Intuitive Eating: Fad or One Big Misunderstanding?

This week at work I spoke with quite a few patients about the concept of intuitive eating.  Hear me out, this is NOT what you think! 

Most often, when people talk to me about intuitive eating, they talk about “giving your body what it wants”.  This could mean eating a bag of potato chips in one sitting or a carton of ice cream.  Often this is with the misperception that if your body is craving something, it must have some deficiency in some nutrient or vitamin.  This can happen for medical reasons.  A great example is Pica in pregnancy.  Iron deficiency in pregnancy can lead to women desiring to eat nonfood items such as ice, dirt, etc. to try to meet their body’s need for iron, otherwise known as Pica.  However, I will tell you that for most people, this is not the situation.  I crave jellybeans, chocolate cake and Twizzlers, but I can tell you my body has never once had a deficiency of artificial food coloring/flavoring or any nutrients in those foods (if there actually are any). If you eat the standard American diet, you are likely NOT deficient in any micro or macronutrients unless you have another underlying condition (pregnancy, celiac, etc.).  So, I recommend starting any dietary changes with the assumption that you are well nourished.

More enlightened nutrition experts have suggested that intuitive eating is about recognizing your hunger, feeling your “fullness”, and coping with your emotions and feelings without using food.  I would agree to some extent with all those suggestions.  I think each of those things is critical to having a healthy diet and knowing when and how much to eat.  However, I don’t think it’s the whole story. 

So, what does intuitive eating mean?  I believe it means not only paying attention to what you desire, your feelings of hunger and satiety, and learning alternative coping mechanisms for emotional distress, but paying attention afterward to what the effects of foods are after you eat them.  What keeps you full and satisfied?  What powers your workouts best?  What foods or beverages cause you not to sleep as well? What is the best timing of your meals during the day and what is the ideal amount of food?  Listening to what your body tells you after you eat is just as important as recognizing hunger and fullness.  One of the best examples of this was brought to me last week by a patient.  She works nights and tells me that when she gets home after a long night and is hungry, she’s found that if she eats an egg frittata with veggies she sleeps well during the day and wakes up ready to go to work.  She noted that eating a sandwich doesn’t produce the same result.  After a sandwich she often wakes up hungry and still feeling tired.  Listening to and learning our body’s needs helps us intuit on future occasions what is going to best serve our health.  In this case, this patient now knows that when she gets home from a long night at work, her best chance of feeling great and being her best self comes from eating a combination of wholesome, fresh foods.  

Intuitive eating also means drowning out the outside messages from the media about what constitutes a health food.  Now, more than ever, the supermarket shelves are full of products with all types of eye-catching health claims on them.  Labels such as “natural”, “fat free”, or “no cholesterol”, and catch phrases like “super foods” or “super greens” are everywhere and imply the product is healthy, but the reality almost always falls short.  Intuitive eating means ignoring the baseless claims (i.e. granola bars with “healthy” printed on the label or supplements promising more energy) and eating the foods we know are good for us – fruits, vegetables, and other whole foods that come from the earth.  Real food doesn’t need a label telling you it’s healthy, natural or any other seductive descriptor.  In fact, real food doesn’t need a label at all.  We don’t need labels on apples, potatoes, milk, eggs, fish, chicken, etc. to know what they are or that they are natural and healthy for us to eat.  Our intuition tells us that they are good for us.  Why?  Because when we eat whole foods in a balanced meal, we feel good and our body remembers that feeling.  Like our intuition around other experiences/people/things, intuitive eating comes from increasing our perception of our own reactions and being aware of others’ behaviors/claims so that we can make better choices about what foods we really “want” to eat. 

So, consider trying real intuitive eating in the future to see what you can learn about yourself, your body and its needs.  I’m not saying that intuitive eating will cure all our cravings, late night binges, or fast food on the run.  However, listening to your gut and ignoring the flashy claims can go a long way towards making better, healthier eating decisions. 

Just some food for thought. ;)

Lemon Herb Chicken with Greek Salad

Greek Salad:

1. Start by rinsing all of your vegetables. Once rinsed, slice the Cherry Tomatoes in half lengthwise and place them into a mixing bowl. You’ll only need 10 or 15, so feel free to save the rest for a light snack later on.
2. To cut the Cucumber, remove both ends, then cut into quarters lengthwise. Remove the seeds by laying the quartered wedges flat on one side and run your knife diagonally down the length of the seedy portion. Be sure not to remove too much of the “meaty” part of the Cucumber. Discard the seed sections, then dice the Cucumber wedges into ¼ inch chunks and add them to the bowl with the tomatoes.
3. Remove both ends from your Shallot, then cut in half through the flat ends and peel of the skin. Lay either half of the Shallot flat and cut into very thin slices and add to the veggie bowl.
4. Measure out ½ Cup of Pine Nuts and add to the bowl.
5. Measure out 1 Cup of Low-Fat Feta Cheese and add to the bowl.
6. Roughly chop 1 Tablespoon of Fresh Oregano and 1 Tablespoon of Fresh Dill and add to the bowl.
7. Measure out 1 Tablespoon of Cider Vinegar, ½ teaspoon of salt, and ¼ teaspoon of Black Pepper, then add the to bowl.
8. Take one Lemon and zest the peel over your bowl of veggies. Then cut the Lemon in half and squeeze one half of the juice into the bowl.
9. Use a serving spoon to gently mix your veggies around so that they are evenly mixed and the “sauce” has covered everything. Set aside.

Seared Chicken:

1. Preheat oven to 400 degrees and place a large baking dish or tray in the oven to get hot. It should be big enough to fit all your Chicken Breasts. Start by wrapping each breast in a paper towel to remove any excess liquid. Once dry, lightly season each with a pinch of Salt and Pepper.
2. Roughly chop another tablespoon of each Dill and Oregano and place into a small dish. Rough chop 3 cloves of Garlic and add to the herbs. Zest the other Lemon into the herb dish and set aside. Cut the Lemon in half and set aside.
3. Heat a large saute pan with 1 Tablespoon of Olive Oil over medium-high heat for about 1 minute. Once the pan is hot, add your Chicken Breast one at a time and make sure they have about an inch of space between them. Sprinkle some of the lemon herb and garlic mix on the uncooked side of the chicken and gently press it into the meat a bit. If your pan is too small, just sear one at a time and set them onto a plate once the first side of each one is seared. Once the first side of the Chicken has been seared, about 2 minutes, flip it and sear the other side for another 2 minutes or so. This will also gently cook the herbs and garlic to bring out the flavor.
4. Once all your Chicken Breasts are seared, place them into the preheated baking dish, herb side up, and cook them in the oven until the internal temperature reaches 165 degrees. It should take 15-20 minutes, depending on thickness. (If you do not have a thermometer, you can cut into the middle of the thickest breast and check it internally. If you see any pink, it is not done. It should be white, but still a bit juicy.)
5. Once fully cooked, remove Chicken Breasts from the pan and transfer to a plate or resting rack to cool.
6. Once cooled, add about 1 ½ Cups of the Greek Salad mix to a plate of bowl. Slice your chicken into strips or chunks depending on your preference, and place them on top of the salad. Squeeze the remaining Lemon Wedge over the dish and enjoy!

