Author: Adv Admin

Keto Diet – The Good and The Bad

Posted on by Adv Admin

Are you looking to lose weight? Have you heard about the benefits of the keto diet? Have you seen friends or family lose several pounds in just a few weeks from eating “keto”?

The keto (ketogenic) diet does work and it may be just what you need to overcome your stubborn weight loss and jumpstart your path to a healthier lifestyle. However, keto diets are very specific and the bad can easily outweigh the good.

What is the keto diet and how does it work?

Our bodies extract energy from 3 main macronutrients – carbohydrates, proteins, and fats. However, the main source of energy in a standard American Diet is from carbohydrates like pasta, sugar, rice, and potatoes.

A ketogenic diet involves limiting carbohydrates and utilizing foods that are high in fat as the main source of energy.

We’re not 100% sure how the keto diet causes weight loss. What we do know is that switching to a diet high in fats and proteins probably means that you will feel more full with each meal. The more you feel full the less you eat. The less you eat, the more your body needs to break down fat in order to fuel your body. The more fat you break down, the more weight you will lose.

Eating less and losing weight while feeling full can be a huge win for those who have struggled to lose weight with conventional diet and exercise. While the keto diet does come with some great benefits however, it also has its drawbacks.

Keto – The Good.

Weight loss:

The Office for Disease Prevention and Health Promotion recommends that our diet consist of approximately 50% carbohydrate, 30% protein, and 20% fat. Our bodies will naturally convert any excess carbohydrate into fat or glycogen for energy storage.

The standard keto diet requires that your diet consist of 10% carbohydrate, 30% protein, and 60% fat. This shift in macronutrients is the driving force behind why we lose weight.

By converting from a less filling carbohydrate based diet to a more filling fat based diet, we are now directing our bodies to utilize the fat in our food for fuel. Because we are feeling full and eating less, we are also depleting our reserves of fat and glycogen for energy.

While there are other factors involved in the process of weight loss such as hormone regulation and loss in water weight, we find that people who adhere to a keto diet tend to lose more weight and keep the weight off for a longer period of time. In fact studies show that diets low in carbohydrates, like the keto diet, lead to a greater weight loss than low fat diets.

Healthier Eating:

One of the benefits of switching to a Keto diet is eating healthier – somewhat. While a keto diet can improve the quality of foods that we ingest, some people can actually do more harm to themselves by eating the wrong fats. More on that a little later.

People who are overweight tend to prefer foods that are highly processed such as simple sugars and refined/processed carbohydrates. This usually leads to weight gain from excessive eating. Switching to a keto diet eliminates many of these foods. As an alternative, the keto diet stresses more filing and often healthier foods such as seafood, poultry, certain nuts, grains, avocados, and cheese. These foods also tend to be higher in certain vitamins, minerals, omega 3 fatty acids, and antioxidants.

Carbohydrates, and especially refined/processed carbohydrates, typically do not not have high amounts of these nutrients.

Keto – The Bad.

Low Energy:

Our bodies prefer carbohydrates and there is a good reason for that. Carbohydrates can be converted into sugars to give us an immediate release of energy. They can also be easily converted into glycogen and stored in the liver and muscles for later use. This glycogen can also be easily broken back down into sugar when needed for energy. This is why marathon runners will typically load up on carbohydrates the night before a race.

Two things happen when we eliminate carbohydrates and switch to a fat based diet. First, we remove our bodies ability to utilize sugar and second we remove our ability to produce glycogen. Activities that require sustained energy now become more difficult. You may also feel a period of low energy for a few days or weeks as your body transitions to using fat for energy instead of glycogen. This sensation is often termed the “keto flu”.

If you have any underlying medical conditions such as low thyroid, low blood pressure, or low cortisol levels, this may compound the problem of low energy for you.

Always consult with your doctor if you have any medical conditions before transitioning to a keto diet.

