Evidence based medical wellness for active people from a doc who walks the walk

November 4, 2016
by PookieMD

Friday inspiration: Beautiful souls–Gino Bartali, 80 yo ice skater, and my friend Paula Rinaldi

I am finally catching up to do a Friday inspiration.  There is a lot to cheer about! The Cubs won, the Colorado Buffs won (which is even more shocking!) and the fall has been unbelievably beautiful.  To celebrate some more, I want to share some beautiful souls with you.

Paula mountain biking, probably right before she did a triathlon!

Paula mountain biking, probably right before she did a triathlon!

First is my friend, Paula Rinaldi.  Paula is my twin sister from a different mother.  She loves to bike (she is a fanatic), hike, trail run and ski “steep and deep.”  What is not to love? She will be having knee surgery and we met today to share the dirt.  Paula is so fit that even with an ailing knee,  she inspired me to go tear it up at PT today.  Thank you, Paula!




Next, watch a couple of inspiring you tube videos.  The first is about Gino Bartali, an Italian cyclist that helped smuggle Jews out of WWII Italy. Then,  an 80 yo woman that still ice skates. Close to my heart, because that was my sport in my (much) younger days.  What will YOU do this week? Much love, my fellow beautiful souls!!







November 2, 2016
by PookieMD

Eating Resistant Starch, Un-sexy but Healthy

I wish I had some magic super food that we could all eat to reduce our waistlines, decrease our blood sugar and improve our cholesterol.  Something along the lines of a luscious chocolate torte or a mouth watering piece of blueberry pie.

Fat chance.

BUT! What you can do is eat “resistant starch.” And yes, you will need to over come your resistance to eating these decidedly un-sexy foods.  What is a resistant starch and why is potentially helpful?  Resistant starch is a type of carbohydrate that is not easily digested by the body, and provides tasty fodder for the bacteria that live in your large intestine.  The theory is that since the starch is not easily digested, the bacteria break it down into stuff like butyrate. (Like you care about the name.) Anyway, butyrate and it’s cousins may aid the gut’s cells in regulating insulin.  (This is theoretical, and a very short version.) Studies have shown that resistant starch can improve insulin sensitivity, decrease waist lines and improve cholesterol profiles. (Click here and here and here for studies.)

Resistant starch falls in to the category of may be helpful, and can’t hurt ya’. Therefore, it’s on to my list of things to eat if you are trying to decrease your risk of diabetes and high cholesterol.  I have a strong family history of high blood pressure, high cholesterol and “pre-diabetes.” So I am willing to eat resistant starch.

What foods have resistant starch, and how much of this “super food” do you need to eat?  The studies differed in men and women.  Men could see benefits with eating 15 grams per day, while women had to eat 30 grams per day. For women, the studies showed most improvement in post menopausal women.

And (drum roll)…The foods with most amount of resistant starch are:

  • Black beans: a half cup includes 8 grams of resistant starch
  • Pinto beans: a half cup includes 8 grams of resistant starch
  • Slightly green bananas: one small includes 8 grams of resistant starch.  (Blech, I hate green bananas!)
  • Yams: 1/2 cup includes 4 grams resistant starch.

    Beans, beans the magical fruit...

    Beans, beans the magical fruit…

Other foods with smaller amounts included barley, brown rice and corn (1/2 cup with 3 grams of resistant starch each) but to me, the amount is too small to be beneficial.  As a female I would have to eat 5 cups of brown rice to get 30 grams.  That is not realistic, and the calorie count from 5 cups of brown rice would be around 1000 Kcal!

It all boils down to this: eat lots of fruits and vegetables with high fiber content. By the way, I don’t know if using beano or something like that would reduce the effectiveness of eating the bean super food. I couldn’t find info to clarify this.

Sorry it’s no sexier than that!



October 27, 2016
by PookieMD

Taking a shower to improve muscle soreness: does it work?

I wish I was one of those hot-shot athletes that had a massage therapist, a cook and physical therapist that travels with them. Nope, I’m just a regular working class stiff, trying to find things that work (safely and legally!). And, I wanted to settle a long time argument with my husband about icing. My hubby loves to ice, and anytime anyone in the family is injured, he trots out our trusty ice device, wrapping the injured limb in a neoprene sleeve that circulates icy water and cools the injury. He thinks it is a magic bullet, even for muscle soreness.  But is there something better out there?

