Tell Me the Truth, Doctor

Disclaimer

Note to reader: This book is intended as a reference volume only, not a medical manual. The information here is designed to help you make informed decisions about your health. It is not a substitute for any treatment that may have been prescribed by your physician nor is it intended to replace the services of a physician. We encourage you to seek the services of a physician for the diagnosis and treatment of illness, disease, or other medical problems. Pregnant women are advised that special precautions may pertain to any nutritional program they undertake. If you are pregnant, talk to your physician before making any changes to your diet. This book should not be used as a substitute for qualified care and treatment and the author and publisher disclaim any liability arising directly or indirectly from the use of this book.

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Introduction

"Hey, Doc, got a minute?"

No matter where I am, a day doesn't go by without someone stopping me with that question. Sometimes the "ask" is for themselves. Other times it's for a friend or relative. Underlying all of these questions, however, is the same fundamental desire: A truthful answer from someone they trust. "Is that new diet as good as they say? Do I really need to exercise thirty minutes every day? If I have high cholesterol, should I go on a statin? How do I find the best doctor?" These questions may sound straightforward, but with all the conflicting information you hear about every day, it's hard to know what to do.

Being able to deliver medical information with a personal touch means a lot to me. I come from a long line of doctors whose patients were like family. House calls weren't unheard-of and offering assistance took precedence over everything else. I think most of us are nostalgic for the days when we thought nothing of picking up the phone to talk to our physician if we had a concern. Now it can take days to get a return phone call, and it's rarely from the doctor you wanted to reach. Feeling discouraged and disconnected, you may try to self-diagnose and end up spending even more money on expensive supplements or treatments that don't work. Instead of throwing that money away, let me give you—in this book—that house call you've been missing so that you can truly make informed decisions about your health.

I will provide easy-to-understand answers to many of your most critical and confusing health questions. My goal is to help you discover what you need to do to feel better now and to live a longer, healthier life. Throughout the book, I will provide tools to teach you how to separate the truth from the clutter and will explain why perception is so often different from reality. I guess I find it easy to tell the truth because I view health quite simply. There's no secret formula to staying well. Health isn't something given to you by a doctor. It doesn't come in a medicine bottle. Health comes to you incrementally over time, and it leaves you in the same way. It happens through a series of choices you make dozens of times each day, choices about what you do and what you ignore. It can be something as small as deciding between a side salad or fries. Taking the stairs instead of the elevator. Hitting the gym instead of hitting the snooze button. It can be more challenging, like telling your doctor you don't want to take a test he's recommending. Asking for a second opinion instead of automatically accepting a diagnosis. Saying no to taking a supplement your friend swears by. All of these actions, big and small, have an impact on your well-being.

You are constantly barraged by experts offering another approach to health, usually the quick fix. It comes in many guises: A new pill to swallow, a new diet or supplement to try. That isn't how you achieve health, and it isn't how you maintain it. But being healthy doesn't have to be hard, either. It just takes understanding the choices you are already making and deciding if you really want to make a change. I want to empower you to own your health, to seek the truth, and to trust your instincts.

I know how hard it can be to navigate the health care system. I too have had the challenges of finding a new doctor, overcoming a disabling medical condition, and watching a loved one die from a medical error. As a parent, I worry about my teenage sons and whether they will make the right decisions for their own well-being. As a pediatrician, I focus on helping my patients understand the underpinnings of health, so they can make informed choices for themselves and their children. And as the Chief Medical Editor at ABC News, I have the responsibility to clearly state my opinion on the critical health challenges of our time to millions of Americans. Every day, new studies pass my desk with banner headlines of medical breakthroughs. Cures for this disease. Ways to stop another. I wish they were all true, but from experience I know to be skeptical. One day eggs are good for you, the next day they aren't, and then they are again. Why? Unfortunately, sometimes medicine is predicated on partial truths, or as Stephen Colbert calls it, "truthiness." If being vitamin deficient is bad for your health (and clearly it is), shouldn't taking extra vitamins be good for you? A whole vitamin and supplement industry is built on that bit of "truthiness," and Congress is responsible for letting them do it unabatedly. That doesn't mean it's the right thing for you.

