloric intake. Even when the participants had eaten several hundred extra calories on the first day, they ate just as much the second day. When the portions were doubled, the women took in 500 calories more per day and 800 calories more. So in two days, the women were accumulating 1,000 extra calories and the men 1,600.

Amar Singh, MD and Poonam Singh, MD Rome, GA

Knowing When You're Full

What causes satiation? Most people would say they stop eating when they feel full. They feel full because their stomach is stretched. But one doesn't eat the same volume at every meal, so there has to be more to it than stomach distention. Hunger and fullness are complex mechanisms that operate differently depending on the situation and the person. Indeed, while some people happily wolf down an extra-large pizza and a liter of soda at a sitting, others declare themselves stuffed after a small soup and salad.

Even when people reach the point where they feel full, they don't always stop eating. If the environment is conducive to munching, as, at a party, it's easy to get carried away. And salty snacks, fatty foods, and sweets can often prompt people to keep eating long past their stomach's usual stopping point.

Sometimes you get bored of one food, but you still have just as high an appetite, or even higher, for another food. So while you can easily turn down an extra serving of carrots, you still clamor for that slice of carrot cake.

Food Is For Nutrition

Mindless munching is also a way of coping with feelings of anxiety and unhappiness. While indulging in an occasional "comfort food" at the end of a lousy day does little harm, frequently using food to escape from negative emotions may lead to more significant problems. Food does not solve problems. It usually sets you up for other bad feelings. After you eat that pint of your favorite ice cream, you'll still have the same emotional issues, and now you also have to cope with the guilt of overeating ice cream.

If you find yourself regularly using food to soothe your emotions, we recommend trying to work out your feelings in other ways, such as with exercise or relaxation techniques. But if you find you still can't control your eating, and it's controlling you instead, you should seek out professional help. The two questions which can help one change the way they think about emotional and mindless eating:

Am I using this food, or am I eating this food?

What’s bothering me? What am I hungry for?

Increase Your Eating Awareness

For milder forms of mindless munching, here are some do's and don'ts to follow.

DON'T:

Eat standing up, on the run, in the car, at the computer, or in front of the TV.
Deny yourself occasional treats. This just sets you up for failure.
Deprive yourself of food if you're hungry.
Use food to cope with stress or depression.
Get discouraged if you overeat -- you'll do better next time.

DO:

Eat sitting down and relaxed, in the place where you usually have your meals.
Stock your kitchen with healthy foods such as fruit, veggies, and low-fat yogurt.
Buy individual serving-size packages of snack foods so that you won't overindulge.
Put only a small serving on your plate at the start of your meals, and wait before you take seconds.
Put aside extra restaurant food at the beginning of your meal, or wrap it up to take home.
Soothe emotional upsets with exercise, a comforting bath, or a chat with a friend.
Keep a journal in which you write down the foods you eat and your feelings about your diet.

Changing a longstanding TV and cookie-chomping routine may be difficult at first, but it can be done. It just takes perseverance and willpower.

Don’t Bury The Evidence.

Use visual reminders of the foods and drinks you consume to help you stay mindful of how much you’ve already consumed. Behavioral scientists believe one of the main reasons people overeat is because they rely on external rather than internal cues to decide whether they feel hungry or full. Naturally, this can lead you to eat more than you need to. To demonstrate this point, researchers provided participants with an unlimited amount of chicken wings while watching a long, televised sporting event. Half of the tables were continuously cleaned, while the bones were left to accumulate on other tables. People with bones on their tables ate 34% less, or two fewer chicken wings, than people who had their tables cleaned. This can apply to any food that leaves evidence. You can do the same with wine. Serve new glasses of wine, and be sure to leave the old glasses out and the bottles too! Some people like to stuff their empty bags of chips and candy wrappers into the very bottom of the trash in an attempt to forget that they ate them at all. Don’t hide the wrappers! Leaving the candy wrappers on your desk at work or the chicken bones on your plate during the football game is an excellent way to remind yourself to slow down. When you’re partying with other people and having fun, it’s often easy to forget how much a person has drunk, whether it’s beer or soda. An easy way to keep track of things is to put the bottle-top in your pocket. That way, once you feel them, it’ll remind you how many you’ve had that night. It’s an easy way to keep track of something that it’s easy to lose track of.

Another experiment used bottomless bowls to refill some participants’ soups as they ate slowly. Those who ate from bottomless bowls consumed 73% more — amounting to roughly 113 extra calories — than those who ate from standard bowls. Yet, those who ate more soup didn’t feel fuller. Most also estimated their calorie intake to be the same as those dining from the regular soup bowls. These two studies show that people tend to rely on visual cues, such as chicken bones or the amount of soup left, to decide whether they’re full or still hungry. To make this natural tendency work in your favor, keep evidence of what you eat in front of you. Examples include the empty beer bottles you drank at a barbecue or the plates used for previous courses at an all-you-can-eat buffet.

See all you can eat and serve yourself in the kitchen and try to eat in another room. With snacks, always pour or put the snack into something. Otherwise, the hand always reaches into that bag without even realizing it.

Don’t Fall In “Health Food” Trap.

Not all foods labeled as healthy are right for you. Focus on ingredients rather than health claims. Also, avoid picking unhealthy sides to accompany your healthy meal. Thanks to creative marketing, even foods labeled as healthy can push some people to overeat mindlessly. “Low-fat” labels are a prime example, as foods low in fat are not necessarily low in calories. For instance, low-fat granola typically only has 10% fewer calories than regular-fat granola. Nevertheless, study participants given granola labeled as “low-fat” ended up eating 49% more granola than those provided with the usually labeled granola.

Another study compared calorie intake from Subway and McDonald’s. Those who ate at Subway consumed 34% more calories than they thought they did, while those who ate at McDonald’s ate 25% more than they thought. What’s more, researchers noted that the Subway diners tended to reward themselves for their supposedly healthy meal choice by ordering chips or cookies with their meal. This tendency to unconsciously overeat foods that are considered more nutritious, or compensate for them by having a side of something less healthy, is commonly known as the “health halo.” Steer clear of the health halo’s effects by picking items based on their ingredients rather than their health claims. Also, remember to pay attention to the side items you choose.