Well, kinda, sorta, maybe. A recent meta-analysis looked at what was better, hot/cold immersion (so-called contrast immersion) versus cold water immersion, versus hot water immersion, vs stretching vs compression garments. (Click here, my fellow science geeks, for the paper.)

  • Turns out, taking a hot shower alternating with a cold shower is better than just resting, with less muscle soreness and less loss of muscle power in the showering group.
  • However, Contrast Water Therapy was pretty much the same as cold water immersion therapy, in that both improved muscle soreness and decreased loss of muscle power.

    Does contrast immersion therapy work?

    Does contrast immersion therapy work?

  • Wearing compression garments for 12 hours was just as good as Contrast Water Therapy as was stretching.
  • All the studies called for immersion of the body up to the neck.  The contrast therapy alternated for about 2 minutes between baths of 50 degrees and 104 degrees F, for a total of 8 immersions. NOTE: 104 degrees is pretty HOT!

So, will I do it? Heck yeah! I don’t see a downside to alternating hot and cold showers, as long as I don’t drain the hot water heater! And, for the record, the only way I can claim a win vs my husband is the fact that the studies uses immersion, not an ice pack.

October 21, 2016
by PookieMD

Why I am drinking tart cherry juice

I got a little crazy at Vitamin Cottage the other day and bought some tart cherry juice concentrate. The theory is that it will make my  joints and muscles hurt less after exercise.  I did a bit of research, and it fit my criteria for supplements:

  1. It must do no harm. I refuse to take something that could hurt me.  (Black coash is a good example. There are documented cases of liver failure attributed to it’s use.)
  2. It is helpful, or may be helpful.

So here is the data:

  • Long distance runners have less muscle pain after an event if they drank sour cherry juice twice per day for 7 days prior to the event.  (Here is the dose: 600 mg phenolic compounds,  and at least 40 mg anthocyanins) Click here for the study.
  • Another study (click here) looked at 58 obese (BMI 30 or more) patients, split in to two groups.  One group received tart cherry juice, the other placebo. This part of the study lasted for 6 weeks, with the participants taking cherry juice or placebo daily. The cherry juice was mixed with apple juice and had 450 mg phenolic compounds, and at least 30 mg anthocyanins.  After 6 weeks, the participants took nothing for a week. Then those that hadn’t previously taken the cherry juice started taking it, and the other group switched to placebo for six more weeks.  The study had patients fill out the WOMAC score to assess pain and stiffness. (Click here to see it and take it yourself).  Those taking the cherry juice had decreased pain and stiffness compared to those that took the placebo. The (sad) kicker: the cherry juice drinkers were not statistically that much better than the placebo takers. Bottom line, the data doesn’t show a clear benefit from the cherry juice.

My WOMAC score was 30%, which is pretty low. (Yup, I should quit whining!)

BUT! Given that there are benefits with decreased muscle pain, and there may be benefits with decreased pain related to osteoarthritis, I’m slurping down my juice once per day.  It can’t hurt!

Here's my bottle of concentrated cherry juice. It doesn't contain any added sweetners. I mix it with water.

Here’s my bottle of concentrated cherry juice. It doesn’t contain any added sweeteners. I mix it with water. So far so good!

October 12, 2016
by PookieMD

Tim Ferris 2: Gelatin for joints — is collagen helpful?

This is part two in my analysis of Tim Ferris’ Outside Magazine article “Question Everything”, from the October 2016 edition.  Today I take a scientific look at, “Gelatin for Joints”.  In it, Ferris suggests using “Great Lakes’ hydrolyzed collagen” as a way to improve skin and joint health.

But does it work?

Well…kinda, sorta.

First off, he is taking hydrolyzed collagen. This is different than undenatured collagen.  When I did the research, the science shows that undenatured collagen has some benefits for people that who have osteoarthritis (“wear and tear”) arthritis and rheumatoid arthritis. The hydrolyzed collagen is not as effective.  Click here to read the study I found.

Anyhoo, the study above looked at undenatured collagen, taken at 40 mg a day vs  daily dose of 1500 mg glucosamine and 1200 mg chondroitin.  Patients that took the collagen had decreased pain with walking and doing “domestic activities.”  Additionally, patients that took the undenatured collagen took fewer other medications like ibuprofen and acetaminophen (tylenol). Patients that took the collagen had fewer side effects (constipation, headache) than those on glucosamine and chondroitin (bloating, stomach pain, hives, water retention.)