Mushroom Tacos (4 servings)

14oz Impossible Sausage

16oz Chopped Mushrooms and Stems

1 Small Head Green or Purple Cabbage

1 Tbsp Peeled and Chopped Ginger

5 Cloves Chopped Garlic

1 C Water

½ C Sliced Green Onions

2 Tbsp Low-Sodium Soy Sauce

3 Tbsp Rice Vinegar

2 Tbsp Hoisin

1 Tbsp Coconut Oil

2 Tbsp Peanuts (garnish)

8 ea Cauliflower Torillas

1. Before cooking, we will prep our vegetables. Start by washing and removing the stems of all Mushrooms and set them aside. Cut Mushrooms into ¼ inch slices. Then roughly chop the stems and combine them all into a bowl and set aside.
2. Cut Cabbage by cutting in half from the stem down, then quarter. Remove Cabbage stems by slicing them off once the Cabbage has been quartered. Slice Cabbage into thin strips and add to the bowl of Mushrooms and set aside.
3. Heat a large saute pan for 60 seconds over med-high heat and add 1 Tablespoon of Coconut Oil. Once hot, add the Impossible “Meat” and begin cooking and stirring every so often, until evenly browned.
4. While “Meat” is cooking peel skin off of Ginger then roughly chop Ginger and Garlic, and thinly slice Green Onions. Add all to bowl of Mushrooms and Cabbage and set aside.
5. Measure out 2 Tablespoons Soy Sauce, 3 Tablespoons Rice Vinegar, and 2 Tablespoons Hoisin and add all to a small bowl. Measure out 1 Cup of Water separately and set aside.
6. Once Impossible Meat is cooked, add the bowl of vegetables and the 1 Cup of water to the pan, stir, and cover to steam. Don’t worry about the amount of food, it will shrink as it cooks.
7. Once Mushrooms and Cabbage have wilted and shrunk, add the small bowl of liquid seasonings and reduce heat to medium leaving uncovered.
8. Cook for about 5 minutes, then remove from heat.
9. Warm 2 tortillas for each person either in the oven or the microwave, scoop about 1 Cup of the meat/veggie mix into each tortilla, then top with crushed Peanuts and leftover Green Onions. Enjoy!

Eating healhy doesn't mean you can't enjoy your favorites! This goes great with a little bread or soft pita chips.

1 lb                  Extra Lean Ground Beef (90% lean, 10% fat)(Alternatively, you can use 1 lb Impossible Beef or even Ground Turkey)

2 Medium       Zucchini

1 Small            Yellow Onion

5 ea                 Button or Crimini Mushrooms

4 ea                 Garlic Cloves

8 oz                 Fresh Spinach

24 oz               Organic Marinara

8-10 ea            Fresh Basil Leaves

1 Cup               Low-Fat Cottage Cheese (optional)

¼ Cup              Shredded Parmesan (optional)

1. Start by cooking the Ground Beef in a large skillet until browned and all fat has been rendered out. Pour Beef into a strainer to drain any excess fat. Do not dump the fat into the sink, as it can clog your drain. Instead place a bowl under the strainer to catch the fat, then dump into the garbage once it has cooled. Save the meat in the strainer for now.
2. Cut your Zucchini by slicing it in half lengthwise, then into ¼ inch half moons and discard the ends. Place Skillet back onto medium heat, add the Zucchini to the pan, and let it cook.
3. Dice the Onion by removing the top, then cutting it in half through the bottom root. Lay one half of the Onion flat, then make ¼ inch wide cuts towards the root, but do not cut all the way through the root end. Then cut perpendicular to you first slices as close to the root as you can. Discard the root and add the diced Onions to the pan, then repeat with the other half of the onion.
4. Remove the stems of the Mushrooms simply by pulling or cutting them off. Cut the top of the Mushroom into quarter inch slices, then roughly chop up the stems and add it all to your pan.
5. Mince the Garlic by chopping them into very small pieces and add them to the pan.
6. Roughly chop the Spinach by piling it up and cutting until they are about ½ inch pieces, then add them to the pan.
7. Deglaze the pan by pouring in 3 Tablespoons of Balsamic Vinegar. Allow all your veggies to cook for 5 or 6 minutes to get rid of their excess moisture and absorb the Balsamic Vinegar flavor.
8. Once all your veggies have become soft, pour in the Marinara sauce and stir to coat all the veggies, and bring to a simmer.
9. Once the sauce begins to simmer, add the Ground Beef From earlier and continue cooking everything in the Marinara for 3 or 4 minutes. This will help the sauce thicken and absorb into all of the ingredients.
10. While everything in the pan is cooking, pluck about 8 to 10 Basil Leaves and stack them on top of each other like a deck of cards. Roll them into a tube then slice down the tube of Basil until you have a small pile of Basil strips, then add them to the pan and stir it up. Cook for another 2 minutes or so to thicken the sauce to your desired consistency.
11. At this point we will add our cheeses if you are choosing to use them. If not, reduce the heat to low and let it cook slowly. If you are adding cheese, spoon a few dollops of Cottage Cheese around the top of your Lasagna. Then sprinkle ¼ cup of Parmesan all around the top.
12. If your pan is safe to put in the oven, place it on the bottom rack and set your broiler to the lowest setting. Close the oven and melt the cheese. Broilers can be tricky to gauge, so be sure to check on it every 30 seconds or so to make sure it doesn’t burn, but a little bit of browning and bubbling is ok. Remove from the oven once cheese is melted to your preference.
13. If you do not feel comfortable placing your pan in the oven, you can also just place a lid on top of it and reduce the heat to low and allow the steam to melt your cheese.
14. Once the cheese is melted, you can scoop yourself a serving of this tasty One Skillet Lasagna and garnish it with some leftover Basil or just eat it as is. There should be about 4 to 5 servings in this pan, depending on your appetite, so eating about ¼ of the pan will be between 450-550 calories. Enjoy!

