Motivation to Quit Smoking

We are all on a journey, and at Plum Health we like to guide people to better lifestyle choices. For example, if you're trying to quit smoking, we can help you by reminding you of your commitment. 

How do we do this? It's really simple, actually. We just send you a text message! Here's a real life example, sent to one of our members last week: 

These are real text messages, and this is a real patient. Their name has been removed for patient privacy sake, but you get the idea. When you're a part of Plum Health, you are someone who I think about and that I care about and that I want to help. Sincerely, whenever I think about this person, I send them a text and ask - "how's it going?"

And, there is a great deal of evidence to support these types of interventions. There is a systemic review/meta analysis on Text Messaging-Based Interventions for Smoking Cessation in the Journal of Medical Internet Research that came to this conclusion: "The current meta-analytic review provides unequivocal support for the efficacy of text messaging interventions for smoking abstinence."

That's why I send messages like this:

Further, texting patients about their health can have different applications. For example, a text message to a patient regarding their exercise patterns or medication adherence can help them to achieve their goals.

So, what's your goal? How do you want to become healthier? Can I help you get there?

Thanks for reading, and have a great day!

- Dr. Paul with Plum Health 

Limitless or My Thoughts on Optimizing Productivity

This week I watched the movie "Limitless" starring Bradley Cooper. The film follows a struggling writer who can't seem to get anything done. Even though he has a book deal, he hasn't written a page, not even a word. He finds himself lingering at the bar, talking about what he might do rather than just doing it. 

Then, Bradley Cooper's character meets an old acquaintance who introduces him to a medication - NZT - that improves his brain's capacity to access information, concentrate and focus. Within 4 days, he finishes his book and within a month, he is the lead consultant on the largest corporate merger in American history. 

I found it interesting that the very first thing Bradley Cooper's character does when taking this mental capacity-enhancing medication is to clean his entire apartment. He literally throws away all of the things he doesn't need, washes his dishes, organizes his book shelf, tweaks the layout of his apartment, and sets up a desk that is most conducive to being productive. 

Hollywood hyperbole aside, I think this movie touches on some really important take-aways. First, how do you organize your life? What does your physical space look like? Are you able to be productive in that space? What about your schedule? Are you creating space in your schedule so that you can capitalize on your peak brain capacity, your peak productivity?

For me, I am most effective when I exercise first thing in the morning and then schedule myself 2 - 3 hours of un-interrupted work. I can really zero-in on the one or two most difficult tasks for the day. This is the time that I'm "in the zone" or experiencing a "flow state" - I am engrossed in my work and able to interact with complex thoughts and decisions. 

The time of day and how you mentally prepare for your peak productivity may be different for you. For example, you may be more productive in the night-time hours, after everyone else in your family has gone to bed. The point is this: it is incredibly important to think critically about how you structure your day and your life for optimal productivity, and even happiness. 

I believe that this has important applications for medical conditions, namely depression, anxiety and ADHD. Let's tackle ADHD, for example. With ADHD, the two mainstays of treatment are medications and cognitive behavioral therapy (CBT). And, in CBT, the focus is on time management, organization, and making short- and long-term plans. 

Here's why CBT is relevant for patients with ADHD, taken from CHADD, the national resource on ADHD: "CBT is relevant for adults with ADHD in two ways. First, in recent years, CBT programs have been developed specifically for adults with ADHD. Some of these programs aim to help adults overcome their difficulties in everyday executive functions that are needed to effectively manage time, organize and plan in the short term and the long term. Other programs focus on emotional self-regulation, impulse control and stress management".

As for Depression, if you are dealing with depression, and you are not structuring your day to include exercise, you may be missing out on a powerful form of treatment. Exercise can be a powerful antidepressant. However, the evidence is limited at this time. According to an article in the American College of Sports Medicine's Health and Fitness Journal, "Only two studies, both from researchers at Duke University, compared the effectiveness of exercise with pharmacotherapy. No differences between exercise and antidepressant medication were noted". 

Final takeaways, you have the power to improve your mood and your productivity by organizing your life. Think critically about how you structure your schedule, physical space, and mental space, and create your schedule around your peak productivity.

Thanks for reading, and have a great day!

- Dr. Paul with Plum Health in Detroit, MI

How many calories should I eat each day?

How many calories should I eat each day? This is a question that my patients commonly ask of me and there is not a one-size-fits all answer. There are several steps to finding the appropriate calorie intake on a daily basis. One of those steps is calculating your basal metabolic rate. 