Ambiance Matters

You are likely to eat more with lowlights, soft music, muted colors, and attentive wait staff. Use the staff to learn more about how the food is cooked and ask your server about which dishes are healthiest. It turns out the dim lighting on your dinner date can affect more than the mood. A recent study shows that patrons dining in well-lit spaces are 16-24 percent more likely to order healthy dishes than those in dimly lit rooms due to a higher level of alertness. Cornell and University of South Florida researchers surveyed 160 patrons at four chain restaurants. Some diners were seated in brighter rooms, while the others ate in more dimly-lit spaces. Those sitting in the darker rooms ordered dishes with 39 percent more calories on average and leaned towards less-healthy items. On the other hand, those in the well-lit room skewed towards healthier choices. A replication of the study with 700 college-aged students found the same results.

Enjoy your dinner at the restaurant of your choice, being mindful of these factors.

Business parties

Take only two items of food on your plate at one time. Chow down on healthy food first, like veggies. While talking, set your food down, so you don’t mindlessly munch. When you enter the room, remind yourself of the purpose: Business or food?

Eat Slowly

Slowing down your eating speed is an easy way to consume fewer calories and enjoy your meal more. Slow eaters tend to eat less, feel fuller, and rate their meals as more pleasant than fast eaters. Scientists believe that taking at least 20–30 minutes to finish a meal allows more time for your body to release hormones that promote feelings of fullness. The extra time also allows your brain to realize you’ve eaten enough before you reach for that second serving. Eating with your non-dominant hand or using chopsticks instead of a fork are two ways to reduce your eating speed and make this tip work for you. Chewing more often can help as well.

Have Your Cake, But Skip The Bread

When eating out at a restaurant, limit yourself to the entree and just two other things—it can be two drinks, a dessert, and a roll, or it could be two rolls—it just can’t be all of the above. For example, if you have a weakness for bread, ask it not to be automatically served or ask for a limited quantity to be served. This way, you don’t even have to look at it. If you have to look at it continually, you’re going to keep asking yourself the question, “Do I want a piece? Do I not want a piece?” Save yourself. If you want to eat a dessert, skip the bread. You can share an entree with your companion or ask to pack half of your food for home even before they bring out your plate to the table. At home, put food in the back of cupboards or fridge. The idea is to make it harder to do the things we don’t want to do and easier to do the things we want to do.

Perception Is Not Reality

When people thought they were drinking “cheap” wine in a study, they ate less and stayed at dinner shorter. But the group with the “good” wine (they were the same wines) stayed longer and ate more and said the meal was better. Like a book, don’t always judge a wine bottle by its label or a restaurant by its exterior.

Drink Water

It’s easy for us to confuse dehydration with hunger. We know our body’s craving something, and we assume it’s food, but frequently it ends up being liquids, especially in active people. We would guess seven times out of ten what they think of as hunger is just slight dehydration. You don’t necessarily have to drink pure water, but make sure the beverage is low in caffeine and sodium. Caffeine and sodium dehydrate you even more, giving your mouth a feeling of thirst, which can lead you to snack.

Make Tradeoffs

A great way to reduce careless snacking is to make up some sort of condition every time you have cravings. For example, you can have anything you want from the vending machine if you are going to work out that day, or if you have a light dinner, something where there’s some sort of trade-off that you have to make. If you regularly stop by your favorite ice cream joint on the way home, start taking an alternative route home to reduce that temptation.

Smaller Packaging

Another external cue that can cause you to overeat is the size of your food packaging. Known as the portion size effect, it may contribute to significant weight gain over time. On the other hand, packages that include pause points may help diminish this effect, as they give you time to decide whether to keep eating. For example, participants eating potato chips from cans of Pringles in which every 7th or 14th chip was dyed red ate 43–65% fewer chips than those eating from cans with no dyed chips. Similarly, people eating from a large bag of 200 M&Ms consumed 31 more candies — 112 extra calories — than people given ten small baggies of 20 M&Ms. Favoring smaller packages can help you reduce the number of calories you consume by up to 25% without even noticing.

Reduce Choices

Reducing the variety of food flavors, colors, and textures you’re exposed to will help prevent you from eating more junk food. Research shows that having a wider array of food options can lead you to eat up to 23% more. Scientists call this phenomenon sensory-specific satiety. The basic idea is that your senses tend to get numb after being exposed to the same stimulus many times — for instance, the same flavors. Having a wide variety of flavors in the same meal can delay this natural numbing, pushing you to eat more. Merely believing there’s more variety can also fool you. Researchers found that participants given bowls with ten colors of M&Ms ate 43 more candies than those given bowls with seven colors, despite all M&Ms tasting the same. To make sensory-specific satiety work for you, try limiting your choices. For instance, pick only two appetizers during cocktail parties and stick to ordering the same drinks throughout the evening.

Keep in mind that this mainly applies to candy and junk food. Eating various healthy foods, such as fruits, vegetables, and nuts, is beneficial to your health.

Choose Your Dining Companions Wisely

When dining in groups, sit next to people who eat less or slower than you. This can help prevent overeating. When you are with one other person, you’ll devour 35% more; with a group of four, it’s 75% more, and with seven or more, it’s 96% more! Be mindful next time you’re in a group. Scientists believe that this is especially true if you eat with family or friends, as it increases the time you spend eating, compared to when you eat by yourself. The extra table time can push you to mindlessly nibble what’s left on the plate while the rest of the group finished their meal. It may also encourage you to eat a dessert you usually wouldn’t. Sitting next to slow eaters or people who typically consume less than you can work in your favor, influencing you to eat less or more slowly. Other ways to counter this effect include choosing in advance how much of your meal you want to consume or asking the server to remove your plate as soon as you’re done eating.

Use Smaller Plates And Taller Glasses

Studies show that people tend to eat 92% of the food they serve themselves. Therefore, reducing the amount of food you serve yourself can significantly differentiate the number of calories you consume. One easy way to reduce portion sizes without noticing the change is to use smaller plates and taller glasses. That’s because big plates tend to make your food portions look small, encouraging you to serve yourself more food. Using 9.5-inch plates instead of 12.5-inch plates can help you quickly eat up to 27% less food.

Studies show that using tall, thin glasses instead of wide, short ones can reduce the amount of liquids you pour yourself by up to 57%. Therefore, pick wide, short glasses to help you drink more water and tall, thin ones to help you limit alcohol and other high-calorie beverages.

