Health Connection - January 2023

Focusing on the Whole You for New Year's Resolution Success

By Molly T. Koehler, DO

By February of each year, close to 80 percent of us lose the resolve to stick with our New Year's resolutions according to U.S. News & World Report. That New Year’s Eve countdown … 5, 4, 3, 2, 1! can be invigorating. The promise of a whole New Year ahead of us can inspire lofty goals and aspirations. It’s wonderful to use that energy to set and achieve personal goals, but the reality is that many of us struggle to stick to New Year’s resolutions for more than a few ambitious weeks.

My advice is to think more about the “whole you” rather than setting an overly specific, unrealistic goal such as completely erasing chocolate from one’s diet. Below are some tips that I hope will help ensure your resolutions are successful and not forgotten:

• Be specific: Instead of resolving to "eat healthier" or "exercise more,” specify exactly what you want to achieve. For example, "Each weekday, I will eat five servings of fruits and vegetables" or "I will put it in my calendar to go to the gym three times a week.”

• Make it realistic: Setting unrealistic goals can lead to disappointment and discourage you from continuing. Make sure your resolution is something that is achievable within the year.

• Reward yourself: Remember that chocolate I mentioned earlier? Celebrate your accomplishments, no matter how small. Treat yourself to something you enjoy after you reach a milestone, such as a piece of gourmet chocolate, a favorite food, or a relaxing activity.

• Be flexible: Life happens, and it's OK to adjust your resolution as you go. If you find that your original goal is no longer feasible, don't give up – find a new way to reach your desired outcome.

• Eat a balanced diet: Eating a diet that is rich in fruits, vegetables, whole grains, and lean protein will provide your body with the nutrients it needs to function optimally. Avoid processed and ultra-processed foods, which offer little in the way of nutrition and can even be unhealthy.

• Exercise regularly: Make it simple so it’s easy to make part of your day; slip on some comfortable shoes and go for a walk around the block. Regular physical activity, such as 30 minutes of moderate exercise most days of the week, can help you maintain a healthy weight and reduce your risk of chronic diseases such as heart disease and type 2 diabetes.

• Catch those ZZZs: Aim for 7-9 hours of sleep per night to help your body recover and recharge. If you have trouble falling asleep, remember to stop scrolling through that smartphone near bedtime and create a comfortable sleeping environment for yourself – dark, cool, and free of electronic devices.

• Reduce stress: Chronic stress can have negative effects on your physical and mental health. Try to incorporate stress-reducing activities into your routine, such as meditation, yoga, or exercise.

• Avoid unhealthy habits: Smoking, excessive alcohol consumption, and drug use can all have negative effects on your health. Focusing on limiting or eliminating these habits in the new year can have a huge impact on improving your health. My favorite advice to give to patients is start small: So, instead of focusing on drinking eight glasses of water per day, I’ll advise patients to drink a glass of water every morning before your coffee. Once that change becomes routine, then pick the next small goal and you’re on your way to making real changes.

• Get preventive care: Regular check-ups, screenings, and immunizations can help you identify and prevent potential health problems before they become serious.

• Manage chronic conditions: If you have a chronic health condition, work with your doctor to manage it effectively. Take medications as prescribed, and make lifestyle changes as needed to maintain good health.

By following these tips, you can ensure that your new year's resolution is successful and leads to personal growth and fulfillment. If you have any concerns or questions, be sure to consult with your doctor. The most important thing is to have fun and enjoy the journey. Good luck and here’s to a healthy 2023!

Molly T. Koehler is a board-certified family medicine practitioner at MarinHealth Family Medicine | A UCSF Health Clinic.

Eating Well to Stay Well: The Anti-Cancer Diet

By Pamela Riggs, MS, RDN, CSOWM

It takes more than an apple a day to keep cancer away. But whether you’re a cancer survivor or simply interested in healthy living, a diet based on plant foods can help you stay energized and reduce your risk for cancer, as well diabetes, high blood pressure, and heart disease. The basic tenants of an anti-cancer diet are as follows:

• Eat a mostly plant-based diet.
• Consume 5 or more servings of a variety of fruits and vegetables a day.
• Limit simple sugars and get complex carbohydrates and fiber primarily from whole grains, nuts, and seeds, as well as fresh fruit and vegetables.
• Consume healthy fats in moderation.
• Choose protein foods wisely—eat more fish, chicken, or plant protein found in beans and legumes instead of red and/or processed meats.

What to Eat

• Fruits and veggies are low in calories and packed with fiber, vitamins, and phytonutrients, plant-produced compounds with antioxidant and anti-inflammatory properties. You don’t need to nerd out over which phytonutrients are found in which plant. Just remember to eat the rainbow! Think blueberries, red tomatoes, yellow squash, green spinach…the more colorful your choices, the healthier your diet. Don’t forget to include cruciferous vegetables (cauliflower, broccoli, Brussels sprouts, and kale). They have specific phytonutrients studied for their cancer fighting ability. If you’re pressed for time or don’t enjoy cooking, frozen vegetables are fine, as are pre-cut veggies and pre-washed dark leafy greens.