Nutrient deficiencies:

Eliminating any macronutrient food groups will also result in a decrease in certain micronutrients (vitamin’s and minerals). Specifically, keto diets may provide suboptimal levels of calcium, vitamin D, phosphorus, zinc, and magnesium. These are essential nutrients that our bodies depend on for bone health and a variety of metabolic functions.

This can be a problem for those who have trouble with nutrient absorption. These include such conditions as metabolic disorders, gastrointestinal disorders, as well as pancreas or liver abnormalities.

It’s important to consult with your doctor and/or nutritionist and to consider multivitamins supplementation before starting a keto diet.

Dirty Keto:

The term dirty keto involves eating high fat nutrient poor foods instead of high fat and nutrient rich options. For example, a good keto option might include grilled chicken or farm raised, grass-fed beef. A dirty keto meal would include fried chicken or processed bacon.

Nutrient poor foods generally tend to be high in saturated fats, and tans-fats. While saturated and trans fats improve the taste of food, they also increase your bad cholesterol (LDL). This can result in heart disease and stroke and may actually cause weight gain when eaten in excess.

When switching to a keto diet It’s important to prioritize foods with high quality fats. This will help prevent long term health complications and support a healthy weight loss.

Bone Health:

We spoke earlier about how the keto diet can lead to a decrease in calcium, zinc, magnesium, phosphorus and vitamin D. All of these are important for bone formation and fortification. While several studies have shown that the keto diet does not affect bone health, some new data may suggest otherwise.

Any significant decrease in calcium, magnesium, zinc and vitamin D will effect the integrity of bone structure. Not supplementing adequately with these vitamins or minerals may put you at risk of compromising your bone integrity. This risk may be even greater for those who already have underlying issues with bone structure such as the morbidly obese, diabetics, and the elderly.

Because few long term studies have been done, we don’t yet know just how the keto diet will affect long term bone health. As stated earlier, just to be safe, it’s important to supplement with at least a multivitamin while on a keto diet.

Adherence:

One of the biggest issues with the keto diet, or any diet for that fact, is how difficult it is to maintain given the food restrictions. The average American gets at least 50% of their calories from carbohydrates. Drastically cutting that number down to almost single digits while on the keto diet can be quite challenging.

In addition, many foods which may not seem to be carb free might be loaded with carbs for flavoring, texture, or food preservation. For instance, the grilled chicken we spoke about earlier is an excellent keto option. However, if you layer it with certain spices or condiments you may be adding carbohydrates that are turning your keto meal into a non-keto meal.

Eating even small amounts of hidden carbs can easily throw you out of ketosis and stifle the weight loss you desire.

While it’s not impossible, sticking to a keto diet and maintaining a state of constant ketosis can be a challenge without proper research and discipline.

Conclusion

The keto diet may be a good option for many people. For instance, if you are relatively healthy and need to loose some weight in a short period of time, then limiting your caloric intake using the keto diet might help. Also, if you are relatively healthy and want to motivate yourself to start loosing weight, then the keto diet might also be a good option.

Outside of these 2 categories you may want to consider other weight loss options.

The keto diet significantly alters your metabolism. By going into a state of ketosis you’re shifting key components of your body’s metabolic activity. While your body may certainly be able to do this without any adverse consequences, there’s no long term studies that have been done to prove this.

Most healthy people may not need carbohydrates to function. There is however a reason why we have evolved with the ability to digest and store carbs. Carbohydrates are an important energy source. Eliminating them to lose weight while possible is not necessary and may not be practical. The time you put into living a life filled with healthy keto meals might be better spent just eating a healthier well rounded diet.

Eating a well rounded diet that includes all macronutrients while limiting your overall caloric intake is still the healthiest way for most people to lose weight.

Dr. Sergio Guiteau is a physician who has certifications in Aesthetic Medicine and is board certified in Family Practice and Sports Medicine. You can read more of his blogs here.

Treating Professional Athletes – A Physicians Do’s and Dont’s

Posted on by Adv Admin

I’ve been very fortunate throughout my medical career to be able to work with some of the premier athletes of our time. Treating these professional athletes has been an amazing experience.