1. Start by boiling the pasta, because we want it cooled off when we add it to the vegetables. Bring a medium pot of water to a boil over medium-high heat. Once boiling, add 1 Cup of Rotini Pasta to the water and boil for 6-8 minutes, depending on your preference of texture. 6 minutes will be more al dente and chewy, 8-10 minutes will result in much softer pasta. You can always taste one before straining to find your favorite texture. While this boils, we will start cutting vegetables, so set a timer to remind you about the pasta and remember to stir every minute or 2. Once cooked, pour into a strainer, shake it up to remove any excess water, then add 1 teaspoon of Olive Oil to prevent the pasta from sticking together. Leave in the strainer to cool.
2. Next, we will prepare our vegetables. For this, grab a large mixing bowl to add ingredients into once they have been cut. Start by cutting 1 cup of Snap Peas into thirds, or smaller bite-size pieces, then add them to the bowl.
3. Cut 15 Cherry Tomatoes in half, then add them to the bowl.
4. Slice the ends off of the Red Onion and cut in half through the flat ends. Lay one half of the onion flat, then cut into very thin slices and add it to the bowl. The onion is pretty strong, so you may not need the other half in this recipe. Luckily, onions are great in any recipe, so feel free to save the other half for another meal!
5. Remove the ends of the Cucumber, then cut in half lengthwise. Cut the Cucumber into thin, half-moon shaped slices and add to the bowl. Once again, if you have a large Cucumber, you may be able to save the other half as a snack for later.
6. Open the package of Extra Firm Tofu, and drain any excess water. Wrap the tofu in a paper towel to absorb any extra moisture. Once it feels dry to the touch, cut the block into small quarter inch cubes. Add 1 cup of tofu cubes to the pasta salad and reserve the rest.
7. Remove some of the leaves from the Parsley and roughly chop them into fine pieces. Measure out ¼ cup of chopped Parsley and add to the bowl. Reserve any leftover parsley and place into a plastic bag with a paper towel to preserve freshness in the fridge.
8. Roughly chop 2 Tablespoons of Fresh Oregano and add to the bowl. Store the extra Oregano in the fridge.
9. Remove the skin from 3 cloves of Garlic and mince by chopping them into very small pieces, then add to the bowl.
10. Add ½ cup of Feta Cheese to the bowl.
11. Cut the Avocado in half by running your knife through the middle of the top until your knife hits the pit in the middle. Once you feel your knife hit the pit, rotate the Avocado around your knife until you’ve cut all the way through. Grab each half of the Avocado and gently twist until one half separates from the pit. To remove the pit, lightly hit it with the blade of your knife and twist. The pit should stay in the knife blade and then you can discard it. Cut one half of the avocado into cubes by gently running your knife through just the light green part until you feel it hit the inside of the skin. Do this in vertical lines, then horizontal lines. Try not to cut through the skin, because we will scoop the edible portion out with a spoon. Add the first half of diced Avocado to the bowl.
12. Now take the other half of the Avocado and scoop it into a separate, smaller bowl. Add 3 Tables spoons of Red Wine Vinegar and 1 teaspoon of salt to the Avocado, then mash it up with a fork until it resembles loose guacamole. If it seems too thick, add another splash of Vinegar or even some Lemon Juice. This will be our “sauce” for the pasta salad, also known as Vinaigrette.
13. Pour the Pasta from the strainer into the large salad bowl. Use a spoon to gently mix everything up, then add the Avocado Vinaigrette and mix until incorporated.
14. Now, simply add a scoop or two to a bowl and enjoy!

Bonus Tip: If you noticed, we have quite a bit of leftover veggies and ingredients. This is very common when preparing smaller portions of meals, because we often don’t need an entire onion or 30 tomatoes. The challenge of any chef or home cook is to find ways to repurpose these leftover ingredients to create something else instead of throwing them in the trash. Therefore, my test for you this week is to find ingredients in your fridge or pantry and use them to create something new! Good luck, Chefs!

My last day of work was April 3^rd, 2021.  I remember it well.  I went home and poured my husband and I a shot of Johnny Walker Blue that we had bought for the occasion.  It was a celebration of the end of my clinical career in medicine.  Over a decade gone since I graduated residency.  Down the hatch it went, burning the whole way down. 

That nasty turpentine like taste stayed with me long after that night.  In fact, whiskey happened to be a great metaphor for my last 10 years in medicine.  It’s sterile, hard to swallow, heartburn inducing nature is either something you can get used to or a bitter liquid that gets harder to choke down every day.  Indeed, medicine today has gone so far away from the sweet, bubbly, prosecco like quality that we all either remember or expected to find that I doubt you could locate anyone other than medical students who are still excited about the practice.  The ability to save someone’s life, change someone’s family tree or work with them to meaningfully improve their quality of life lies in stark contrast to the day-to-day existence of documentation requirements, billing and coding denials, HIPAA regulations, organizational KPIs, online training, etc. etc. etc. 

No one really knows when the wine changed to whiskey, but the insidious nature of it indicates it started with our language.  Years ago, when physicians were owners of their clinics and leaders of their hospitals, people were patients and not customers.  Patients were neighbors, friends, coworkers, and family.  Doctors provided care, not services.  Surgeons performed surgery, not billable procedures. The focus was on how people felt, not outcomes.  The language described what people did, not what insurance billed. 

When our language changes, so does our perspective.  With layers of administration, come new terms like ROI, value-based care, market share, etc.  Business terms previously had no business in the doctor patient relationship and in my mind, they still shouldn’t.  We all know this instinctively, so we change our wording to make the words that burn more palatable and easier to swallow.  Sales becomes marketing, payment becomes compensation, and mistakes become medical errors.  In the numbing process, we lose the humanity of medicine.  Hugs become handshakes, time in the room gets shorter and everyone feels rushed.  No one (doctor or patient) feels heard.  Interactions become about conveying information and less about the feeling and living.