How do you know what to believe? It's not easy. The reality is that today more than ever, medicine is a business as well as a calling. It is critical to understand when the health care industry crosses the line, as more services are being pushed for profit rather than your benefit. How does this affect your perception of the truth? Just turn on the television. There are constant advertisements from pharmaceutical, weight loss, and supplement industries barraging you with images of happy, healthy, smiling people enjoying their products. It's government assaulted by special interest groups' and lobbyists' dollars, hoping to sway policies. How can government regulatory agencies solely focus on the health of the public with these corrupting influences? It's the power of HMOs to pressure medical personnel to be more efficient, even if that means taking less time with their patients—a lot less time. And then there are medical research and science. How do you interpret the latest information when some studies are designed to promote products rather than to find more objective truths? It's hard to make good health care decisions when the person giving you advice stands to make money off what you decide to do.

Corporate, government, and institutional malfeasance aren't the only barriers to overcome. Even your most well-meaning friends, neighbors, and colleagues can be stumbling blocks on the road to better health. Every winter I hear the same complaint from people at work: "I got the flu shot once and it gave me the flu. I'm never getting that shot again." Before I know it, half of my office is eschewing the vaccine. As hard as I try, no amount of data can budge that firmly held opinion. How a vaccine that doesn't contain any live virus can cause the flu is beyond me, but for some things, "the truth" is based on personal experience. More and more frequently, these anecdotal beliefs are trumping science. It is harder and harder for the untrained eye to sort out the good from the bad.

Why do I care so much? It's because there were so many inspirational people who believed in me and set an example for me to follow. My grandfather was a family doctor and my grandmother was his nurse well into their eighties. They were my idols. My grandfather would always give me logic problems to work out and taught me that medicine combined the mental challenge of figuring things out with the joy of helping people. My grandmother, an immigrant via Ellis Island, taught me the importance of hard work and instilled in me a strong sense of right and wrong—a moral thread that forms the backbone of my approach to medicine and to life.

I was the third generation in my family to go to medical school at the University of Pennsylvania. When I went to the children's hospital for my first rotation in pediatrics, I knew that I had found my calling. Here was a field of medicine that spoke to my heart. It focused on prevention: How do you help parents raise children who will live long and healthy lives? The concepts seemed so straightforward. Prevent disease and promote health. Simple in concept, but not always as easy to put into practice.

When I was a pediatric resident at Johns Hopkins Hospital, my chairman was Frank Oski. A brilliant man, he inspired me to pursue medicine as a field of inquiry. He wanted me, and everyone he trained, not just to practice medicine, but to move the field forward. Ask questions and when you found one without a good answer, do the research to get that answer. He taught me not to accept a way of practicing medicine without understanding why. He never seemed quite as happy as when he was debunking a myth or challenging the status quo. The year I spent as his chief resident infected me with that same passion.

After training in pediatrics, I chose a career in public health while continuing to practice pediatrics part-time. For me it was an easy career choice. As a doctor I got to interact with and have an impact on the health of my patients, one at a time, but as a public health practitioner, I got to do much more. In public health all the people of the world are our patients. By understanding what causes disease and by developing and implementing prevention programs as a public health doctor, I got to improve the lives of entire populations.

In 2009, when I was acting director of the Centers for Disease Control and Prevention, an influenza pandemic broke out. As part of the response, I took to the airways every morning and evening for the news broadcasts. I also held a press conference every afternoon to talk about the state of the outbreak and the response. People were scared, and rightfully so. The communication principle I applied, taught to me at CDC, was simple: Tell the truth. Tell people what you know as soon as you know it. If you don't know the answer, say so, and then say what you are going to do to get the answers. So simple, but so rarely done. It was my experience during the pandemic response—engendering trust by telling the truth in straightforward language—that led me to take the job as Chief Medical Editor at ABC News. My idea was to see if I could practice public health through the power and reach of our network.