Maximize Food Volume

High-volume foods help you feel full and decrease food intake at the next meal. Eating fiber-rich foods is an easy way to do this. Eating large volumes of food tricks your brain into thinking you consumed more calories, helping decrease the likelihood of overeating and weight gain. Researchers examined this effect by serving participants two smoothies identical in calories. However, one had air added to it. Those who drank the greater-volume smoothie felt fuller and ate 12% less at their next meal. An easy way to add volume to your meals without increasing the calorie content is to pick high-fiber foods with low-calorie densities, such as vegetables. That’s because extra fiber and water add volume, which stretches your stomach, helping you feel fuller. Fiber also helps slow down your stomach’s emptying rate and can even stimulate the release of hormones that make you feel satisfied. A good rule of thumb to maximize food volume is to fill at least half your plate with vegetables at each meal.

Follow Your Body’s Clock

Rely on internal cues of hunger rather than external ones to decrease the likelihood of eating more than your body needs. Relying on external cues like the time of day to determine your hunger level may lead you to overeat. A study demonstrated this idea by isolating participants in a windowless room with a clock as their only time cue. This clock was then artificially controlled to run faster. Researchers noted that those who relied on the clock to know when to eat ended up eating more often than those who relied on internal hunger signals. Interestingly, normal-weight participants were less likely to rely on the clock to determine whether it was time to eat. If you have difficulty distinguishing physical from mental hunger, ask yourself whether you would readily eat an apple. Remember, real hunger doesn’t discriminate between foods. Another telltale sign of mental hunger is wanting something specific, such as a PBJ. A craving for a particular food is unlikely to indicate real hunger.

The Bottom Line

Taking control of mindless munching is all about making conscious decisions—deciding to start eating, choosing to stay aware, and deciding when to stop. To transition from mindless to mindful eating, try some of the simple tips above. Keep yourself accountable. In doing so, you will improve your overall health. For the best results, choose just three of these tips and aim to apply them consistently for around 66 days — the average time it takes to create a habit. Excellence is simply a habit. Start now. Not later. Consistency is the key to looking great and staying healthy.

References:

https://pubmed.ncbi.nlm.nih.gov/17450988/

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2715054

https://pubmed.ncbi.nlm.nih.gov/15827310/

https://academic.oup.com/jcr/article-abstract/30/3/455/1790637

https://academic.oup.com/jcr/article-abstract/28/1/105/1851151

https://pubmed.ncbi.nlm.nih.gov/19875483/

https://pubmed.ncbi.nlm.nih.gov/14599286/

https://psycnet.apa.org/record/1969-00237-001

https://pubmed.ncbi.nlm.nih.gov/20470810/

https://pubmed.ncbi.nlm.nih.gov/5016089/

https://onlinelibrary.wiley.com/doi/abs/10.1002/ejsp.674

https://pubmed.ncbi.nlm.nih.gov/17450988/

Published 1/25/2021

About Us

Amar Singh, MD and Poonam Singh, MD 1/17/21 Amar Singh, MD and Poonam Singh, MD 1/17/21

Ouch! Why your body hurts?

Pain is the most common reason to seek medical care. More than 10 million people in the US have pain on a daily basis. Chronic pain is the leading cause of long-term disability in the US. Pain serves an important purpose, warning you when something is wrong with your body. However, ongoing, severe pain can cause worsening health and disability, dramatically impacting one’s quality of life. We will post a series of blogs to discuss pain in the coming months. Let’s explore how we feel pain.

When you drop something on your foot or slam your finger in a drawer, you know that pain will usually follow. Did you ever wonder why you feel that pain? Pain is mysterious for most of us: how does a stubbed toe or backache translate into such an uncomfortable sensation? And why does some pain go on and on?

Our body has pain receptors everywhere, both outside and within. These receptors send electrical messages through the spinal cord to the brain. One only becomes aware of pain after the brain receives and interprets these electrical messages. In some cases, such as touching a hot surface, the body can spring into defensive action even before the brain knows what is happening. That's because pain messages that reach the spinal cord can cause an automatic reflex response, making muscles near the source of the pain contract to get away from the pain.

Pain receptors and nerve pathways differ throughout the body. Therefore, the sensation of pain differs, too, depending on where the message comes from and how it travels. At times, the source of pain is difficult to locate. For example, some people feel the pain from a heart attack in the neck or jaw. People also differ in their ability to tolerate pain and how they respond to pain medication.

When tissue damage occurs, two different signals communicate the injury to our brains, one after another. Imagine a person hits their finger with a hammer. At first, they feel a sharp pain in the finger. This immediate, acute pain in direct response to cell damage is called discriminative pain. Its signal is carried by A δ fibers nerves in the injured area through a central control center in the spinal cord to a part of the brain dedicated to comprehending pain in that region of the body. In this case, from the finger to the specific brain region receiving signals from that finger.

The exact sensation of pain depends on what sort of external factor damaged the cells. For example, thermal receptors detect temperature-related pain (e.g., a burning sensation). In the hammer example, mechanical receptors detect the extreme pressure causing cell destruction. This pain signal is protective; it promotes a specific action: for example, remove your hand from the hot stove! Or don't hit yourself with a hammer again!

Within a few seconds, the finger injury's pain will begin to feel more like a dull ache. The entire hand may feel like it's throbbing, even though only some cells in that finger are damaged. This sensation is carried as a slower-moving signal by C fiber in a different pathway. This type of pain intensifies when byproducts released from injured cells cause inflammation in the surrounding area.

In an instant, following this acute pain, the injured person will experience an emotional reaction. This reaction is generally anticipation of additional pain to come, a sense of dread about the magnitude of the injury (How bad is this? Will I need to see a doctor?), and a feeling of embarrassment or anger (Of course I hit my thumb with the stupid hammer!). This response is mediated by higher brain centers, such as the amygdala, involved in ascribing an emotional or affective, quality to pain. Although affective pain isn't directly caused by injured cells, the signal still plays an important role. Anxiety response to pain motivates us to stop doing something that is causing harm to our bodies and seeking help.

However, for people experiencing chronic pain, pain continues for long after the tissue damage has healed. It is caused by changes in nerve cell connections in the spinal cord, the central control center, and the pain often accompanied by on-going anxiety, which exacerbates the sensation.

Dr. Amar Singh, MD and Dr. Poonam Singh, MD.