So, would I take undenatured collagen? Yes. I think it could be helpful, and the side effects appear to be mild. And if it doesn’t work, or if there are side effects, I would just stop taking it!

But, just to be clear, I would buy the undenatured collagen, not the hydrolyzed collagen! And check the label to see how much undenatured collagen is in it.  I would keep with the study guidelines of 40 mg daily of undenatured collagen.

Here is what you can find on the back of the bottle:

Supplement Facts
Serving Size: 1 Capsule
Servings per Container: 120
Amount Per Serving % Daily Value
Calcium 81 mg 8%
UC-II® (25% undenatured type II collagen) 40 mg *
*Daily value not established.
Other Ingredients: Dibasic calcium phosphate, gelatin (capsule), colloidal silicon dioxide and magnesium stearate.

October 7, 2016
by PookieMD

Friday Inspiration: Giving back

My life is filled with inspirational moments. I took care of a gravely ill patient this week, who was so sweet and positive that I was filled with inspiration to do better and be better. During these moments, I cherish being a physician as every day can bring new amazing people in to my life. Please find a way you can give back this week and share it with me!

To get you started, read, listen and enjoy this weeks of “curated” (sorry, had to use that word!) inspirational pictures, sound bites and you tube videos!

I saw this ad, and loved it. Thank you Jockey for this beautiful picture!

Jockey's hunky model

Jockey’s hunky model

Next, a glowing blue side walk, powered by solar energy. Created in Olsztyn, Poland, the special  “Luminophore” particles embedded in the pathway collect energy from the sun. Makes me wanna go ride on it because it is so beautiful!

Luminescent bike path in Poland makes you want to go ride your bike.

Luminescent bike path in Poland makes you want to go ride your bike.

Last, a physician that treats rape victims in the Democratic Republic of the Congo. God bless Dr. Mukwege, who was nominated for the Nobel Prize for his work!









October 5, 2016
by PookieMD

Deconstructing Tim Ferriss “Question Everything” article in Outside Magazine

Outside Magazine’s October “special fitness issue” contains a five page article by Tim Ferriss (of Four Hour Work Week fame) containing “the best tactics, routines and insider tricks…” to improve fitness and health.  The article is packed with things Mr. Ferris has tried and found helpful. I thought it would be interesting to examine some of his “tactics” to see if science holds them up as viable ways to become more fit and healthy. Now, let’s be clear here: I am not a hater, but rather a lover of science and evidence.

Outside Mag's October Issue with Tim Ferris

Outside Mag’s October Issue with Tim Ferris

First up:” Heat is the new black.”  In this tip Mr. Ferris references a podcast done on his show by Rhonda Patrick, PhD.  In the podcast, Dr. Patrick discusses taking a sauna after a work out and suggests that it has several helpful effects. She references a study done with six male runners, endurance runners or triathletes, average age 23, who either took a sauna after a work out or did usual post exercise cool down.  The study showed that in this population, runners that took a sauna after a work out were able to run 32% longer than those that didn’t.  This is hardly great science, and it is not necessarily applicable to all.

In addition, Dr. Patrick suggests that taking a sauna will improve hypertrophy during immobilization,  (I.e. if you are injured and unable to move!)  The scientific support she supplies is from a study on immobilized rats (27 rats with plaster casts on crutches!) In the study, the rats that took saunas had bigger leg muscles than those that didn’t sauna. I don’t think this can be generalized to immobile humans.


Taking a sauna after a work out will likely not hurt you if you use heat in a rational manner. It may even help, and I will consider adding this to my work out routine.  However, I don’t think there is enough convincing evidence that it will improve endurance and muscle hypertrophy. More evidence is necessary.

BTW: I subscribe to Outside Magazine. I just don’t subscribe to everything I hear and read. For your pleasure, here is a p0dcast about “heat stress” from Dr. Patrick.  Click the blue links for the studies.

September 30, 2016
by PookieMD

Friday Inspiration: We are what we think we are

We all make choices, and what choices we make have profound impact.  It all starts with the stories we tell ourselves, and these stories impact the choices we make, which in turn shapes our lives. Our stories and words should inspire us to move past what we are to what we can be.  We all are capable of so much!

Which will YOU be?

Which will YOU be?