So now, every day at ABC News, as I prepare to do a report, I sift through the medical literature to find "the story behind the story." I look at the research to see what the science says. Usually there are conflicting studies. If I am going to recommend something or give my opinion, I want to know the evidence. I then want to know how the experts in a particular field interpret the same information. Do they agree or disagree? Do they feel there is enough evidence to recommend that people change their behaviors based on the current information? And when I hear experts give opinions, I want to know what they are based on and whether they have any conflict of interest. Are they receiving money from someone who could benefit from the outcome of the study? This information doesn't make me discount their opinions, but it allows me to interpret them through the right filter. This is how I was trained. Always ask questions and always question dogma. In the end, translate all this information into commonsense, straightforward advice that you can use.

The inquisitorial skills that I use for every story are the same ones I use to answer the questions you will find on these pages. Many topics reflect on the everyday concerns about diet and exercise, two of the fundamentals of good health. I'll explore what works, what doesn't, and why. I'll also combat the common myths and misperceptions that pervade our lives, everything from how to fall asleep to whether you can catch a cold from going out in the cold with wet hair. I'll also take a good look at your medicine cabinet and tell you what you need, when you need it, and what to do with everything else. The more you know and understand about your health, the more it will empower you to make difficult decisions that are best for you. Understanding the nature of diseases and your risks of contracting them will allow you to be more involved in your health care choices and improve your relationship with your doctor, a relationship that is at the core of your well-being.

Throughout the book I'll be talking a lot about risk and risk factors. These are terms that are used so much when it comes to health. I'll talk about different kinds of risk. There are certain risk factors that you can't do anything about, for instance those you inherit. I'll explain why it's important to know about these even though you can't change them. Knowing you are at increased risk for certain diseases may help motivate you to focus on changing certain behaviors to minimize those risks, and it will definitely help your doctor guide your health decisions. Most of the focus, though, will be on what are called modifiable risk factors, those things you can do something about. I'll be blunt about the consequences of risky health behavior, but I'll also make the changes as easy to handle as possible. Once you are successful at making the first small change to improve your health, you'll be hooked. It only gets easier and easier.

This book will give you the information you need to start improving your health today, but pace yourself. There's too much information to take in at once. My wife is a cookbook writer. No one reads a cookbook from cover to cover at once. I think that the approach to this book should be the same. A little at a time. Let your glance drift to something that catches your eye and read a question or two. Put it down and the next time you pick it up, another issue might be of more interest. Every answer ends with an easy-to-digest summary called Dr. B's Bottom Line. Sprinkled throughout are sidebars that give you more quick tips for improving your health. Many topics offer changes you can implement right away to improve your health. Pick an easy one. Then put the book down for a week or two. Make that change and focus on sticking to it. If you were one of my pediatric patients I would say keep a calendar and give yourself a star every day you do it. After a bit of time, if you are still doing it, give yourself a big pat on the back and move on to the next change. It's the key to success. Start small and savor the incredible feeling you'll get as you head down the road to better health. And don't forget to look in the back for references, resources, and information that will help you along your way.

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1

Drop That French Fry and No One Gets Hurt

Your Questions on Diets, Nutrition,
and Food Safety

I get more questions about diets than just about any other subject. It's easy to see why. We are a nation obsessed with eating as well as with losing weight. We are bombarded with food ads showing happy, attractive, thin people chowing down on mega-meals. The result: We're one of the fattest nations on earth.

You know that being overweight isn't good for your health. Most of us want to take the extra pounds off, and we want to do it as fast and as painlessly as possible. There's an entire weight loss industry happy to supply you with a variety of products and methods claiming to help you do just that. Most of these are fad diets that deprive you of calories in a big way, at least early on. In doing so, the pounds may come off quickly. However, these diets aren't sustainable, so the pounds slowly return. Overeating followed by over-restricting becomes an endless cycle that profits those who make money by selling diet foods and weight loss plans. But it is a terrible approach to health.

It's easy to see why failure is common. Many of us have a complicated relationship with food. From the time we were young, food wasn't just sustenance. It was comfort. It was a reward. It was a way of showing love. Withholding food was a form of punishment. When we were bad, it was "No dessert for you." If we didn't finish our meals, we were told, "There are children starving in China," and we remained at the table until the plate was clean. It's no wonder we're so conflicted about enjoying food without overeating and feel guilty for stopping when we are full.