• Fresh herbs and spices are often recommended as a flavor-boosting salt substitute. Many also have powerful health benefits:
  • Curry and turmeric are anti-inflammatory, thought to promote cancer cell death and inhibit the development of blood vessels to feed tumors
  • Ginger root helps soothe the stomach
  • Oregano packs a powerful antioxidant punch
  • Garlic, onions, and shallots are rich in organosulfur compounds that have anti-cancer properties

• Whole Grains—look for 100% whole grains, not just “made with whole grains.” Some examples of whole grains include:
  • Amaranth
  • Barley
  • Corn, including whole cornmeal and popcorn
  • Millet
  • Oats, including oatmeal
  • Quinoa
  • Brown or wild rice
  • Whole wheat (spelt, farro, bulgur)

• Plant protein, including beans, peas, lentils, chickpeas, and soy. Although soy intake has been controversial as it relates to breast cancer, studies have found that when consumed as part of a healthful, plant-based diet, soy may have a protective effect against cancer and cancer recurrence. Choose organic tofu, tempeh, edamame, and other soy foods and avoid soy protein powders and soy supplements.

• Seafood is a terrific source of protein and healthy omega-3 fats. Try to eat fish twice a week. Choose wild-caught fish rather than farmed. Salmon, mackerel, herring, sardines, and tuna are all rich in omega-3s. However, albacore tuna can have a high mercury content so it’s best to limit your consumption to once a week.

• Meats can be on the menu, in small doses. Limit yourself to no more than 10 ounces of red meat per week, max. Choose grass-fed, organic beef: grass-fed cattle have a healthier fat profile. Avoid smoked, salted, fatty, or preserved meats, especially those containing nitrates or nitrites. Be careful when you barbecue. Charred, blackened meat contains carcinogens.

• Poultry is less fatty than red meat, but you’ll want to trim the skin. White meat contains less fat and calories than dark meat, but the difference is minor so choose whichever you prefer.

• Dairy products may be protective against colorectal cancer, but have been linked to an increased risk of prostate cancer. Choose organic milk to avoid antibiotics and hormones. Many milk alternatives, like oat and nut milks, are calcium-fortified, but keep in mind that unlike cow’s milk, most are not good protein sources.

• Healthy fats include omega-3 (found in fatty fish, walnuts, canola oil, and flax seeds) and monounsaturated fats (olive, canola, and avocado oils). Limit your consumption of saturated fats, found in red meat, butter, cheese, ice cream, and tropical oils like coconut and palm oil.

• Probiotics are friendly bacteria that help support good digestion and a healthy immune system. Fermented foods such as yogurt, kefir, sauerkraut, kimchi, and miso soup all contain probiotics. Avoid flavored yogurts, which have a high sugar content. Instead, add fresh fruit to plain yogurt.

Tips to Keep You on Track

• Keep a well-stocked kitchen. You don’t have to go out if there’s always something healthy to eat at home. Similarly, limit bringing junk food into the house. If it’s not there to tempt you, you’ll be much better off.

• Shop the grocery store perimeter first. That’s where the healthy foods are. Start in the produce section, then dairy, meat, and seafood sections. Most processed foods live in the center aisles so go there last and pick up just what you need: some spices, whole grains, healthy oils, and toilet paper!

• Eat seasonally. Farmer’s markets are a fun alternative to the supermarket. Think about joining a co-op or sign up for a fresh farm box full of produce to be delivered right to your doorstep.

• Download the EWG Healthy Living App. The Environmental Working Group, or EWG, allows you to scan bar codes of prepared foods, shampoo, cleaning supplies, etc. to check for unhealthy chemicals and additives. You can also check out their recommendations for what fruits and vegetables are best to buy organic (the “Dirty Dozen”) and which you may be able to buy conventional (the “Clean Fifteen”).

• Observe meatless Mondays. Ease your way into eating more plant-based meals by skipping meat on Mondays. Try different recipes and discover some delicious new go-to dinners for any day of the week. Looking for vegan recipes online? Check out websites like www.forksoverknives.com and www.ohsheglows.com.

• Stay hydrated. Drink more water, sparkling water, and green tea. Green tea in particular contains cancer-fighting antioxidants (matcha and sencha are great choices).

• Drink alcohol in moderation, if at all. Although one 5 oz. glass of wine, 12 oz. beer, or ounce of hard liquor a day would be considered moderate, studies have confirmed a strong link between alcohol consumption and breast cancer risk. So, if you choose to drink, keep it moderate and for breast cancer survivors, limit alcohol intake to no more than 2-3 drinks per week.