April 3^rd, 2021 was my last day of work.  My last day of working within a system designed to separate the patient from the doctor.  After 8 months of decompression, deep introspection, and a lot of long runs, I was ready.  In 2022, I started a clinic designed to strengthen the doctor patient relationship.  Discreet Reductions is my answer to the question “What will I do now, now that I can do anything?”.  There are no layers of staff between myself and my patients.  When you call, you talk to me.  If you email or message through the patient portal, I answer.  I take your vitals, examine you, listen to your concerns and dispense medications and advice.  Discreet Reductions is not a business, but a passion project about bringing the joy back to medicine for both the patient and the doctor.  I want to show the world that the impossible can be done.  That medicine is not a business but can pay a fair wage.  That we should work towards improving health, not treating disease.  That while the doctor customer relationship burns, the doctor patient relationship can still effervesce. 

1. Preheat oven to 400 degrees about 10 minutes before video begins.

2. Remove the stems and gills from the Portobellos. The stems can either be pulled orcut off and the gills can easily be scooped out with a spoon. Rinse the mushrooms,gently shake off any excess water, then place them onto a baking pan, hollow side up.Sprinkle with a pinch of salt and pepper, then place into the preheated oven. Set atimer and bake for 20-25 minutes.

3. While the mushrooms are baking, start prepping your hash by dicing the potatoesinto very small cubes, about 1/4 of an inch thick. Do this by slicing the potato into 1/4inch circles, then cut them into cubes. There is no need to peel the potatoes, the skinprovides an excellent flavor and texture. After dicing, give them a good rinse to removeany excess starch.

4. The potatoes will take longer to cook, so heat your large saute pan over medium heatand add a teaspoon of oil. Once the pan is hot, add your potatoes and cover with a lid.This will help them cook a little quicker.

5. Next, dice the bell peppers by cutting off the top, close to the stem. Pull out as manyof the seeds as you can and remove the thin white membrane, or pith. Slice the pepperinto 1/4 inch strips, then dice them into 1/4 inch squares. Add them to the potatoes andstir a few times to mix it up. Put the lid back over the pan.

6. To dice the onion, cut off the top and bottom and discard. Cut the onion in half sothat each half has the top and bottom ends. Take one half and slice 4 or 5 times fromtop to bottom, like half onion rings. Turn the onion and slice the other direction,leaving you with evenly diced squares. Add the onion to the pan and stir once again.Put the pan back over the pan.

7. Dice the Tempeh into cubes about the same size as your potatoes. Simply cut theblock into strips, then cubes from there. Remove the lid and add the Tempeh to thepan, increase heat to medium-high. The potatoes should be sufficiently steamed at thispoint, so discard the lid and stir the hash every minute or so.

8. Add 2 teaspoons each of chili powder, cumin, and garlic powder to the hash and stiroccasionally. Cook for 5 more minutes, uncovered.

9. While hash is finishing up, heat a small saute pan, preferably non-stick, overmedium-high heat with 1/2 teaspoon olive oil and crack one egg into the pan. Cook theegg to your preference, Make one egg for each bowl.

10. The Portobellos should be finished by now, so put one on each plate and fill themwith your hash. Place an egg on top of each one. Finally, chop a few leaves of freshparsley and sprinkle over the egg as a garnish and enjoy!

I know a lot of people struggle with fitting in exercise into our day-to-day activities.  It seems almost impossible to carve out an extra 30 minutes to an hour from an already jam-packed day.  As someone who has run almost every day for the past 26 years, I can honestly say it’s not always easy to find the time.  However, through the years, I have learned some tips/tricks to make exercise happen. 

First, schedule it!  Treat exercise like any other appointment on your calendar.  Treat it like your job or your haircut, dentist visit, or kid’s after school play.  You wouldn’t just blow off your job for a week or two at a time randomly, would you?  You wouldn’t just no show your dentist, right?  Exercise is as critical to your health (or more) as getting your hair cut, keeping your teeth clean, or any other regularly scheduled appointment.  The only difference is that it needs to happen a lot more frequently.  Each week, look at your calendar and plan those appointments with yourself.  If you have an erratic schedule, this becomes even more important.  You may decide to just wake up earlier in the morning, because there are no guarantees after 8am.  You may need to put it on the calendar after the kids go to bed or you may need to change it depending on the day.  It doesn’t have to be pretty, it just has to get done.

Second, no backsies!  After you make the commitment, stick to it.  If I say I’m going to run tomorrow at 6:30a, I will be running tomorrow at 6:30a.  Nothing short of fire raining down from the heavens is going to stop me.  I don’t leave it to my 6:30am self to decide anything…ever.  I know that if I consider not running even a little, my 6:30am self will abandon all hope, pull the covers up and snuggle in.  I have even slept in my running clothes to ensure that I would get that run in.   Some common excuses that go through my brain are the weather (too hot, too cold or really any form of precipitation – even if just predicted, but not actual), feeling too tired, my day is so busy, or I might be getting sick.  I remind myself frequently that I won’t melt in the rain, that the extra 30 minutes of sleep isn’t going to make me bright eyed, and bushy tailed, and that my day will still be busy whether or not I go for this run.  The key is to not think about it.  The only exception I ever make is illness.  I have a rule that if the symptoms are from the neck upwards (headache, stuffy nose, etc.) then I’m going for a run.  If the symptoms are from the shoulders down (body aches, cough, etc.) then I give myself a pass.  It’s rare that I’m sidelined for illness because most of the time, the symptoms are usually in my head – real or imaginary ;).

Lastly, be consistent!  I generally go for a run every day.  My default is to run and if don’t, it’s because we have something on the calendar that makes it reasonable to take a day off.  For example, I may run 10 days in a row, but on the 11^th day I’m getting up early to fly to a conference, so I let myself take the day off.  However, it’s planned well in advance.  I know that I’m traveling that day and I have exercised every day that week already.  Every day I plan for exercise regardless of where I am or who I am with (traveling for work, visiting family, on vacation, etc.).  Being consistent is critical to success for a couple of reasons.  First, and probably most importantly, it means you don’t lose ground on your goals.  If you take a few days or a week off randomly here and there, it’s easy to slide backwards.  If you are consistent with exercise every day (even when you don’t want to), at a minimum you will maintain what you have.  Second is that the body loves routine.  You will get stronger, find it easier to lose or maintain your weight, and sleep better at night with daily exercise.  It will become like brushing your teeth – a weird uneasy sensation will wash over you when you accidentally skip a session.  Finally, to quote Simon Sinek: “Consistency is more important than intensity” in achieving our goals.  We all know that the person that works out once in a while, hard core for 45 minutes is not going to achieve nearly as much as the person who works out every day for 20 minutes.  The key to progress is consistency.  It’s not sexy or glamorous and some days, it’s a grind.  However, it’s showing up on those days when you don’t want to, putting in those workouts consistently day after day that make change happen. 