Learning how to unload this baggage will allow you to make better decisions about which foods to choose. Foods shouldn't be categorized as "good" or "bad." There are clearly some foods that work best as "everyday" foods and some foods that are better as "sometimes" foods, but we tend to get into trouble when certain foods are labeled "never" foods. The temptation can just be too great. How do you get that balance between these types of food? This is a theme you will see running through many of the questions and answers in this chapter.

Dietary changes should not just be about losing weight, though. Choosing foods higher in fiber and lower in fat, salt, and sugar helps prevent heart disease, diabetes, and cancer. And the benefits of better eating choices can help the next generation, too. One of the most common concerns from my patients' parents is how to get their kids to kick their junk food habit. I tell them it starts with them. Setting a good example is paramount to their children's success.

The truth is this: You have to decide that you want to live a longer, more robust life. Maintaining a healthy weight is the first step. But it can't be done with a quick fix. The only route to success is making long-term diet and lifestyle changes. I'm not asking you to give up anything. Healthy eating is about making simple choices and simple changes that you can live with. Follow the principles in this section and you'll see how to do it. Remember, start small, experience success, and build from there. The little sustainable changes you make add up over time to major weight loss and improved health.

 

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ARE DIETS THE BEST WAY TO LOSE WEIGHT?

A couple of years ago I did a segment for Good Morning America in which I presented a panel of nutritionists with some of the latest, hottest celebrity diets: A raw food diet, a blood-type diet, a macrobiotic diet, and the master cleanse. Their job was to tell me which was the best, which was the worst, and which might be downright dangerous. I knew what I thought were the correct answers, but I wanted to see if they agreed. Turns out they did.

All of the diets resulted in weight loss for a simple reason: They restricted calories. Some eliminated whole categories of food; others used pseudoscience to tell you what to eat. While a macrobiotic diet can be a healthy approach to eating if done carefully, none of the diets was a healthy approach to weight loss. I view a diet as a "quick fix" when you need to lose an extra pound or two after a weekend splurge or to kick-start swimsuit season. As a long-term approach to weight loss diets just don't work. You can't stick to them forever, and with some diets it would be dangerous to do so.

The diet industry is huge, and Americans spend billions of dollars a year trying to lose weight. For some reason we continue to believe that the answer to losing extra pounds has got to be the newest diet book or product. When that fails, we try the next one. The result is yo-yo dieting or weight cycling: Your weight goes down due to severe, unsustainable caloric restrictions and then it comes back up, usually to a point higher than where you started.

This country is in the middle of a health crisis. More than one-third of adults are obese. Another third of adults are overweight but not yet obese. The impact on our health is deadly: Heart disease, stroke, type 2 diabetes, and certain types of cancer, all increased by obesity.

I firmly believe that the only meaningful way to lose weight is to make long-term changes to your eating habits and incorporate more activity into your days. It all starts with small steps. Even a modest weight loss will provide important health benefits. Don't get discouraged if it takes a while to see dramatic results. Chances are you have put on your extra weight over the course of years. It could take that long to get it all off.

There are a million weight loss strategies; you can check them all out on the Internet. For me it boils down to three rules:

There's nothing fancy or complicated. This isn't a short-term change where you eat something crazy for a week. It isn't about eliminating foods you love or training to be a triathlete. It is about small, livable changes that become habits. It is as much a mental adjustment as a physical one.

Eat Less

You need food to fuel your body. Food gives you the energy to do what you need to get done. But there's no way around it—you may be eating too much. Portion size has exploded. Everything is supersized. Remember what a bagel, a muffin, or even a fast-food hamburger looked like twenty years ago? Now they are two or even three times as large. We need to get back to healthy portions and the right balance of foods.

Cut back gradually. When you serve yourself, start by taking only three-quarters of what you would normally eat. After a month or so, do that again. Fill your plate with veggies and whole grains first, then add lean protein. Learn to eat only when you're hungry. How many times have you gorged yourself only to think, "I didn't even really need that"? Be conscious of when you are eating and learn your triggers for overeating—for some it's boredom, for others stress.

Don't be afraid to use a visual reminder. Put a big sign on your refrigerator—"Stop. Are you really hungry?" or tack up a photo of yourself at a former weight or someone at a weight you want to achieve for inspiration. Maybe you have a goal. Put a picture of someone doing an activity you hope to do, an athlete you admire, or a reward, like an outfit you want to fit into. Motivation comes in all forms.