A condition called complex regional pain syndrome is an intense form of chronic pain felt after a minor injury out of proportion with what a patient anticipates. With this syndrome and other pain conditions, an initial pain signal stimulates microglia cells in the brain and spinal cord. The microglia react by releasing inflammatory signals that then stimulate other microglia, and the feed-forward cycle continues. This likely contributes to a person's persistent sensation of pain.

We received COVID-19 vaccination injections recently. Although they were just a bit uncomfortable, we received them willingly in a safe and comfortable setting, to give us protection from this awful virus. We forgot about the discomfort by the time we got back to our cars. And it is true, that we were often surprised when we felt a twinge at the injection site when we moved our arms the next day. Now imagine a scenario where a random person on street ran up to us and jabbed our arms with a needle of the same size. We can assure you, we will not feel the same way as we felt while taking the vaccine injection. You get the drift.

A person's feelings about the source of their pain affect their perception of the experience. Though a person is likely to feel sore and uncomfortable after running a marathon, they will probably consider the experience less unpleasant than a person who experiences pain following an accident. It is because a marathon is an accomplishment and requires preparation and training. On the other hand, an accident is unplanned and unwarranted.

The experience of pain is highly individualized, and therefore, often misunderstood. You may be living with chronic pain and likely struggling to explain your pain experience to others. Or, you may be a caregiver trying to figure out how to comfort someone living with chronic pain. When it comes to chronic pain, a patient's feelings toward the sensation may affect how intensely they experience it. If they describe the pain as "punishing," "cruel," or "malicious," it can give insight into the patient's relationship with it -- for example, they may believe they deserve the pain. People who think that their lives are out of their hands are more likely to experience chronic affective pain following acute pain. On the other hand, people who have a strong internal sense of locus (generally feel in control and charge of their lives) are less likely to experience chronic pain and may experience less intense acute pain.

People experiencing chronic pain also tend to rank high on depression, anxiety, sleep interference, and anhedonia (inability to feel pleasure). The question becomes: are people with depression and anxiety predisposed to experience chronic pain? Or is living with chronic pain responsible for their sleeplessness and inability to feel pleasure? To some extent, the answer is probably both. Regardless, understanding a patient's psychological state can be helpful while making treatment decisions.

Scientists continue to unearth connections between psychology and chronic pain to help clinicians get even better at personalizing potential treatments. In the meantime, the best general approach for treating chronic pain includes a combination of medications, interventions, physical or occupational therapy, and psychological techniques, such as cognitive-behavioral therapy. Patients should keep an open mind to treatment options, engage actively in their care, and learn self-management strategies, such as improving sleep or easing stress and tension. Overcoming chronic pain is like baking a cake; first, you have to assemble all the right ingredients, mix them under ideal conditions, and wait. The longer you have a medical problem, the longer it takes to correct that, usually.

Stay tuned for more information on pain. A person in pain is like a car with four flat tires.

Pain is inevitable, but suffering is optional

References:

https://bit.ly/3muJjLt

https://bit.ly/37tpfVC

https://bit.ly/3r1Yyz3

Published 1/17/2021

About Us

Amar Singh, MD and Poonam Singh, MD 1/10/21 Amar Singh, MD and Poonam Singh, MD 1/10/21

Quick Guide: Decoding Blood Test Results

Even if you’re a CrossFit champ or a marathon maven, getting a regular checkup makes sense. What doesn’t always make sense is the baffling list of medical terms on the blood test results that are often part of routine exams. If you try to take help from “Dr. Google,” you end up deep down a rabbit hole. What the heck is TSH? Apart from the puzzling jargon, the design of bloodwork lab reports is dismal. One is stuck deciphering highly technical and administrative-looking documents that make tax forms look like greeting cards. But do not worry. You can make sense of your blood test results.

We don’t want to bore you with a comprehensive glossary of technical terms but attempt to provide basic definitions and a better sense of how the information on a typical blood test report is presented and organized so that you can interpret your blood work with more confidence.

“Normal” and “Abnormal” results

Before we go any further, we have to debunk the overrated “normal’ and “abnormal” labels. You may notice that there may be a few values that are often outside the “normal” range. This is a common source of concern for many. For most blood routine tests, the standard ranges were determined decades ago based on soldiers’ studies. And even though reference ranges for some tests now vary by gender and other categories, those scales are rarely specific enough to correlate to a person’s exact age, race, and other circumstances. Different labs, meanwhile, can set their normal range at different levels. The way normal is defined inevitably leaves some people out. The ranges are generally set to correspond with 95 percent of healthy people in a large study group. But some people will always be on the margins. And sometimes, bodies can acclimate to unusual internal circumstances. As your physician, we individualize the results on what they mean to you at this point. We explain what is our patient’s optimal range, which is more nuanced. Even so-called normal levels may be an indication of a problem that’s already taken root and need to be addressed. It’s also important to understand that none of these tests exists in isolation and we need to begin looking at labs in a more nuanced way and understanding the labs in context with each other. There is a lot of human variation, and the context is essential to interpret any result correctly. A “normal” test result doesn’t always rule out medical problems, while an “abnormal” result doesn’t always indicate a problem. Here is a handy guide to commonly used lab tests:

Comprehensive Metabolic Panel (CMP)

The comprehensive metabolic panel (CMP) is a broad screening tool to evaluate your organs’ health and screen for conditions such as diabetes, liver disease, and kidney disease. It helps monitor known conditions, such as high blood pressure, and monitor treatment with specific medications that may affect kidney or liver function.

Kidney function tests: BUN and Creatinine

Blood urea nitrogen (BUN)

Urea is a waste product made in the liver when protein is broken down. This test measures the volume of nitrogen in the blood. High levels can be caused by dehydration or kidney damage, while low levels may be a sign of malnutrition or severe liver damage.

Creatinine

A creatinine test reveals important information about your kidneys. Creatinine is a chemical waste product that's produced by muscle metabolism. Healthy kidneys filter creatinine and other waste products from the blood that leaves your body in urine. If kidneys aren't functioning properly, an increased level of creatinine may accumulate in the blood. A serum creatinine test measures creatinine levels in the blood and estimates how well the kidneys filter. A creatinine urine test can measure creatinine in urine. Low serum creatinine may indicate low muscle mass.
Liver function tests

Liver function tests (LFTs) are done to determine if the liver is functioning normally. These are part of CMP. Elevated numbers can indicate compromised liver function. Abnormal liver function test results don't always indicate liver disease. An additional test, called a GGT, may be added to the liver panel. This test can indicate that there is damage to the liver or surrounding ducts but does not specify what type of damage is present. A typical liver function study includes:

Aspartate phosphatase (AST), also known as SGOT
Alanine aminotransferase (ALT), also known as SGPT
Alkaline phosphatase (ALP)
Total bilirubin
Direct bilirubin
Indirect bilirubin
Albumin

Albumin

Albumin is a protein that is made in the liver and is found in the blood. It is the most abundant protein in the plasma (plasma is the liquid component of your blood that carries cells, protein, and other substances around the body).