This idea that “consistency is more important than intensity” applies to every part of life and I got to experience this again recently with my German language studies.  As some of you may know, I’m relearning German to speak with my 7-year-old Godson who lives in Germany.  I lived there briefly in college in a study abroad program where I had a semester’s worth of German before I left (to say I was an A1 level learner was a stretch).  The levels are A1, A2, B1, B2, C1, C2 with C2 being a native language speaker.  The girl who was my roommate while I was there became my best friend and we have been best friends ever since.  She spoke Ukrainian, Russian and German at the time (no English), so my German improved rapidly and by the time I left 3 ½ months later, I was a level B1.  Over the next 20 years she learned English (and Polish) and I forgot German. 

When my Godson was 6 and speaking full sentences, I decided it was time to relearn German.  I realized I hadn’t learned anything in 20 years, despite saying I would – so I scheduled classes.  I also paid for these classes, so there was no excuse good enough for me to miss them.  I started in A2 and quickly remembered a lot of what I had forgotten and over the course of 6 months moved back into B1.  However, over the last 6 months the struggle has been real.  I’ve been stuck in B1, despite taking a 1-hour class per day and sometimes 2 hours on the weekends.  I have thought more than once that maybe I will never become fluent and should just give up and get an hour of my day back.  However, I have been reminding myself that if I keep showing up and learning every day consistently, I will get there eventually.  After a rough 6 months, I’ve finally had some breakthroughs.  Akkusative and dative cases are making more sense, my vocabulary is expanding, and B2 is getting closer by the minute.  The key has been and will always be to be consistent, especially when times are tough. 

So, as we go forward, I hope you can use these tips to help motivate and sustain you on your health journey.  It’s not always easy, but being consistent and showing up every day for yourself will get you where you want to go.  Lass uns gehen!

Orders that are placed between Monday and Friday will ship out within two business days, and orders placed over the weekend will ship out by Tuesday. There are exceptions to this based on unforseen circumstances including inventory, personnel and shipping delays.

We strive to keep our costs low so we can pass these savings onto our customers. As a small, locally owned business, shipping costs are by far our most significant expense. We will always try to accommodate returns within 14 days of delivery, but unfortunately do need to charge for return shipping (unless the product was damaged during shipping). Once products are opened we are unable to accept them for return. Items that are damaged in shipping may be returned, but please take pictures of the damaged items so we can make a claim with our shipping service. We will ask for pictures of the damaged product as well as pictures of the damaged shipping box. If your items were damaged in shipping we must be informed within 5 business days of delivery to be able to submit a claim and accept your return. In the event of package theft, we are not liable for replacement. The carrier (UPS, Fedex, USPS, etc) will also not assume liability for the loss. After the package is successfully delivered to your address the carrier and Discreet Reductions are no longer liable for package loss. If your package notes as "delivered" but the package was not delivered to your address, please let us know and we will open a claim with the carrier. At our discretion we may hold on issuing a replacement or refund until the carrier completes their investigation (as if they determine your package was stolen from your property they will not reimburse us for the claim). Thank you for your understanding.

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Have you ever heard of a “crime of opportunity”?  It’s a crime that is unplanned but happens when the perpetrator is in the “right place at the right time” to take advantage of a situation for their benefit.  While it has a negative connotation, I often look for “activities of opportunity” in the winter.  

For those of us who are not really into winter sports, December through April is a pretty rough time.  There’s usually a fair amount of snow and going outside in the cold can be quite unpleasant, especially when temperatures hover in the single digits.   After months working out inside, around February, the treadmill at the gym starts to look pretty boring.   If you’re anything like me, soon my motivation wanes and the cookies add up.  

However, opportunities to change things up while still getting in a great workout for free do exist!  You just need to remain vigilant and open minded.  For example, this morning I walked out on my driveway to 9” of new snow that had fallen overnight.  On any other day, this amount of snow could provide me with a decent 15-minute cardio workout.  However, I had the unfortunate luck of getting a new plow guy that piled up 5 feet of that snow onto a portion of my driveway…the portion I need to use in order to get out of my garage.  Sigh.

I was feeling rather burned out of treadmill running anyway, so I picked up my shovel and got to work.  An hour later the snow was relocated, and I had a great workout!  My back, arms and chest muscles are sure to be sore tomorrow, but I gave my legs a day off and feel mentally refreshed.  

Snow shoveling isn’t the only “activity of opportunity” in the winter though.  The possibilities are endless if you’re willing to bundle up and get moving.  We took our dogs out for a longer walk in the deep snow last night before the plows came through and our German shepherd loved it!!  Walking through deep snow requires significantly more leg strength and endurance than walking on a treadmill or around a track.  Use this to your advantage to improve your workout while taking in the fresh air and getting a little sunshine.

Digging out your car (or someone else’s) can snag you 5 minutes of cardio up to a couple times a day and may even give you the warm fuzzies in the process.  Pulling your kids around in their sled or building a huge snowman can get your heart rate up quickly.  Chopping or carrying firewood can be a chore…or a great opportunity to move around and work on your upper body strength.  Finally, cleaning up after everyone tracks in the snow and wetness into the garage or entry way by mopping, vacuuming or sweeping can add another 5-10 minutes of unplanned activity.  

The biggest thing is to keep your eyes open for these opportunities and take advantage of them when they arise.  Keep your planned daily physical activities going, but don’t be afraid to sprinkle in some good old fashioned outdoor chores regularly. 

Dr. Dietrich gave a presentation on the our diet and how it affects inflammation in our body. Check it out on YouTube HERE!

Lately, every time I go to the grocery store, I feel like prices have gone up.  Everywhere I look, foods that used to be “cheap” are suddenly marked up and stores seem to be holding fewer sales.  For the sales they do hold, I feel like these were the same prices a year ago when the items were NOT on sale. 