• Observe the 80/20 rule. Do your best to make “good” choices 80% or more of the time and limit your consumption of sweets and other indulgences to 20% or less.

To learn more about the anti-cancer diet, watch this video presentation hosted by MarinHealth Integrative Wellness Center's registered dietitians.

Whether you are seeking to lose weight, prevent the onset or progression of a disease, or simply improve your eating habits, meeting with a registered dietitian nutritionist can help. MarinHealth offers personalized nutrition coaching, medical nutrition therapy for diet-related health conditions, and Healthy Weight for Wellness, a 12-week lifestyle program available for individuals and small groups.

To learn more, please call 1-628-336-7689. Depending on your health insurance, a visit with a Registered Dietitian Nutritionist may be covered with a referral from your physician. Self-pay options are also available. Learn more about our nutrition offerings here.

Pamela Riggs is a Registered Dietitian Nutritionist at MarinHealth Integrative Wellness Center.

As Men Age: Health Issues to Watch Out for

By R. James Yu, MD

We all like to think we’re young at heart, but our bodies have a way of reminding us that we’re getting older. For men, three common urologic health concerns associated with aging include urinary symptoms, elevated PSA, and erectile dysfunction (ED). Roughly five percent of men under age 65 experience problems with urinary control, and the incidence increases to 15-30 percent after age 65. PSA is a blood test that can be elevated in men with prostate cancer, which is the second most common cancer affecting men, after skin cancer, and the fourth most diagnosed cancer in the world. As for ED, one study of male aging found that approximately 40% of men have some degree of ED by age 40. By age 70, that figure rises to nearly 70%.

Urinary Issues

As men age, their prostates sometimes become enlarged and cause obstruction of the bladder that manifest as urinary symptoms including urinary frequency, urgency, nighttime waking up, and weak stream. This is a condition called benign prostatic hyperplasia (BPH).

There are many options for treating BPH. Lifestyle changes can be helpful as a first start including quitting smoking, reducing caffeinated beverages and alcohol, and bladder training and pelvic floor exercises. Most men start with medications such as alpha blockers or 5-ARI’s that can be effective, but may have bothersome side effects. As a result, many patients consider minimally invasive procedures such as the Urolift Prostatic Urethral Lift, or Rezum water vapor ablation that are effective and allow patients to discontinue medications. Some patients, however, have prostate anatomies that are not amenable to these minimally invasive procedures, and therefore must consider transurethral resection of the prostate (TURP) or robotic simple prostatectomy as better options. Choosing the right treatment option will depend on the size and orientation of the prostate, as well as each patient’s individual preference.

Prostate Cancer

Regular checkups allow for early detection and treatment of all kinds of conditions. This is especially important with prostate cancer because the disease rarely causes any symptoms until the late stages. That’s why many PCPs and urologists recommend having an annual Prostate Specific Antigen (PSA) blood test starting at age 50. PSA is a protein produced by prostate tissue. Elevated PSA levels in the blood could indicate prostate cancer, prostate infection, or benign enlargement of the prostate (BPH). To distinguish the cause of elevated PSA, sometimes additional blood tests are needed, as well as MRI prostate. If those results are suspicious, that may lead to a prostate biopsy, which can determine the presence and aggressiveness of prostate cancer.

Treatment for prostate cancer depends on the aggressiveness and stage of the cancer, the patient’s age and general health, and the patient’s personal preferences. Many slow-growing prostate cancers can simply be monitored with a process known as active surveillance. If treatment is needed, options include radiation, chemotherapy, hormone therapy, and surgery.

Erectile Dysfunction

Erectile dysfunction, or ED, is often a progressive problem with the ability to achieve or maintain an erection declining over time. ED can have emotional causes like depression, anxiety, stress, or relationship difficulties. However, it can also be a sign of a serious physical condition such as heart disease, high cholesterol, high blood pressure, or diabetes, which is why it's important to seek treatment right away.

As anyone who’s seen the TV commercials knows, erectile dysfunction can be treated with prescription medications. These drugs increase blood flow, making it easier to achieve an erection. Testosterone may also be prescribed if it is contributing to the cause of the ED. Psychological counseling can also be helpful if the ED has emotional causes.

It’s easy to minimize the impact ED or urinary issues may be having on your life, or rationalize that these issues are just a natural part of aging. However, doing so limits your ability to enjoy a great quality of life and may delay the diagnosis of another more serious health condition. A broad spectrum of treatments is available, and the earlier an issue is diagnosed and treated, the better the outcome. Whether you have been postponing that yearly checkup or haven’t followed up by seeing a urologist, make 2023 the year to take charge of your health.