Eating is also a social activity and no one wants to give up those get-togethers. Unfortunately, research shows that most of us eat more when we're with others than when we are by ourselves. Find additional ways to socialize, preferably ones built around physical activity. Even going to a movie or strolling around the mall with a friend is better than always meeting for drinks and nachos.

The number of calories you need depends on your size and your amount of activity. Two helpful tools for assessing your needs are the Centers for Disease Control and Prevention's adult BMI calculator, www.cdc.gov/healthyweight/assessing/bmi, and the U.S. Department of Agriculture's ChooseMyPlate.gov site, which offers the new governmental food guidelines to help you make healthier choices, www.choosemyplate.gov/weight-management-calories.html.

Keep a diet diary and then go online to figure out how many calories you are consuming right now. Then look at ways to make a change. If you take in five hundred calories less each day than you burn up, you will lose around a pound per week, a realistic goal. This can be split between eating a bit less and exercising a bit more.

Eat Differently

In a 2007 New York Times article, the food writer Michael Pollan gave simple but accurate advice: "Eat food. Not too much. Mostly plants." I couldn't agree with him more. Eat food your great-grandmother would recognize—fruits, vegetables, and products with ingredients you don't need a degree in chemistry to understand. Start fresh. I like to say there are no bad foods, but I make one exception: Soda. Get rid of it. Sure, you can have one occasionally, but best to get it out of the house so it's not there to tempt you. It's just empty calories that have absolutely no nutritional value. Cut back on other sweetened beverages. Say good-bye to the chips and all the other junk food that is going to sideline you. I'm not saying you should never eat processed food, but if you don't keep it around, it will be easier to regulate. Save it for a treat when you are dining out. You'll also be less tempted to indulge if it's not in your cupboard. You might need to "retrain" your palate to enjoy less sugary and salty snacks. Replace junk food with healthier options. Instead of processed food snacks, keep dried fruit and nuts for munching. Keep a bag of baby carrots in the fridge but get rid of the ranch dressing.

These steps aren't easy to do, so here's my advice: Do it gradually. As a pediatrician, I often help parents wean their toddlers off juices. We start by mixing the juice with a little bit of water, then gradually increase the water and lessen the juice. After a month or so, the children are drinking water and enjoying it. You can go the same route. Gradually wean yourself from sodas, juices, and snack foods. If it's too hard for you to eat a sandwich without chips, try the baked variety and eat half of what you normally would. I like to put a serving on my plate and put away the bag so I'm not tempted to go back for more. Fill up your plate with a side salad, carrots, or sliced apples, so you don't feel deprived. Trade half-and-half in your coffee for milk, and go from full-fat dairy to lower-fat options.

Move More

I'm not even going to say exercise more. Just move. Take the stairs. Go for a walk—two or three times a day if you can, even for five to ten minutes: Before you start your day, at lunch, and after work. It doesn't have to be far, but just start somewhere. Once you are walking for a while, try seeing if you can walk faster, longer, or even jog a little. Ask a friend to go with you. Join a gym. Get a trainer, anything to get you to stick to it. That's all it takes, little steps that become bigger ones.

Changing your lifestyle to lose weight permanently is not going to be easy. You are not going to be perfect. You shouldn't be. Just forgive yourself and get back on track if you get derailed. Food is something we should enjoy. Losing weight will never work if you equate it with punishment. Think of all the benefits of being healthier, instead of fixating on what you are giving up. It's all about balance.

 

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WILL EATING SIX SMALL MEALS A DAY INSTEAD OF THREE BIG ONES HELP ME LOSE WEIGHT?

Six meals instead of three? As my kids would say, "Sweet!" Who wouldn't want to eat twice as often? Why stop at six? Eight is even better. Or is it?

With all the diet books and various weight loss strategies, it is so hard to convince my patients that losing weight is all about taking in fewer calories than you burn off. It doesn't matter if you eat three meals or ten—if you consume the same total number of calories and types of food over the course of the day, your weight loss or gain will be the same.