Unfortunately, according to the Consumer Price Index, my instincts might be right.  Prices for food have gone up 7% in the last year and certain categories have been hit harder than others - meats, poultry, fish and eggs are up over 12%!

For many, this has placed additional challenges on already strained budgets.  One of the most common refrains I hear now is that it’s too expensive to eat healthy.  However, when I say that doesn’t have to be true, I’m met with skeptical glances and side eyes…

From a bird’s eye perspective, fruits and vegetables are up only 5.6% year over year.  When compared with other categories, these may be less of a financial strain.  Pantry staples such as grains, beans, and legumes also remain more modestly priced and can be bought for pennies in the bulk section.  Both categories are full of fiber, vitamins, and minerals and are part of a healthy diet. 

However, the temptation for some people may still remain with “cheap” fast food.  After all, we all remember the dollar menu at the McDonald’s drive through.  Even though that’s long gone, some people point to the daily deals and value meals as cheaper options.  However, to prove this is not actually the case, my husband volunteered (meaning raced right over to the closest McDonald’s) to order a value meal for a side-by-side comparison.

On the day he shopped, it was “buy one, get one” Big Macs.  He bought two Big Macs, a medium fry and medium diet Coke for $9.38.  The total calories: 1,420 with 55g protein. 

The next day we went shopping for the makings of a tuna melt.  We went to Natural Grocer’s to look for high quality ingredients and tried not to purchase anything on sale.  We bought Dave’s Killer 21 Grain Burger Buns (160cal, 5g protein.  $5.85/8 = 73 cents), a can of Wild Planet albacore tuna (150cal, 32g protein.  $3.79/can), and Natural Grocers brand Cheese (1 oz – 110cal, 7g protein.  $6.36/8oz, 79 cents).  We used 1 tbsp of Mayo from the fridge (100cal, 0g protein) and a bag of Proti Chips (120cal, 14g protein. 10/$14 or $1.40).  For the tuna melt, we paid $6.71 and the total calories: 640cal with 58g protein. 

For these two meals, the tuna melt from home was $2.67 cheaper.  We also tried to get a deal at McDonalds and tried NOT to get any sales and buy only the highest quality, most ethically sourced food possible at Natural Grocers.  However, you can definitely find tuna, cheese and whole wheat bread for cheaper if saving money is the priority!  The tuna melt also has more protein, less saturated fat, less cholesterol and less sodium.  Plus, the tuna melt won’t set you back on your weight loss goals and it’s easy to throw together.  You can buy multiple cans of tuna, a block of cheese (or slices), and a package of whole wheat buns to make the entire week’s meals. 

If you wanted to step up your game even more, consider making a soup or stew from scratch.  A homemade lentil vegetable soup can be made over the weekend and frozen in lunch size portions to pull out of the freezer anytime during the week.  The recipe linked below costs $16.85 for all the ingredients (minus a few pantry staples) or $2.10 per serving.  Each serving is 475 calories with 21g of protein and 8g of fiber.  If your blood pressure is a concern, omit or reduce the salt and/or use low sodium broth. 

https://www.foodnetwork.com/recipes/ina-garten/lentil-vegetable-soup-recipe-1948822

McDonald’s meal:  $9.38 per serving

Homemade Tuna Melt with Chips: $6.71 per serving

From Scratch Organic Lentil Soup:  $2.10 per serving

Ultimately, it’s almost always cheaper to eat from home and definitely a lot healthier!  When doing your shopping for the week, plan for easy to make sandwiches or prep a large meal to break into lunch sized portions to reheat throughout the week.  With a little preparation, you’ll avoid paying more for food, both now and later.

This month I traveled to Germany to see family.  Between having family in multiple different countries (not to mention both coasts), vacations, work and medical education, I actually travel quite a lot – usually 1-2 times per month.  However, after so many years of practice, I feel like I have healthy living in any city down pat.  This trip was something special though…it was as if all the years of practice and training left me the second the plane took off.   

It started with not having much of a plan.  I had been so busy the last 2 months at work that I hadn’t gotten around to planning anything around our trip to Germany beyond booking the flights and a car.  I even forgot to book a hotel for parts of our stay.  I certainly didn’t look at the towns where we were going and forgot to see if the hotel had a gym.  (It didn’t, BTW).  After a really busy last week at work, packing and cleaning furiously on Saturday, we headed to the airport Sunday morning only to be turned around for a 6-hour delay as our flight got bumped.  We normally don’t eat in the morning, but since we had ample time, the trip started with brunch at Sophies.  Somehow with the travel, we ended up catching a late dinner in SLC and most definitely were not within an 8-hour window.  The next morning, we were up early and started the epic adventure that is traveling to Europe.  A very long red eye and multiple plane meals later (as you know, not my recommended meal plan) we arrived and had a 3-hour drive to Gernsbach.  We arrived at the hotel, tired, somehow hungry again despite multiple meals and not exactly sure what day it was.  Apparently committed to bad decision making at that point, we had a multiple course meal with wine and then went to bed.  Exercise had not even crossed my mind.  We also made the rookie mistake of going to bed later than we should have and ended up sleeping 14 hours until noon the next day.   Yes, you read that right, noon…

We had planned to go to Baden-Baden about 45 minutes away, so after a quick breakfast, we hopped in the car and headed over.  Again, exercise somehow got pushed back another day.  The next day we made it out of bed at 10a but had to pack and wanted to take advantage of the free hotel breakfast.  I figured I would get in a run when we got to our family’s house in Köln that afternoon, but what is normally a 3-hour drive turned into a 5-hour traffic nightmare on the autobahn.  We ended up just driving to a local restaurant they suggested to have dinner with them.  It was a lovely meal, but we had anticipated a healthy, home cooked meal and once again were thwarted from our good intentions by time and circumstance.  The next day I did manage to sneak in a run, but it was the only one for the entire trip.  We normally plan the days’ schedule in advance of our trip (the Germans are known for their love of plans and schedules ;) and we had forgotten to check in with them.  They had a full calendar for us!  Beyond the normal family brunch and visits, champagne and wine with friends, there was a 4 hour visit to the local pumpkin patch for my 7-year-old Godson complete with delicious German pastries.  There was also a 6-hour trip to pack medical supply boxes for the Ukrainian relief in Köln, and a 6-hour dining event at a famous local restaurant complete with 6 courses and wine pairings. 