The people who compete at the highest levels of their sport are among the most driven and focused individuals I have come across. Unlike the average patient, professional athletes are proactive when it comes to their health. They also tend to be more knowledgeable about their health than their doctors.

However, treating professional athletes isn’t always easy and it comes with its fair share of drawbacks. Being able to navigate the tightrope between doing what’s best for a professional athlete while also helping them perform while sick or injured can be tough. Things can get even more difficult when you factor in agents, team management, media, advertisers, friends, family, and the millions of dollars that can oftentimes be at stake.

Despite this difficulty I have learned a few things along the way that have helped me immensely.

Do

Give VIP treatment:

The same is true when it comes to professional athletes. Because of the nature of who they are and what they do, they will expect better accommodations. While this doesn’t mean sacrificing the care of other patients, it will mean sacrificing your time and energy for their accommodations. I regularly miss meals and work off-hours to accommodate my patients who are professional athletes. While I certainly can’t do this for every patient, when it comes to professional athletes it’s sometimes a necessity. Your ability to treat them in a timely fashion can make a difference of millions of dollars for the organizations they play for, the people those organizations employ, and the athlete themselves. If you’re not able to make decisions or treat them when they need to be treated, they will quickly find someone else who can.

Work with their expectations:

Many athletes want to play and they want to play despite injuries. As a physician, my job is to help them return to the court or field quickly and in the safest way possible. To do this you have to be 100% honest with what your expectations are versus what their expectations are. If an athlete wants to play next week and it isn’t possible, their expectations have to be re-oriented to what’s safe. We’ve all seen stories of athletes who returned too soon and compromised their long term careers. Professional athletes are highly competitive individuals and many want to play at all costs. Working with their expectations can be difficult. Learning how to do it in a way that maximizes a working relationship with them is key.

Keep the lines of communication open:

When you’re treating a professional athlete you’re not just working with the player but oftentimes you’re also working with family, close friends, the agent, the team, other team doctors, and trainers. Navigating through the myriad of opinions and expectations can be tough. There are times when the athlete wants to play but the agent disagrees. Other times the athlete doesn’t want to play and the team disagrees. Or sometimes the athlete wants to play and the team wants him/her to play but the family disagrees. Recognizing everyone’s concerns and viewpoints while doing what’s best for the athlete can be a challenge. Being available for the athlete and his/her immediate circle will help mitigate this challenge.

I personally ensure that the athlete and the people who they allow to have access to their medical information, have a direct line of communication to me whether it be via phone or email. Being available for questions or medical advice goes a long way towards gaining their trust. It  will also hopefully help foster a positive working relationship.

Respect boundaries:

There is nothing wrong with being friendly with your patients, whether they be athletes or otherwise. However, it’s usually not a good idea to treat your professional relationship with them as an out of office friendship. This can lead to situations where patients may try to take advantage of your working relationship because of your friendship. I’ve seen situations where physicians who develop a friendship with patients begin receiving personal calls or requests. This includes things like signatures for medical exemption forms, controlled substances, or other medications that may not be indicated. Keeping the relationship with the athlete professional can help continue to ensure that you’re objectively looking out for their best interest without them having to expect anything in return.

Go above and beyond:

Professional athletes are used to dedicating themselves 100% to their craft. Many of them rarely have days off and it’s not uncommon for them to expect the same from the people they work with. As a physician, it ‘s expected that you go above and beyond for patients who are professional athletes. Treating them can sometimes mean staying late, getting to the office or training room early, answering calls off-hour, or sacrificing your time for theirs. The ability to go above and beyond for their care is part of what keeps them performing at an elite level. While it may often go unrecognized, their success is in many ways directly tied to your ability to be there when they need care.

