Good Health Simply

I am Dr. Thomas Hoffmann.  I'm a Rheumatologist who treats auto-immune diseases like lupus or RA where the body's immune system overreacts and attacks joints or organs in the body.  Inflammation is a central part of this process.  I was also a Special Forces Medic in the Army and learned how to train people for many situations.   I have developed unusual expertise in how to adjust diet and exercise and use supplements to help your body suppress inflammation.  

Diet and exercise contribute to (or help contain) inflammation.  The details of exactly how this happens are unclear.  However, on average, people with healthy body composition are less inflamed than obese people.  When people are more fit, almost all aspects of their health is improved – including being less inflamed.  The same is true of people with good sleep.  There is also mutual feedback between diet, exercise and sleep that help the overall health of the individual build up (or run down).  The average health of middle age people is an example of this interaction.  Most people are busy with job, family, chores, etc and just “don’t get around” to good fitness.  After a few years, this reduced activity contributes to gaining body fat and to worse sleep.  Worse diet will accelerate the decline of healthy.  

These “average” results can reverse with better diet and a gentle and appropriate exercise plan.

The surprising part is that these changes are not very hard or unpleasant.  Even better, as people adjust habits and become fitter and have a healthy body composition they also find that they enjoy their life more!  There is no specific requirement for this or that exact diet or exercise.  However, you have to find a diet and exercise pattern that works to get the better health that makes you feel better! 

These same benefits reduce inflammation in the body.  The inflammation is a harmful way that the general health of the body and inflammatory disease interact. Inflammation from the general health of the body “aggravates” the immune system and the inflammatory disease. This also goes in the other direction.  An example of this is Rheumatoid Arthritis and atherosclerosis.  The atherosclerosis is inflammatory damage to the body from poor general health, especially elevated blood sugar (which becomes diabetes if severe enough) and elevated cholesterol.  The inflammation from Rheumatoid Arthritis is known to accelerate the damage to the blood vessels from atherosclerosis.  Good treatment of the Rheumatoid Arthritis helps to control the atherosclerosis.  Poor diet and exercise contribute to progression of both conditions.  Better diet and exercise contribute to control of both conditions.

I fully believe that good diet, supplements, and proper activity can help your body heal, sleep, and gain strength.  Let's start with diet.  There are many different diets. We know a lot about how good diet can help you be healthy.  My theory is that the basic diet that is required for most adults to maintain good health is to eat mostly vegetables, some protein and not much junk.  This theory ties together many of the ideas put forward in other diets with proven health benefits, like Mediterranean, Adkins, Weight Watchers, etc.  There is no perfect diet and some diets are better for some people.  Some people (and families) have more health problems like obesity, diabetes, high blood pressure or cholesterol.  Each type of problem goes with more (or less) caution about certain parts of the diet.  

Obesity is one of the most common health problems in the US -and San Antonio!  Here is my approach.  Some parts of the diet approach to controlling obesity are well known, for example -  controlling the amount of sugar in your diet.  Everyone knows that too much sugar is bad but any given week, for each of us, it is a question of if we are “doing what we are supposed to” or not!  This part of a good diet we all learned both from mom and in our nutrition classes.  

We also learned that we need vegetables.  There are several key reasons for this.  Vegetables contain vitamins, minerals and fiber, all of which are good for you.  The fiber helps reduce the blood sugar spike that happens when we do eat sugar, which allows your body to process the sugar with less problems.  

We were all taught to think about the nutrition in our diet in terms of the content of fat, protein and carbohydrate.  Thinking about your health in terms of carbohydrate is confusing and not helpful.  Sugar is a carbohydrate but is bad for you.  Fiber is a carbohydrate but is good for you.  Starch is also a carbohydrate.  

Starch is a chemical chain of sugar.  Once starch is cooked and eaten, it becomes sugar in the body.  We were all taught that a “good dinner” is protein, starch, and a vegetable.  Starch is taught in nutrition class as an energy source.  Nowadays, when we all have more calories (and energy) than our bodies need, our need for starch is mostly gone.  Only people who are short of food, endurance athletes or people doing hard physical labor need starch.  

This explains why “counting carbs” can be confusing.  I find it is much simpler to just think (and eat) fiber (vegetable) is good, sugar and starch are bad.  For your health, your diet is not “high carbohydrate” or “low carbohydrate”.  To be healthy everyone needs enough fiber and low enough sugar and starch.  Once you have a health problem like obesity, you need more fiber and your sugar and starch intake should be almost zero or “cheat day ONLY” foods!

For the body gaining fat there are two main diet issues.  These issues are excess fats and excess total of sugar and starch as above.  The sugar and starch both cause your body to produce insulin. Insulin is a body hormone that helps your body handle blood sugar.  It does this by stimulating uptake into tissues, including into fat cells.  Insulin “turns on” the bodies energy storage system, telling the fat cells to “fill up”!  Extra fat has twice as many calories per ounce as any other food and needs no processing to add to a fat cell. It just needs to be stored.  The best, fastest way to make someone gain fat is to do both at once.  Give extra starch or sugar to turn on the storage and extra fat to get stored!  Think of foods that do this:  Pizza with dough and cheese, sausage, and pepperoni.  Pasta with alfredo sauce or sausage.  Rice with fatty meat like barbacoa or carnitas.  