Total Protein, Albumin:Globulin ratio

A total protein test is frequently ordered as part of a comprehensive metabolic panel (CMP) when you have a routine health checkup. Total protein measures albumin and globulin. Eating more protein will not increase your total protein test result. Many medications may affect total protein levels.

Low A/G ratio may be caused by:

Overproduction of globulins
Underproduction of albumin
Selective loss of albumin from the circulation

High A/G ratio may be caused by:

Underproduction of immunoglobulins

Usually, the A/G ratio is not a clinically monitored test.

Lipid Panel

The lipid panel is used as part of a cardiac risk assessment to determine your heart disease risk and decide what treatment may be best if you have borderline risk, intermediate-risk, or high risk. The lipid panel results are considered along with other known risk factors of heart disease to develop a treatment plan and follow-up. Additionally, a lipid panel is used to monitor whether the treatment has effectively lowered cholesterol levels.

Total Cholesterol

It is a measure of all the cholesterol in your blood, including HDL and LDL. Total cholesterol should be less than 180 mg/dL. But there’s more to it, as this number needs to be taken in context with triglyceride and HDL levels.

LDL

LDL (Low-density lipoprotein) is the cholesterol that clogs blood vessels. It is called “bad” cholesterol because it can transport lipids into artery walls and harden the arteries. Major prevention trials have demonstrated a linear relation between LDL levels and the coronary event rate.

Absolute values of LDL can be misleading, as the types of LDL that make up the total number matter more, including the amount of small dense LDL particles and high-density LDL particles. Triglycerides and triglyceride-to-HDL ratio can give us additional insight into our cardiovascular health and risk. Overall, shoot for LDL <100 mg/dl, but less than 70 mg/dL is considered optimal by some. And, look at the LDL value in the context of triglyceride-to-HDL ratio, as this ratio is a helpful biomarker for risk of cardiovascular disease and the presence of insulin resistance

Triglycerides

The fasting lipid profile test also measures another particle, which is much more egregious than LDL: triglycerides. It is a type of lipid stored in fat cells when calories go unused. The main reason for high triglycerides is the refined carbohydrates and sugars in your diet. Triglycerides are responsible for storing extra calories and providing your body with energy when it is needed. Triglycerides are a good marker of dietary quality. In our practice, we have seen a significant drop in triglycerides levels in less than one month in patients who eliminate refined and processed foods (refined grains and sugars) and eat whole unprocessed foods rich in fiber.

Triglycerides are a very important marker of metabolic syndrome and insulin resistance. You definitely want them to be <150 mg/dL, but optimal is likely less than <100 mg/dL, or even lower.

HDL

HDL (High-density lipoproteins) are a type of complex made of proteins and fat that carry cholesterol in the blood. HDL particles remove lipids from cells and blood vessels. When cholesterol is in an HDL particle, it is sometimes called “good” cholesterol because HDL scavenges for and ferries LDL cholesterol away from the arteries and back to the liver for redistribution, metabolism, and elimination.

Epidemiological studies have shown that higher concentrations of HDL (>60 mg/dL) are associated with reduced cardiovascular risk. For a given level of LDL, the risk of heart disease increases 10-fold as the HDL varies from high to low. HDL is known for its ability to It’s also known for its anti-inflammatory, antithrombotic, anti-immune, and antioxidative activity. The prevailing dogma for the past 30 years was that high total HDL was cardioprotective because it reflected better clearance of LDL. However, the emerging narrative is that HDL is far more heterogeneous than previously understood. In order for HDL to be cardioprotective, it must be functional. Because of the heterogeneity of HDL, measurement of HDL cholesterol alone does not provide a complete picture of the protective qualities of HDL.

HDL goes down in the setting of insulin resistance, and low HDL is associated with heart disease risk. It should be above 60 mg/dL, but the higher the better.

Total Cholesterol to HDL ratio

For a given level of total cholesterol, the risk of heart disease increases 10-fold as the HDL varies from high to low. Men have double the risk for heart disease if their ratio reaches 9.6:1, and they have roughly half the average risk for heart disease with a cholesterol ratio of 3.4:1.

Together, these numbers provide more information about your coronary heart disease risk than knowing only one of the numbers. The higher the ratio, the higher the risk. Keep the total cholesterol-to-HDL ratio less than 3.5:1, but optimally as low as <2:1.

Triglyceride to HDL ratio

This test is the best way to check for insulin resistance other than the insulin response test. According to a paper published in Circulation, the most powerful test to predict your risk of a heart attack is the ratio of your triglycerides to HDL. If the ratio is high, then your risk for a heart attack increases 16-fold—or 1,600 percent. This is because triglycerides go up and HDL or good cholesterol goes down with diabesity (insulin resistance).

Triglycerides to HDL-cholesterol ratio has been shown to show the strongest association with cardiovascular disease than any other lipid marker or ratio.

The triglyceride to HDL ratio is the best biomarker of small dense LDL, the best biomarker of cardiovascular disease, and the best surrogate marker of insulin resistance and metabolic syndrome.

This is a marker you should focus on. Many experts agree that the triglyceride-to-HDL ratio is one of the best surrogate markers of insulin resistance and metabolic syndrome. If the triglyceride-to-HDL ratio is over 2.5:1 in Caucasians or over 1.5:1 in African Americans, that’s a correlate of metabolic syndrome. Lower is better.

Thyroid Function Tests: TSH, FT4, FT3

The thyroid-stimulating hormone (TSH) test is often the test of choice for initially evaluating thyroid function and/or symptoms of a thyroid disorder. TSH, free T4, and sometimes free T3 may be ordered together as a thyroid panel. High TSH usually indicates underactive [low] thyroid function, while low TSH usually indicates overactive [high] thyroid function. These tests are a "snapshot" of what is occurring within a dynamic system. A person’s thyroid testing results may vary often and may not always indicate a health problem.