Everything was amazing and so much fun, I don’t regret a minute of it!  However, the reality of the week’s culinary events and sedentary lifestyle hit me as we embarked on our 22-hour duration flights home.  A series of flights that, once again, I hadn’t planned for as I usually do with a more prolonged fast or at least some healthy meal options.  I realized that I was NOT looking forward to getting back to the grind and losing those pounds that found their way on while I was on my 10-day culinary world tour. 

However, this is not my first misadventure.  While I normally plan well ahead to avoid airport food, get daily exercise, and keep to an 8-hour eating window, I know that 10 days of poor eating and no activity does not end in complete destruction of a healthy lifestyle.  It may feel like it when you get started again, but the reality is that I can apply myself to my normal routine and be back on track within a month.  The first few days are always tough with a lot of fresh salads and sluggish workouts, but ultimately, I will feel much like myself again in a week or two.  

Why do I tell you this?  Because I want you to know that we all make mistakes.  No one lives perfectly and a healthy lifestyle SHOULD have occasional bumps in the road that make you go off course.  If I look back in my life, the best times were often when I did something I probably shouldn’t have (i.e. staying up too late with friends, going to that concert the day before a big test, etc.).  A little misadventure now and again is good and the road less traveled often comes with wonderful surprises and memories.  Often, I hear patients talk from an “all or nothing” perspective, but it’s what we do on a day-to-day basis that really matters.  It's being consistent with healthy decisions the MAJORITY of the time that makes for a healthy life.  It’s getting to the gym or going for that walk 5 times a week, consistently getting 8+ hours of sleep, or making good food choices 85% of the time.   It’s the day-to-day choices that shape us and make us who we are. 

I can’t tell you the last time this happened (definitely not in recent years), but I can tell you it will happen again at some point and I’m glad.  A perfect life is not worth living and black forest cake enjoyed together with your 7-year-old Godson is priceless.  My life lesson: take the road less traveled occasionally but make healthy choices daily.  Viel Spass!

It's time to stop trying diets that do more harm than good.

The year is 10,000 BC, a time when sabertooth tigers and wooly mammoths are still walking the earth. Humans lived in small tribes, and survived off of a hunter and gatherer lifestyle. The men would traditionally hunt, while the women would gather berries, fruits, plants and other food sources that they could find. Food wasn’t a guarantee, and no one ever knew for sure when they would have their next meal.

Luckily for the human race, our bodies are experts at preserving energy so we can stay alive when times are hard. Our resting metabolic rate is the number of calories we burn while we are sleeping, resting or not moving. Commonly referred to as our metabolism, this has the ability to be turned up or down, depending on whether food is scarce or plentiful at the time. 10,000 years ago, this was integral to the survival of the human race. Unfortunately, the evolution of our bodies has yet to catch up with our current lifestyles where calorie rich foods are readily available. As such, it continues to be easy to turn down our metabolisms, but much more challenging to turn our metabolisms up.

Why is this important? Our resting metabolic rate determines the minimum number of calories we need a day to maintain our weight. If your resting metabolic rate is higher, you burn more calories on a daily basis when you’re doing absolutely nothing. If it’s lower, you need to eat significantly fewer calories than another person in order to maintain your weight.

Thanks to evolution, when you starve your body for calories it goes into survival mode and turns down its metabolism. A modern day example of this is the popular TV show from the 2010’s called “The Biggest Loser”. Contestants would go on very low calorie diets and exercise in order to lose weight. And it worked! Of 16 contestants who participated in a scientific study during their time on the show, they lost an average of 128 pounds. However, this weight loss came at a cost.

During their time on the show, these contestants on average decreased their resting metabolic rate by 600 calories a day. That means in order to continue losing weight, they had to eat 600 fewer calories a day than they did prior to joining the show. Six years later, well after the show ended, the scientists who conducted the study followed up with the contestants. Six years after the show was over, the contestants had gained back 90 pounds of the weight they lost. Despite this, their basal metabolic rate was 700 calories lower than it was before they started the show. That was even lower than it was when they were on the show!

We have heard from our patients time and time again the same story:

"I did one of the very low calorie diet plans for 6 months, and during that time I lost 60 pounds. But the diet wasn’t something I could keep doing, and when I stopped the diet I gained back all the weight. And I didn’t just gain back the 60 pounds I lost, I gained an additional 15 pounds on top of it”

 Why is this? Because they significantly decreased their basal metabolic rate while on the very low calorie diet. When they started eating a normal diet again, their body immediately began storing the extra calories as fat. And it continued to do so. Our bodies still think it’s 10,000 years ago, and our body is worried that soon there won’t be enough food and it wants to store every calorie it can for when that day comes. Even though the diet works initially, it sets your body up for long term weight gain when you return to a normal diet.

That’s why we specifically recommend against very low calorie diets. Diets of 600 or 800 calories a day will lead to rapid initial weight loss, but this is not sustainable life long for most people. Rather than looking for the rapid, short term fix, we focus on strategies you can use life long to steadily lose weight and then maintain your goal weight. Through intermittent fasting you decrease your daily insulin spikes (which in turn leads to less fat storage). And through exercise and building lean muscle, you can increase your basal metabolic rate. This allows you to eat more calories, not less, and maintain your goal weight in the future.

Before you consider a very low calorie diet, pre-packaged food based diet or other “fad diet plans” out there come sit down with Dr. Katherine Dietrich to talk about other strategies that are going to work better in the long term.

What is “Sleep Hygiene”

The term “Sleep Hygiene” is all too well known to anyone who has ever struggled with insomnia, or poor sleep in general. Whether it was with your doctor, or doctor google, you invariably have come across this term at some point while researching what you can do to sleep better. And if you happen to take a board licensing exam, the answer to the question of improving sleep is in fact sleep hygiene, and not prescription medications as one may believe.

So first off, let’s talk about insomnia versus non-restorative sleep (or poor sleep as it’s called). Insomnia can be short term (less than 3 months) which is often in response to a life stressor, or it can be chronic. Chronic insomnia is defined as difficulty falling asleep or maintaining sleep more than 3 times a week for longer than 3 months. Difficulty falling asleep means it takes longer than 30 minutes to fall asleep, and difficulty maintaining sleep means you spend more than 30 minutes awake each night after having been asleep for a period of time. In addition to the difficulty sleeping, this lack of sleep must impair your day-to-day life. This can be through daytime fatigue, mood swings, increased errors, poor concentration, etc.