MarinHealth’s expert urology team covers all urologic subspecialties and understands the highly personal nature of urologic conditions. We provide highly-personalized care, encouraging our patients to collaborate on treatment plans that fit their lifestyles and personal preferences. Find a MarinHealth urologist near you.

R. James Yu, MD is a board-certified urologist at MarinHealth Urology | A UCSF Health Clinic.

Awareness is the Key to Cervical Health

By Katerina Zappas-Levy, MD

While the month of January is Cervical Health Awareness Month and highlights the importance of screening for cervical cancer, as a busy physician and a new mother to a six-month-old boy, I’m acutely aware of the importance of maintaining my own health and paying attention to cervical health throughout the year so I can be there for my patients and my family.

Sadly, more than 13,000 women are diagnosed with cervical cancer each year in the U.S. and more than 4,200 die. Both in the U.S. and internationally, the disease takes the greatest toll on vulnerable populations, according to the National Cervical Cancer Coalition, a program of the American Sexual Health Association.

The good news is that cervical cancer is one of the few cancers for which we have really great prevention. For that reason, awareness is key! Not only do we have a highly effective HPV vaccine to prevent cervical cancer, but we also have a good screening test in the Pap test to catch abnormalities before the cancer develops. These are tools that, if everyone utilized, would make huge strides in eradicating cervical cancer.

So, what is cervical health, generally speaking? To explain it clearly, the cervix is the opening to the uterus. It connects the uterus to the vagina, so it is located at the bottom of the uterus and the top of the vagina. In layperson’s terms, it’s the part of the uterus that dilates when a woman is in labor so that the baby can come out. Cervical health includes routine screening and a vaccine to prevent cervical cancer. Cervical cancer is almost always caused by a virus called the human papilloma virus (HPV), which is the most common sexually transmitted infection worldwide. The HPV vaccine (known as Gardasil, approved for ages 9-45) protects against some of the most common high-risk strains of HPV that are known to cause cell changes on the cervix that can slowly develop into cancer. The Pap smear many are familiar with is the test in which your doctor collects cells with a swab from the surface of the cervix. A cytologist is able to see these cells under a microscope and determine whether there are any pre-cancerous changes. The Pap smear is often (but not always) done in combination with an HPV test. It is recommended to start Pap-smear screening at age 21. Depending on the results of the Pap, your doctor will recommend how frequently you need to repeat it, which typically will range from every 1-5 years. The guidelines are always changing with new research and development, so if you’re not sure if you’re due for a Pap, check with your doctor!

HPV is not just an issue for women. HPV is the most common sexually transmitted infection worldwide, which means it is carried by men, also. While men don’t have a cervix to infect, HPV is starting to be implicated in some other cancers that can affect men, including head and neck cancers. Unfortunately, there is no test for HPV in men yet, but men can (and should) receive the HPV vaccine to help stop the spread of the most high-risk strains of HPV.

One of the most meaningful things to me as a physician is having the privilege of taking care of women throughout the span of their lives – from teenage years to pregnancy to menopause and beyond. To use Cervical Health Awareness Month as a springboard to connect with your healthcare provider, make that appointment for your next exam and bring the below questions with you to start the conversation during your visit.

10 Questions to Ask Your Healthcare Provider

Stigma leads many patients and health professionals alike to avoid conversations around sexual health. Sex is healthy and natural, and your care should reflect that. One place to start is with ASHA’s guide, "Ten Questions to Ask Your Healthcare Provider about Sexual Health." The following questions are recommended by the American Sexual Health Association to start the conversation at your next visit:

• I want to make sure that I’m taking all of the right steps to protect myself from sexually transmitted infections. Where should I start?

• How can I talk to my partner about STIs? Can you give me some advice?

• I want to make sure that my partner and I get tested before we have sex. Where should I go? How can I bring up the topic?

• Given what we’ve talked about in terms of my relationship history, should I be tested for STDs/STIs? Which ones?

• How often should I be tested for STIs? Which ones?

• Are there any vaccines I should consider to protect myself from STIs? Are there vaccines that are recommended for me?

• What are my options when it comes to birth control? How can I talk to my partner about birth control options?

• I’ve been feeling differently about sex recently. Can we talk about what might be going on?

• What screenings* are recommended for someone my age? (*such as cervical cancer screening, mammograms, prostate cancer screening, etc.)

• I’m not always happy with the way my partner treats me. Can we chat about that?

Your provider needs to know some personal information about you so that she or he can help answer your questions and assess your risk and offer the correct advice. You may want to talk to your provider about the following:

• Your sexual history
• Your current sexual practices
• Your condom use
• Any symptoms you have
• If you could be pregnant

Katerina Zappas-Levy, MD is an obstetrician & gynecologist at MarinHealth OB/GYN | A UCSF Health Clinic.