Complete Blood Count (CBC)

The CBC is a group of tests that evaluate the cells that circulate in the blood, including red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). The CBC can evaluate your overall health and detect a variety of diseases and conditions.

Red blood cell (RBC) tests:

RBC count is a count of the actual number of red blood cells in your blood sample. RBCs carry oxygen from your lungs to your entire body. Low red blood cell counts may indicate disorders, such as anemia or blood loss.
Hemoglobin measures the total amount of the oxygen-carrying protein in the blood, which generally reflects the number of red blood cells in the blood.
Hematocrit measures the percentage of your total blood volume that consists of red blood cells.
Red blood cell indices provide information on the physical features of the RBCs:
- Mean corpuscular volume (MCV) is a measurement of the average size of your red blood cells.
- Mean corpuscular hemoglobin (MCH) is a calculated measurement of the average amount of hemoglobin inside your red blood cells.
- Mean corpuscular hemoglobin concentration (MCHC) is a calculated measurement of hemoglobin’s average concentration inside your red blood cells.
- Red cell distribution width (RDW) is a measurement of the variation in your red blood cells’ size.

White blood cell (WBC) tests:

WBC count is a count of the total number of white blood cells in your blood sample. WBCs help with immunity, so low counts may be a sign of infection or immune system problems.
There are different types of white blood cells; a blood differential test measures each type: neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

Platelet tests:

The platelet count is the number of platelets in your blood sample. Platelets help your blood clot. Low platelet levels may lead to too much bleeding; high levels may raise your risk of blood clots.
Mean platelet volume (MPV) may be reported with a CBC. It is a measurement of the average size of platelets.
Platelet distribution width (PDW) may also be reported with a CBC. It reflects how uniform platelets are in size.

Fasting Glucose

It is a measure of your blood sugar levels unaffected by a recent meal and can help identify problems with carbohydrate metabolism. Fasting blood glucose is one of the easiest blood biomarkers to track and is highly correlated with metabolic syndrome, cardiovascular risk, dementia, and many other chronic diseases. Blood glucose matters—chronically high levels will damage blood vessels and nerves through several distinct mechanisms. However, to be most valuable, glucose needs to be viewed dynamically—how does it rise and fall in response to certain stimuli (e.g., diet, exercise, sleep).

Once the fasting glucose rises over 100 mg/dl (signifying glucose intolerance; 126 mg/dL or above means frank diabetes), metabolic syndrome is in full force. Try to keep fasting glucose <90 mg/dL.

Hemoglobin A1c (A1c)

Hemoglobin A1c, also called glycated hemoglobin, is hemoglobin with glucose attached. It is a way to measure blood glucose averages over the preceding three months; based on glycation, the process by which glucose molecules attach to hemoglobin in red blood cells (which tend to live around three months, although this varies from person to person). The value is expressed as a percentage of hemoglobin molecules that are glycated.

Even in the face of normal fasting blood sugar, your hemoglobin A1c can be high, because it measures your average sugar, including the effects of all the food you eat throughout the day. We use it to screen for overall blood sugar balance.

The A1c test will not reflect temporary, acute blood glucose increases or decreases, or good control that has been achieved in the last 3-4 weeks. The glucose swings of someone who has "brittle" diabetes will also not be reflected in the A1c. Any condition that affects the quality and quantity of red blood cells (RBCs) and hemoglobin (e.g., iron deficiency, bleeding, hemolysis, etc.) will affect A1c test results. For example, if someone is iron-deficient, the A1c level may be increased, or if a person receives erythropoietin therapy or has had a recent blood transfusion, the A1c may be inaccurate. It may not accurately reflect glucose control for 2-3 months. By everyone’s estimation, under 5.5% is normal, while over 6.5% is frank type 2 diabetes. It’s what goes on in between that’s up for grabs and it’s in this grey zone where most adults live. The higher it is, the greater the glycemic excursions, and the more risk for metabolic disease.

Insulin

Insulin is the hormone that helps shuttle glucose into cells (among many other things). Fasting Insulin is a measure of insulin levels unaffected by a recent meal and evaluates insulin production by the beta cells in the pancreas. It helps figure out the cause of abnormal blood glucose and to helps identify insulin resistance.

The body will do everything it can to maintain a fasting serum glucose below 100 mg/dL, including increasing insulin (that’s insulin resistance!). So, irrespective of fasting glucose, you want to have a simultaneous fasting insulin level, which tells you how hard the pancreas is working. Fasting insulin is an extremely important test because fasting insulin rises long before fasting glucose does, so maybe an early warning sign for metabolic disease. Optimal levels of fasting insulin are probably somewhere between ~2-6 uIU/mL.

High-Sensitivity C-Reactive Protein (hs-CRP)

It is a protein made by the liver that rises in blood concentration when you have inflammation. Inflammation is a key driver of metabolic dysfunction, and metabolic dysfunction leads to further inflammation. hsCRP can give you a signal of how much general inflammation is going on in the body. This test is used in conjunction with other tests, like lipid panel, to assess heart disease risk. The optimal range is usually less than 1.0 mg/L. The lower, the better.

Testing for inflammation: Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP)

These tests detect the presence of inflammation anywhere in the body and monitor its treatment.

Tests for ‘“thinning of blood”: PT, PTT, and INR

These tests, known collectively as a coagulation panel, look at the ability of your blood to clot. Disordered clotting ability can cause problems in surgery, during which bleeding is often expected. This test may also be used to monitor blood-thinning medications, such as Coumadin (warfarin).

Urinalysis

A urinalysis is a urine test to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease, and diabetes. For example, a urinary tract infection can make urine look cloudy instead of clear. Increased levels of protein in urine can be a sign of kidney disease. Unusual urinalysis results often require more testing to uncover the source of the problem.
Urine microalbumin creatinine ratio

This test is used to screen for kidney disease. It can detect small amounts of albumin that escape from the blood through the kidneys into the urine several years before significant kidney damage becomes apparent.

Bottomline

A normal result does not promise health and an abnormal result does not mean you are sick. While it is helpful to have a general understanding of lab results and what they mean, your healthcare provider has training, knowledge, and experience to help figure out what significance they have on your health and wellbeing. The lab tests are complex, they represent inter-related systems in your body, and they’re worth investing time to understand. Medicine is an art and science shaded gray. There are very few absolutes, black and white. Interpreting lab results is a skill that is honed over the years, so don't feel a need to understand every nuance of your lab results. With your newly acquired awareness of the terms and objectives of your blood test, you can become a more active participant in your healthcare and a better custodian of your body.