True chronic insomnia is less common than people who intermittently have difficulty sleeping. Remember, you need to have problems more than 3 times a week, for longer than 3 months, for it to meet criteria. And it has to impact your day-to-day life. For true insomnia, the best treatment we have is cognitive behavioral therapy in addition to improved sleep hygiene. For the more common condition of difficulty with sleep, that’s where sleep hygiene can play a major role.

So what is sleep hygiene? It’s practices you can utilize to try and improve sleep quality while limiting the time it takes to fall asleep. As you’ll see below, many of these come down to common sense. But if you truly think about how often you or people you know follow these practices, you’ll be shocked just how uncommon that common sense may be.

Sleep Hygiene Recommendations

Now that you’re an expert in the textbook version of sleep hygiene, it’s time to put it into practice. Rather than trying to tackle the entire list at once, it’s often better to pick one thing and incorporate it into your sleep routine every few days. For example, start with setting a bedtime and an alarm clock that you stick to every day – once you’ve become used to this you can look at getting rid of your bedtime Facebook binge. Just like Rome, you can’t build your foundation of sleep hygiene in just one day.

Guten nacht!

I’ll admit, I did about as much research into this topic as it takes to do one of those little scratcher lottery tickets at the local gas station.  A couple swipes back and forth and you know you’ve lost the game.  The reason I didn’t have to do much research though, was that the results were obvious as soon as I started scratching the surface.  Based on what I found, protein products on your grocery store shelves are disappointing at best and dangerous at worst.  Read on to understand what exactly is going into your OTC supplements.

Protein bars and shakes are a go to for a lot of people nowadays.   We keep them at work, in our cars, backpacks, gym bags, purses, and in the pantry for easy go to snacks for both kids and adults.  Ideally, they’re jam packed with vitamins, nutrients, and a good amount of protein to keep us fueled for a few hours while we are running during the day.  However, many come with added sugar,fat, excess calories,and some even come laced with heavy metalslike arsenic, lead and cadmium. 

This actually came to light over 10 years ago when Consumer Reports did an expose on Muscle Milk, EAS Myoplex, GNC, and several other well-known protein supplements. They found dangerous levels of contaminants including arsenic, cadmium, lead, and mercury in multiple supplements that could easily exceed maximum limits with normal daily intake of these supplements.  (https://www.consumerreports.org/cro/2012/04/protein-drinks/index.htm).   Unfortunately, the FDA does not require that dietary supplements like protein shakes and bars be tested to ensure they are safe and free of contaminants.  Many of these supplements do not list where they source their ingredients on their websites and, to cut costs, will source from questionable protein supply sources, such as many Chinese manufacturers.  In looking briefly into Muscle Milk, I found they were owned by Cytosport Inc. (which also makes Monster Milk and Cytomax brand), which was acquired by Hormel Foods Corporation which was then acquired by PepsiCo Inc.  Having trouble keeping up?  Yeah, me too…. I couldn’t find on any of their sites where they source their protein from and considering the results from the Consumer Reports study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509468/) I’m very concerned the right hand may not know what the left hand is doing.  Plus, I didn’t see any third-party certification of safety and purity such as GMP or NSF anywhere on their websites.

Since the Consumer Reports article came out in 2012, there are some new tricks being played on the public by protein companies.  In 2015, a lawsuit was filed against several major companies alleging a practice called “protein spiking” where cheaper non-protein substances are added to fool lab tests into indicating higher protein levels in protein products (  https://www.forbes.com/sites/alexmorrell/2015/03/12/lawsuits-say-protein-powders-lack-protein-ripping-off-athletes/?sh=594eebb07729).  CVS Health, Giant Sport, Body Fortress and MusclePharm are some of the companies named in the lawsuits.  In one test, a supplement containing “High Quality Protein” contained less than half of the protein it advertised.  Worse yet, the newest concern is for hydrolyzed leather protein (from animal skin scraps) being added to supplements from China and Hong Kong to increase the protein content.  The scraps often contain metallic contaminants that are unfit for human consumption.

After being thoroughly horrified by the protein powder industry, I decided to check out protein bars.  While I didn’t find multiple lawsuits on the first page of Google, what I did find was, in many ways, just as bad.  I haven’t purchased an over-the-counter protein bar in quite a long time so I decided to see if the protein bar selection had improved in the last 10 years.  I went to Natural Grocers on 24^th Street and picked up every protein bar they had to do a side-by-side comparison. 

Despite being labeled words like “healthy”, “natural”, “low glycemic”, and “the ultimate energy bar”, these bars were no better than most candy bars.  I included a chart below of the bars I picked up, but specifically I wanted to call out Clif Protein Builders bar.  They are labeled as “low glycemic” with 17 grams of sugar and ALL of it is added sugar…for shame Clif Builders, for shame!  The American Heart Association recommends a maximum of 24 grams of sugar (6 tsp) per day for women.  One of those bars and a teaspoon of honey and you’ve hit your maximum quantity of sugar consumption for the day!  Just for fun, I looked at a couple of my favorite candy bars and Kit Kat has 220 calories with 21 grams of sugar.  A snickers bar is 250 calories and 25 grams of added sugar.  If you’re going to eat candy, it might as well be real candy.

When I compared any of the grocery store bars to one of the DR bars, there was no comparison.  Calorically, each of the grocery store bars were significantly higher and often contained much more added sugar.  The only one that even came close was the Think High Protein Bar in Cookies and Cream Flavor.  Though topping out at 100 calories more than DR Vanilla Choco Protein and tasting like someone put chalk in a blender with a little glue, I’m not sure “close” is the right word. 

They say “you get what you pay for” and everything I am seeing in the protein supplement industry tells me that is true.  Over the counter/grocery store protein bars and shakes are often a little cheaper, but the safety of the product and the nutritional value is questionable at best.  If you’re going to use supplements to help navigate our crazy busy lives, I would highly recommend purchasing medical grade nutrition supplements from reputable companies like Celebrate, Robard, and Bariatrix.  Sure the packaging isn’t as flashy and you won’t see them on TV, but they often taste better, are lower calorie, have higher quality protein and are third party vetted, so you know they are safe. 

Come join Greg and Kat as they walk you through one of Kat's workouts! It's been specifically designed for you to do at home with little to no formal gym equipment!