Since it is election season, I thought I would share my favorite book of all time, Team of Rivals, about Abraham Lincoln.  Lincoln’s list of “failures” is almost longer than his list of successes.  He failed in  business, lost races for the state legislature, speaker of the state house, US congress, US senate (TWO TIMES!), vice president, and somewhere along the way had a nervous breakdown.  Of course, he went on to become one of our best and most beloved presidents!  Check out the book. It’s hefty, but so well written, I couldn’t put it down.  We all know he dies in the end (duh!) but how he deals with all the politics, persoaln tragedy and various agendas is awe inspiring. What stories do you think he told himself?

My most favorite book of all time, Team of Rivals

My most favorite book of all time, Team of Rivals

Last a video to lift you up! I love this video. We are never too old or too young to tell ourselves what we can be and become.

September 28, 2016
by PookieMD

How to be more resilient in sports and life

My daughter was complaining/worrying about something. Out of my mouth came this pearl of wisdom: “Life will serve you up a sh*@ sandwich, but you don’t always have to take a bite.” In retrospect, I was trying to teach her to be resilient. So what is resilience? Resilience is the ability to get knocked down, and not only to stand up again, but to move forward.  I read a great paper in which 10 Olympic gold medalists were interviewed about how over coming adversity helped them win a the gold.  Here are some pointers from the paper for those of us who don’t have gold medals!

  • View stress and pressure as an opportunity for growth and development.
  • Use negative emotions as motivation for improvement.  Many Olympians were angry at getting passed over, or under performing.  They used these “negative” emotions to focus more intently and increase their efforts.
  • Step back and think about why the event happened.  Olympians had to get over “why me” and move to “why”.  Once they were able to analyze why they didn’t perform as they wanted, they could then make a plan to overcome what had happened.  The athlete had to calm down enough to analyze the event in a “cool” manner rather than becoming “hot” (angry/overwhelmingly frustrated.)
  • Actively seek “stressful” events as a mechanism to cope with failure and as a mechanism for growth.

I heard a great podcast interview of one of the authors, Mustafa Sarkar PhD, on the podcast “Coach Your Best”, a podcast by Jeremy Boone. Click here for the link to the podcast.

I was told, during a medical school interview, that I would never become a physician because I wasn’t smart enough. I will never forget that, and frequently used it as motivation when I was tired or discouraged during medical school.  I still can picture the physician who said that, me sitting in my interview outfit, hands sweating, and he sitting at his desk, talking down to me.

Take that!

And, just for fun, check out the “Weebles” YouTube. Remember: weebles wobble, but they don’t fall down!

September 23, 2016
by PookieMD

Friday inspiration: my fall most awesome list

I was walking outside in the beautiful fall weather, and it hit that there are so many awesome things out there. So here are my Most Awesome Things.  Please share your awesome things!

Most awesome shoes after knee surgery: I have worn this shoe brand for about three years, and it has made walking tolerable.  I know they look like clown shoes, but any port in a storm.

These are my Hoka "clown shoes." Love 'em

These are my Hoka “clown shoes.” Love ’em!

I have tried other brands, and nothing compares. And yup, this is what I wear to work.  I actually have a shirt to match….

Most awesome place to work out: My YMCA.  Such a great deal! And they have reciprocal arrangements with other Y’s in the area.  Check out your local Y!

Most awesome ski run: Prima at Vail.  I hope to back on my favorite run this season.  I love bumps, and can’t wait to get out there! Lots of strength work to do til then!

Map of Vail with my favorite run.

Map of Vail with my favorite run.

Most Awesome podcast: it’s a tie.  I am lapping up “Better Humanology” and also love “I’m Not You.” Better humanology takes on a variety of fitness topic from the perspective of two friends, one is Jerred Moon, a former Air Force Fighter pilot that runs a fitness business, and his friend Talon Schwalm, who is a counselor.  I’m Not You is a podcast from Olaniyi Sobomehin, a former NFL player.  He talks about sports motivation.

Most awesome movie: Hoosiers! I have watched this again and again!


Most awesome physical therapists:  RevoPhysiotherapy and Sports Performance, Today, I got to 13131620_1739875992917628_4448341150396835171_o.jpgget on a force plate.  It (briefly!) measures how much force I put on my legs when I jump, and it is hooked up to video cameras and a giant screen.  They also used a computer program to analyze what I am doing right (and wrong!)  It was awesine, and inspiring, and made me feel like a big time athlete!  Thank you Brian Briggs, Dane DeLozier and Matt Smith for always believing in me, and the constant encouragement!