Q&A: best exercise hacks; when to take probiotics; limits on Advil use; & soy and breast cancer risk
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ICYMI 👉
The first question (about optimizing exercise) is free for all subscribers. Questions 2-4 (on when to take probiotics; how much Advil is too much; & soy and breast cancer risk) are for paid subscribers only.
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
QUESTION #1: BEST EXERCISE ADVICE 🏃🏽♂️
I know I’m supposed to do some form of aerobic exercise every week … my doctor tells me all the time but I don’t feel like I have the time or motivation to do so. What are some easy & accessible ways to exercise? I need a jump start or a miracle maybe .. thanks in advance.
-Christine
Dear Christine,
Patients tell me all the time that they have no time to exercise. I get it. For busy people, it can feel overwhelming to get started when you aren't in a regular habit of exercising. However, I will remind you that even a 5-minute walk around the block is better than nothing. Just taking the stairs instead of the elevator counts as valuable movement in your day.
Also, know that changing habits takes about three weeks to take hold. So, if you decide to start exercising, I wouldn't give up if you hit the snooze button two mornings in a row. Try again, and give yourself a break if you don't follow through on every promise to yourself.
Patients also regularly ask me, What’s the best kind of exercise to do?
That’s easy to answer. The best exercise for you is the one you will do—which is one that meets three of the following four criteria:
You enjoy doing it.
It doesn't cause pain or injury.
It fits your budget and schedule.
It’s social.
There is no “right” mode of exercise. In an ideal world, people would get 150 minutes of exercise per week, with a combination of strength training, cardiovascular exercise and stretching. However this can be difficult for mere mortals. If you’re in a rut of non-activity and you want to get started on exercise, my best advice is to start by tricking yourself into exercising. Take the stairs, chase your kids around the house, shimmy while you vacuum. Walk whenever you can, and know that 10 thousand steps isn’t a magic number. And if you already enjoy walking, try wearing a weighted vest in order to “supercharge” your cardio and add upper body strength. Voila!
My other favorite trick? Put on exercise tights when you wake up on Saturday and Sunday mornings. I call this the “eventual exercise” plan, such that if you happen to move toward the post office, for example, suddenly you’re wearing the right clothes to walk there instead of getting in the car.
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QUESTION #2: WHEN TO TAKE PROBIOTICS 🌿
Should I take a probiotic? The Gut microbiome & “bif” are in the news a lot… how does one know if theirs is “healthy” or in need of supplementation? Do you see the value of testing such as “GI Mapping”?
-Reagan
Dear Reagan,
It is probably safe to say that your own gut microbiome is healthy if you have regular, formed bowel movements and you don’t experience excess gas, bloating, or abdominal pain. The absence of gastrointestinal symptoms generally suggests that the diverse array of bacteria, viruses, and fungi that reside in your GI tract are working together to maintain balance and protect against harmful pathogens. (Note that “Bif” is short for a species of healthy gut bacteria is called Bifidobacterium.)
However, if you do have these symptoms, this can indicate an imbalance in the microbiome, known as “dysbiosis,” which has been linked to a variety of health conditions, including inflammatory bowel disease, obesity, and even mental health disorders.
GI mapping is a type of stool test that analyzes the gut microbiome and provides detailed information about the composition of bacteria in the gut. This type of testing is designed to identify imbalances in the gut microbiome and determine the most appropriate treatment or supplementation plan. In clinical practice, however, I have not found these tests particularly useful unless I am looking for causes of an active infection in a patient with gastroenteritis (i.e., acute GI distress after travel, recent antibiotics, or eating spoiled food).
I find that the most helpful way of identifying potential triggers of gastrointestinal distress is to start by writing down what you eat and drink every day. Common things are common, like GI symptoms due to caffeine, alcohol, sugar, dairy, and processed foods. Recall that the gut is the final common pathway for everything we put into our bodies! I also recommend taking an honest look at your emotional health. While it may sound kooky to some, stress often “lives” in our gut, such that addressing these issues head-on can be better than any probiotic. Last, see your doctor. Gastrointestinal woes can also stem from a variety of other health conditions—from diabetes to colon cancer—so be careful not to load up on probiotics before getting to the root cause of your symptoms first.
So, should you take a probiotic—one that includes Bifidobacterium—as a matter of course? I sometimes recommend probiotic supplements for healthy people when:
They are taking antibiotics for an infection.
They are elderly (our gut microbes aren’t as robust as we age).
They are recovering from a recent gastrointestinal virus.
For now, and until we have more compelling data on the general utility of probiotics, I agree with Dr. Allan Walker, Professor of Nutrition at the Harvard Chan School of Public Health and Harvard Medical School who says, “If you’re dealing with a healthy adult or older child who isn’t on antibiotics, I don’t think giving a probiotic is going to be that effective in generally helping their health.”
QUESTION #3: LIMITS ON ADVIL 💊
I read a recent NYT article about how much Advil is too much. What do you think of this, and do you commonly recommend Advil to your patients?
-Sally
Dear Sally,
Advil is one of the brand names for ibuprofen, which is an over-the-counter anti-inflammatory medication. It’s a cousin of Motrin. Advil is a terrific medication for certain conditions like acute skeletal pain, fever, and migraine headaches. However, taking ibuprofen has potential downsides. It can injure the kidneys and liver. It can elevate blood pressure. It can irritate the lining of the gastrointestinal tract, particularly the stomach and esophagus. It can trigger reflux/GERD symptoms. It increases the risk for bleeding and bruising. So it's important to talk with your doctor before using it on a regular basis—or at all, depending on your health issues.
The other main problem with Advil is this: because it effectively treats pain and inflammation, it can mask symptoms which, ultimately, should be treated with other modalities. For example, take a common scenario I see in my practice: a patient with chronic back pain takes Advil on a regular basis. The Advil might lessen the pain enough for the patient to not engage in the physical therapy exercises they need (specifically to strengthen their core and glute muscles), such that the back pain only gets worse.
In other words, Advil is a wonderful medicine for short-term relief from pain and inflammation, but it’s not a long-term solution.
QUESTION #4: SOY DURING BREAST CANCER TREATMENT 🥛
I am in long-term treatment for metastatic breast cancer. I've been stable for a number of years on anti-estrogen meds. Is it safe for me to eat small amounts of soy-based foods?
-Judy
Dear Judy,
While it's understandable to be cautious about soy-based foods due to their phytoestrogen content, current research suggests that consuming moderate amounts of soy-based foods is safe for women with breast cancer, including those on anti-estrogen medications. In fact, some studies suggest that soy consumption may even have protective effects against certain types of cancer.
However, it's always best to consult with your healthcare provider or a registered dietitian who is familiar with your medical history and treatment plan to get personalized advice.
Soy milk can be a nutritious part of a heart-healthy diet, as it is low in saturated fat and cholesterol-free. It provides protein and can be a good source of calcium and vitamin D if fortified. Again, it's essential to consider individual health needs and preferences when making dietary choices.
Adding edamame beans for added protein is also a great idea, as they are a rich source of plant-based protein, fiber, vitamins, and minerals. As with any food, moderation is key, but incorporating soy-based foods like edamame into your diet can contribute to overall health. I hope that helps!
My husband, the nephrologist, always harps on “too much ibuprofen as a cause of renal failure.”
But how much is too much?
Always great information and often results in some interesting family conversations!