Know your athlete:

Every athlete approaches their medical care and physical conditioning differently. Some athletes prefer to be in the training room constantly for exercises, rehab, stretching, massages, etc. Others prefer a more hands-off approach and will rarely seek out help unless it’s needed. I have some athletes who reach out to me almost weekly for advice on health, nutrition, exercises, training regimens, etc. Others are comfortable doing their own research and probably take everything I say with a grain of salt. Knowing what an athlete needs to perform his or her best is key when it comes to tailoring how you deliver their care. To maximize their recovery and performance it’s important to provide and communicate their care in a way that they can relate to so that they can best utilize your care to their advantage.

Don’t

Treat them like a celebrity:

Asking a professional athlete for autographs, selfies, or other perks/favors is probably the quickest way to never work with them again. When a player comes to you for help, the last thing he/she wants is for you to ask them for something in return. A trusting relationship means treating them like a patient and not as a celebrity. Many of them are already bombarded daily with requests for interviews, autographs, photos, or the like. In order to build trust with that individual they first have to feel comfortable around you. I have personally seen employees get fired on the spot for asking for these things. As a physician, asking a professional athlete for something can easily hamper the relationship and their ability to trust in your advice and medical recommendations.

Be the team’s physician:

While your job may be the team’s physician you don’t want to be seen as the physician that works for the team. Your primary responsibility is to care for the athlete to the best of your ability while doing no harm. The wants and needs of the team and those who operate the business of the team come secondary. Most professional athletes understand the business of the sport that they play. They are hypersensitive to decisions that are made from people they see as “from the team”. If you are in any way perceived as making a decision that is in the best interest of the team instead of the athlete, you will lose that athlete’s trust as well as the trust of other members of the team.

Violate HIPAA:

This one should be a no brainer. However, you would be surprised how easy it can be to violate HIPAA laws in a professional athletic setting. HIPAA privacy laws regulate the disclosure of patient health information. Under these laws disclosing patient health information without their consent can be a federal offense. A professional athletes health is constantly being evaluated by media, opposing teams, family, friends, trainers, etc. Because of this, violating HIPAA can easily be just an inadvertent slip of the tongue away.

I once had a player from another team ask me what I thought about my patient’s rolled ankle. Divulging any details without explicit consent from the athlete himself would have been a clear violation of HIPAA privacy laws. I always make it a habit to ask the athlete who they would like me to disclose medical information with. I also always try to have them present when I am discussing their personal health information with others.

Talk in absolutes:

Professional athletes LOVE absolutes. I wish I had a dollar for every time I heard questions like, when will I be back? Or how long until I get better? Or when can I go back to practice? The reality is that doctors aren’t fortune tellers. All we can do is estimate outcomes based on our medical knowledge and experience. I never tell an athlete when something will happen. Instead, I let them know when something is likely to happen. A lot of athletes hate it, but they will hate it even more if I give them an absolute timetable and it doesn’t happen the way I guaranteed.

I’ve seen many cases where athletes are considering surgery in the offseason. They’re then told that if they get the surgery they can be back by the start of the next season. If they are still in rehab when the season starts the athlete is now stuck wondering why their recovery is taking so long. Now they’re unhappy and their trust in you might be in question. I never talk in absolutes. It avoids a lot of headache and disappointment down the road.

Be easily offended:

Working in the world of professional sports means dealing with some pretty intense situations. At this level of athletic care you’re working with highly competitive individuals. They’re often under immense pressure to perform on a stage where millions of dollars are involved. Tensions can run high and frustrations can run even higher. Having thick skin is a necessity to work in this environment whether you’re a team physician or in any way involved in the world of professional sports. Most of the scenarios we see are not life or death decisions. However, careers and livelihoods are often at stake not just for the professional athlete but for their family/friends, as well as team management, trainers, and staff. Being able to function in this environment will mean not taking things personally and focusing on positive outcomes instead of the setbacks that will eventually happen.