There is a way around this.  One of the easiest and best is to add extra vegetables – this reduces the insulin production and slows the absorption of the fat, both helping to reduce the fat gain.  Also, the more vegetables that are eaten, the less of the the starch and fat are eaten.  So have a big salad with every lunch or dinner.  

Food is an important source of pleasure and joy.  If you “really like” a certain starch, then you can have some, just remember that it has the same effect on your body as sugar.  For example, my family is from the Mid-west and I was raised on meat and potatoes.  I don't mind rice but I like potatoes more.  As I got older and started having to be careful with my diet to protect my health, here is how I made this adjustment.  I cut out the rice first.  I switched from fish, vegetable, and rice to fish, vegetable, and a salad.   Later I reduced potatoes to “cheat day only”.  

Once you have switched to more vegetables, and starch and sugar as “cheat day only” you will begin to lose weight.  You can enjoy your meals, have a steak or pork-chop, and still become healthier.  Body fat actually produces insulin by itself.  A person with extra body fat has extra insulin.  This is one of the reasons why it really is harder for a person with a lot of extra body fat to lose weight than a person who only has a few pounds of fat to lose.

Another reason why it is harder for people with more fat to lose weight is that it is harder for heavy people to exercise without pain.  My years in the Army, both in Special Forces and as a doctor, taught me that a proper training plan is required for people to regain fitness just like recovering from an injury.  A young healthy athlete who is recovering from a sprained ankle will prolong the injury if he tries to run on it too soon.  

The best way to recover fast is to combine recovery training with medical treatment.  NSAIDS are drugs like Motrin or Naprosyn, which are also available over the counter.  These are anti-inflammatory medications.  For the drugs to be effective as an anti-inflammatory, they need to be taken regularly.  If you just take one “when the pain is too bad” then the anti-inflammatory effect comes and goes and does not help you heal faster.  The training change is to reduce the hard activity to a level that allows activity without aggravating the injury.  For example, stop running on the sprained ankle and try a low impact exercise like an exercise bike or elliptical machine.   If your ankle can't do a good workout on the bike, you are NOT READY to run!  

Regular stretching helps to prevent injury.  One of the effects is to help you be aware of “how bad” the injury is.  If the ankle is still “pretty sore” with just stretching, you need to stick to the bike or elliptical!  Remember, the fast way back to fitness is steady progression of activity as you heal.  This same method applies if you are out of shape.  Start stretching and some walks, then start low impact.  If you don't know which one you like, please try both the elliptical and the exercise bike.  Try them by working only as hard as a steady walk.  Try both.  One bad knee won't like the bike but will like the elliptical.  Another bad knee with the same injury will like the bike! You should use the ony that your body likes.  

Everyone needs activity to stay healthy.  The Framingham studies reported on how much exercise is needed to prevent heart attack or stroke.  These guidelines are the minimum requirements to prevent heart attack, not “what is really good”.  By Framingham, everyone needs to walk 30-60 minutes, 5 days per week.  You get the same protection by jogging 25 minutes, 3 days per week.  I'm now in my 50's.  I'm lucky that I've never had major injury.  My joints still ache when I run.  Being old is almost like a slow version of having a sprained ankle.  Most of the time, I use the elliptical, instead of running.  

My heart needs me to work hard to keep it strong.  My heart can't tell how I'm working hard – it can't tell if I'm jogging or on the elliptical.  My 50 year old joints can tell!  So I use the elliptical until I'm feeling well enough and I'm strong enough to start jogging again.  As long as I can work on the elliptical as had as a jog, I don't need to actually jog to maintain good health.  This also helps me get enough done in a normal, busy week.  One 25 minute jog intensity workout does your body as much good as 2 days of 45 minutes of walking!

Supplements can help your body work better or handle some damage but are not strong enough to correct for bad diet.  Supplements don’t make your body strong but do help it repair better.  I take a multi-vitamin even though they do not prevent disease – I want to “cover my bases” and make sure that my body has the vitamins and minerals it needs to build a strong healthy body.  Most people need extra vitamin D but you need to check your levels – vitamin D is fat soluble (ADEK are) and will accumulate over time.  Vitamin D is extra important because it is the hormone for bone health.  

I hope this explanation provides you some insight into how to adjust your diet and exercise so you end up with better health!  Please don’t feel “bad” that your diet or exercise is not what I describe.  Almost all adults are not doing a good job of these basic aspects of taking care of your health.  I usually go through this in enough detail with people to both find out how they are doing and to be able to give specific changes and a plan to get your diet and health better!  Sometimes people feel upset but if we don’t have the details of what you are doing, I can’t give you the detailed plan that makes easy, adjustments to your current habits to get you more healthy!  I will also share my personal experiences to help you make these adjustments!  Best wishes and I hope you all can live happy and healthy!  The simple things are the key to a healthy body and mind.  Here’s to Good Health Simply for everyone!

Thomas Hoffmann, MD

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