References:

https://bit.ly/3hBNdkP

https://bit.ly/385BCY0

https://bit.ly/2X1q5T9

Published 1/10/2021

Updated 10/26/2021

About Us

Amar Singh, MD and Poonam Singh, MD 1/2/21 Amar Singh, MD and Poonam Singh, MD 1/2/21

This will make you drink more

At our weight management clinic, drinking enough water is one of the first recommendations we make when embarking on a weight loss journey. We recommend that you forget about the standard advice to drink 64 ounces a day and focus instead on your urine color, drinking enough to keep the urine clear.

Think about it: doesn’t a construction worker in Phoenix needs more water than a person at a desk in Rome, Georgia? Doesn’t a man who is 6’2” and weighs 250 pounds require more water than a 5’4” woman weighing 130 pounds? So forget about counting ounces and pay attention to your urine instead.

Many of our patients find difficulty with this advice. Usual issues we hear are

“I don’t like water; it’s boring.”

“ I get busy and forget.”

“This seems like it could be a lot more water than is usually recommended.”

“Won’t I be spending time in the bathroom all day? I have to be in meetings, or I have a commute … I can’t stop every hour from running to the bathroom…”

We get it. We struggle too. Here are some reasons why drinking enough water is essential; perhaps these facts will help keep you motivated.

Water is essential to life.

Water transports oxygen and nutrients to the cells of your body. When you become dehydrated, the cells suffer. It leads to mental fogginess, weakness, and tiredness. Chronic dehydration can cause a host of complications, including low blood pressure, constipation, muscle cramping, kidney stones, and more.

Fat cells need water to release fat.

There is considerable evidence that increased water leads to loss of body weight. In rodent studies, the effect is clear and consistent. Increased hydration leads to improved mitochondrial function, which increases fat release (lipolysis) from fat cells. On the other hand, dehydration makes fat cells insulin resistant, impairs fat release, potentially leading to weight gain. Water may also affect energy metabolism. Researchers think that rodents who stayed more hydrated were less likely to gain weight because they were burning fat more effectively. We don’t know about you, but we think quicker fat loss is a great motivator to keep that urine clear!

Those who drink more water eat less.

It’s easy to misinterpret thirst signals as hunger. If you’re feeling hungry, try drinking a glass of water before eating. You may be thirsty.

Dehydration is associated with weight gain.

A 2016 study that included nearly 10,000 US citizens found a relationship between dehydration and weight gain. This study was unique because instead of measuring water intake – which is variable - the researchers looked at urine concentration, a much better hydration status indicator. The researchers found that those with more concentrated urine were much more likely to struggle with their weight.

Water keeps your cardiovascular system healthy.

Kidneys are remarkable organs that are always sensing the fluid balance in your body and adjusting urine output accordingly. When you become dehydrated, the hormones the kidney releases to conserve water cause stress to the cardiovascular system in many ways. Not good, especially considering cardiovascular disease is the leading cause of death among Americans.

Ok. So hopefully we’ve convinced you to drink more water. Here are seven tips to make sure it happens.

1. Have water with every meal and snack.

2. Keep a water bottle with you at home, at work, in the car, and while exercising. Avoid plastic bottles, which may contain toxins and will pollute our environment. I like to use one of those insulated water bottles to keep my water cold.

3. Set an alarm to remind you to drink water every hour. Many wearable fitness devices have reminder features built-in, or you could set the alarm on your cell phone.

4. Put a sticky note on your monitor that says “(Your name) drink water!” I think it’s important to use your name on the sign. This works all the time for people glued to their monitors.

5. Give yourself a break every hour. Stand up and walk, get some steps in, and get your blood moving again. And head for a little bathroom break. You’ll return to your work refreshed.

6. Avoid diet drinks. Artificial sweeteners are associated with weight gain. Keep things interesting by infusing your water with lemon, lime, or even cucumbers and mint to make a nice flavoring.

7. Try some of these delicious and healthful methods to spice up your drinking water routine:

Citrus fruits: Lemon, lime, orange, any combinations of these.

Berries and citrus combinations: Lime and raspberry make a great pairing, while lemon and strawberry bring perkily spring flavors
Cucumber: brings a mellow, subtle flavor to water and can be another great pairing with berries
Spices: Cinnamon, turmeric, mint, ginger, and chili powder are all popular ways to liven up your water. These are also great in combination with other additions like lemons. Try pineapple and chili powder, for example, basil and strawberry, sage and blackberries, or lemon and anise seed. Many spices have their advantages, like ginger aiding digestion and being great for stomachs in general so that you can match your water recipe to your mood or your needs.

8. Increase your intake of fluid-packed foods like lettuces, cucumber, and celery.

Remember, fluid losses occur continuously. Don’t forget to replenish regularly, and you’ll reap the benefits of improved weight control, better health, better focus, and more energy. Bodyweight regulation is a complex process, and water is one small piece of the puzzle.

References:

https://bit.ly/35QG0Ja

https://bit.ly/3fkTFvb

https://bit.ly/37Om2Qx

Published 1/2/2021

About Us

Amar Singh, MD and Poonam Singh, MD 12/26/20 Amar Singh, MD and Poonam Singh, MD 12/26/20

Good Bye, 2020. Hello, 2021!

There is no simple way to sum up, the year 2020. Tumultuous, terrifying, wearisome. In 2019 at this time, it was doubtful any of us would have readily agreed to all the challenges that the new year, 2020, would bring. We’ve been confronted with creating and adapting to new ways of learning, working, and living our lives amid stressors that we have never experienced before. A drizzle became a monsoon. But for all the hardship the new year ushered in, 2020 has also provided a unique opportunity to reflect. Its lessons are many. Here are a few that rise to the surface for us - resilience, creativity, hope, and gratitude.

Let’s look ahead.

When people want to change something in their lives, they often start at a temporal milestone. Psychologists refer to this as the fresh-start effect. The most significant temporal milestone of them all, however, is the beginning of a new year. It’s that time of year when people make their New Year’s resolutions —indeed, 93 percent of people set them, according to the American Psychological Association.