Eat before the players:

I’ll let NBA Hall of Famer Paul Pierce explain this one. In short just don’t do it

https://www.thescore.com/nba/news/1090936

Dr. Sergio Guiteau is a physician who has certifications in Aesthetic Medicine and is board certified in Family Practice and Sports Medicine. You can read more of his blogs here.

Emotional Support Animal Letter – Can I get one?

Posted on by Adv Admin

If you have a psychiatric disability, having an emotional support animal can really be an asset. Emotional support animals can provide excellent companionship to help you cope with such things as anxiety, depression, OCD, acute stress, or other psychiatric disorders.

Unfortunately, living or traveling with your emotional support animal can be a challenge when “no pet policies” or “extra pet fees” are involved. In these situations, getting a letter for your pet from your health care professional can be quite helpful.

However, there are a few things you should know before getting an emotional support animal letter.

Where can I get an emotional support animal letter?

To obtain a letter to accommodate your emotional support animal, you will need documentation from a physician or licensed mental health provider. There are some websites that will put you in contact with a medical provider for a fee. Here at our office we also provide evaluations for emotional support animal letters. Be aware that every medical provider will likely have their own process for providing emotional support animal letters. Some medical providers do not provide these letters at all for liability concerns.

What qualifies an animal to be an emotional support animal?

The Dept of Housing and Urban Development which oversees housing discrimination requires that landlords consider 2 questions when evaluating the legitimacy of emotional support animals.

1. Does the person seeking to use and live with the animal have a physical or psychiatric disability?
2. Does the person making the request have a “disability-related need” for an emotional support animal?

Generally, emotional support animals help provide comfort and alleviate an owner’s disability.

Where can I use an emotional support animal letter?

As of this writing, emotional support animal letters can be used by those with a disability who are looking to move into pet restricted housing. Letters can also be used to waive pet fees for housing and airline flights if the emotional support animal is considered a necessity as per Federal Fair Housing Amendment (FHAA) and Air Carrier Access Act (ACAA) guidelines.

Who can get an emotional support animal letter?

Anyone with an ongoing medical or psychiatric disability can obtain an emotional support animal letter. However, the animal must be therapeutic to that person’s disability. In order to qualify for a letter, you must meet with an appropriate healthcare professional who can certify your need for an emotional support animal.

How often will I need to get a certification letter for an emotional support animal?

There are no regulations regarding how often you will need to obtain a letter for your emotional support animal. This will depend on how often your medical provider certifies your letter or how often your landlord or the airline requires one. Generally, most landlords and airlines will want a fairly recent letter.

What animals qualify as an emotional support animal?

There is no governing body or regulating entity that certifies what type of animal may be an emotional support animal. Wild or exotic animals that may cause disease or injury to other individuals can be excluded. Aggressive animals or those that may cause property damage can also be excluded. The type of animal allowed is generally up to the discretion of the landlord or airline. According to the Dept of Housing and Urban Development, an emotional support animal is not considered a pet.

Where can I take my emotional support animal?

Emotional support animal regulations have only been written for airline travel and housing. As of this writing, no governing body regulations exist regarding their access to other public or private property.

What’s the difference between an emotional support animal and a service animal?

The regulations for emotional support animals are still quite vague. Service animals however are much more strictly regulated. Service animals are certified by certain non-profit organizations. Their regulations are governed under the American with Disabilities Act, 1990. These animals are considered working animals and are specifically trained to help those with both physical or psychiatric disabilities such as PTSD and anxiety. Only dogs and miniature horses can be certified as service animals.

What will my doctor need to know to certify an emotional support animal?

Your doctor or licensed mental health provider will need to document a psychiatric disability. Your emotional support animal letter however should not include your diagnosis, unless you would like it stated in the letter. There may also be ongoing intervention or follow up visits to manage your disability. While an emotional support animal is a great adjunct in helping those with a disability, it should not replace therapeutic medical or psychiatric care.

Dr. Sergio Guiteau is a physician who has certifications in Aesthetic Medicine and is board certified in Family Practice and Sports Medicine. You can read more of his blogs here.