Welcoming the new year may feel a bit different this year, given the challenges of 2020 and the inability to celebrate together. For many people, this puts a greater focus on long-term goals than their busy lives usually allow. For others, common New Year’s resolutions focus on behavior changes expecting positive outcomes regarding physical and mental health. Increasing the likelihood of people succeeding with their New Year’s resolutions could benefit the individual and society.

Surprisingly, 45 percent of people fail to keep their resolutions by February, and only 19 percent keep them for two years. Lack of willpower or self-control is the top-cited reason for not following through, recent research indicates. Life-changing commitments are just hard to commit. If most people can’t stay at it for six weeks, something must be wrong with the whole process. How can you increase your willpower and fulfill your New Year’s promise to yourself? How can you nudge yourself in the direction you'd like to go? Here are a few strategies, based on scientific evidence, to help you create long-lasting change:

Be clear about your goals and values.

Ask yourself why this goal matters to you. Do you want to lose weight because you value getting in shape to return to a favorite pastime of hiking, or because of societal expectations and pressures? People who are guided by their authentic values are better at achieving their goals. They also don’t run out of willpower because they perceive it as a limitless resource. Figure out what makes you tick and choose plans consistent with those values.

Resolutions work best when they are specific, measurable, achievable, relevant, and time-bound. If you fail to plan, you plan to fail. Be realistic about what you can do. Please keep it simple and be precise. Most long-term change happens slowly, so identify small changes that you can make successfully. Change is a process, not an event.

Frame positively

Focus on what you want to accomplish, not what you don’t. Instead of planning not to drink alcohol on weekdays during the new year, commit to drinking your favorite sparkling water with Sunday to Thursday evening meals. Struggling to suppress thoughts takes a lot of energy, and they have a way of returning to your mind with a vengeance. It also helps to reflect on the aspects of yourself and your life that you are already happy with. Although you might fear that this will spur complacency and inaction, studies show that gratitude and other positive emotions lead to better self-control in the long run.

Control what you can control

Restructure your environment. Research suggests that people with high willpower are exceptionally good at arranging their environment to avoid temptations. Although we love ice cream, we don’t have any in our freezers. Supportive friends and family can dramatically increase the chances of success. Joining a group whose members practice behaviors you’d like to adopt is another excellent way to bolster your willpower because having role models improves self-control.

Have the ‘if-then’ strategy

Do not get angry with yourself if you fail. Change is a journey. Setbacks are to be expected and are part of the learning process. Forgive yourself and reflect on what happened. Think through the barriers to achieving your goal and try again. Even the best resolution falls apart when your busy schedule and exhaustion take over. Formulate a series of backup plans to handle obstacles when they present themselves. These ‘if-then’ plans improve self-control and goal attainment. Each time you wake up in the middle of the night craving candies or chips, you can eat an apple slowly and mindfully, savoring each bite. When you’re tired, and about to skip that gym class you signed up for, call your supportive sibling who is on standby. Anticipate as many situations as possible and make specific plans, vividly imagining the problems and what you will do at the moment.

Be gentle and realistic.

Small steps move you forward to your ultimate goal. Avoid taking on too much too quickly. When you embark on a new pursuit, start small and build on early successes. Use one less spoonful of sugar in your coffee. Eventually, you might be able to forgo any sweeteners at all. If resisting that muffin proves too hard, try waiting 10 minutes. By the end of it, your urge will likely subside. You might be surprised to realize that change in one domain of life tends to spread to other areas. You might find you can bike longer distances or moderate your caffeine intake more efficiently.

Be persistent

Remember, sticking to resolutions is hard, especially in the beginning. One 2016 study from the University of Chicago found that the most significant predictor people would keep to their long-term goals was whether they received an immediate reward. Delayed gratification just wasn’t much of a motivator. People swear they’re going to the gym for the health of their future self, but if they’re not enjoying it at the moment or seeing quick results, they tend to drop out. Those first few weeks of doing something new are almost always the worst. You’re unfit, unpracticed, and just unable to cope. Combine that with the often miserable January weather, post-holiday blues, and work stress, and almost nobody is having any fun until at least St. Patrick’s Day.

Reward yourself

Picture the feeling of endorphins circulating through your body after a run or the sun on your skin as you approach the end of a hike. Pay attention to all five senses: smell, sight, hearing, touch, and taste. The imagery of rewards improves your chances of engaging in the activity that results in them. If it’s hard to imagine or experience these rewards initially, decide on small, meaningful gifts you can give yourself until the positive effects of the new behaviors kick in. For example, imagine yourself taking a break after finishing a project. Visualize what you would do and how you would feel, and then do it.

Self-compassion

It’s a common belief that the way to increase willpower is to ‘whip oneself into shape’ because being kind to oneself is indulgent and lacks self-discipline. But the exact opposite is true — people who harshly blame themselves for even small willpower failures tend to do worse in accomplishing their goals in the long run. Try self-compassion instead. Cut yourself some slack and remember that being human means being imperfect. When you fall for that doughnut, don’t despair, and don’t throw in the towel. Treat yourself with care and understanding, and then recommit to your goal the following day. Remember, you aren’t likely to achieve your New Year’s resolutions by being self-critical and hard on yourself. Instead, boost your willpower through a series of small and strategic steps that will help you succeed.

Start now

No marathon runner ever steps up to the start line in a big race without putting in the training miles. He or she has been practicing for months, if not years. It would help if you did the same with your New Year’s resolutions. It will make it much easier to stick to them. By starting now, you will get a much deeper understanding of what you’re resolving to do. It’s better to find out in December that a five-mile run is a bit optimistic for your current fitness level, so you can dial it back and start with two-mile runs in January. And to make sticking to your New Year’s resolution even more manageable, with a few weeks of occasional warm-up jogs, you won’t be starting from scratch on Jan. 1. You would already have gotten over the worst of the starting period. You might even be beginning to see results. If you’re planning to eat healthily in January, use the time to find meals that you love and that are easy to cook. If you want to write a journal, start now, and sticking to your resolution will already be part of your daily routine. Do not wait until the conditions are perfect to begin. Beginning makes the conditions perfect. Every moment is a fresh beginning.

What are your 2021 resolutions? Feel free to share in the comment section below. We wish you health, happiness, and peace in 2021! The best is yet to come.

References

https://bit.ly/2KyeCbe

https://bit.ly/37N9Mjm

https://bit.ly/37MCIrG

https://bit.ly/3heKnlH

Published 12/26/2020

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