Once you know your basal metabolic rate, you can add in the amount of calories that you burn each day from exercising. If you jog for 30 minutes each day, you may burn about 200 calories. If you do yoga for 30 minutes each day, you can burn around 150 calories. 

Take the number of calories burned in the day and add that to your basal metabolic rate. If you have a reasonably stable weight, you can estimate that you are taking in about that calorie total in your diet. 

Then you have to consider your weight goals. Are you trying to lose weight or gain weight? If you seek weight loss, then removing 100 - 200 calories from your diet each day may be a safe number for you to achieve your goals. Remember, in general, it is unsafe to lose more than 1 - 2 pounds each month.

Using an app like MyFitnessPal can be really helpful, especially if you are meticulous about documenting the foods that you consume and workouts that you perform each day. If you're a patient with Plum Health, I will review your data in the App and then we can make better decisions about dietary changes and exercise regimens. 

In general, my opinion is more about eating healthier foods, not necessarily less food. I recommend eating foods discussed in "The End of Dieting", found on Amazon here: http://amzn.to/2snb78z

In it, Dr. Fuhrman recommends eating GBOMS, Greens, Beans, Onions, Mushrooms Seeds and Nuts. The point is to get more nutrients/calorie and he sums it up this way: Health = Nutrients/Calorie. The more nutrients per calorie, the better your health.

Kale, Bok Choy, Quinoa, Blueberries, Almonds, Walnuts, Wild Caught Salmon are a handful of examples of highly nutrient dense foods! This would be in contrast to Iceberg Lettuce, bananas, peanuts, and ground beef - these foods are less nutrient dense then the aforementioned foods. 

Making healthier food choices, especially those foods that are nutrient dense, can help you to be healthier. Further, if you make organic selections, you will have less toxins in your body. Physician and author Dr. Mike Dow discusses the importance of eating organic foods in his book The Brain Fog Fix. 

I hope that this is a helpful and comprehensive answer for you! Thanks for reading, and have a wonderful day,

- Dr. Paul Thomas with Plum Health Direct Primary Care in Detroit, Michigan

Health Benefits of Plums

Plums are a great source of fiber and vitamin C. I recommend eating 4 - 5 fruits and vegetables each day, and Plums can be a great part of this. When you eat a healthy balanced diet, you don't need to take as many supplements; the foods that are available for consumption have all the essential vitamins and minerals that we need to be healthy.

As an update, we were recently featured in Crain's Detroit Business, so a big thanks to their editorial staff and Mark S. Lee for giving me the platform to spread the word about Direct Primary Care. Here's a video update:

Thanks for reading and watching, and have a wonderful day! Also, Happy April Fool's Day!

- Dr. Paul with Plum Health DPC

What Should I Read During My Pregnancy?

This week, I met with a young woman who is beginning her journey with pregnancy, child bearing, and starting a family. This is an exciting time and I'm happy to help young families as they make this transition. She asked me a question that I haven't been asked before, "what should I read during my pregnancy?"

As an avid reader, I wanted to recommend something. But, the truth is this: I haven't read any pregnancy books! I've been pushing this off until my own family becomes pregnant. I still wanted to answer the question, so I took it to my social media community and they showed up with some great responses.

First, they recommended books! This seemed like an obvious first response, and they had good reasons for each one that was recommended.

• What to Expect When You're Expecting is a perennial classic and best-seller, but it receives some criticism for being too "harsh, punitive, and almost like a parody". Or as a friend on social media put it: "What to expect when you're expecting scares the living crap out of me."
• The Mayo Clinic Guide to a Healthy Pregnancy is a guide written by Doctors who are Parents, too. This is "good for all the technical stuff", per social media.
• The Wonder Weeks
• Ina May's Guide to Childbirth and also the Guide to Breastfeeding
• The Happiest Baby on the Block
• HypnoBirthing, Fourth Edition
• Bringing Up Bébé, which gives a French perspective on parenting on child raising. 
• The Expectant Father, which is a dad's guide to pregnancy
• You and Your Baby, written by an Ob/Gyn, Dr. Laura Riley
• Expecting Better, a somewhat anti-establishment take on pregnancy and the birthing process that re-examines some of the hard and fast rules of pregnancy put forth by the medical establishment. 
• Nursing Your Baby, recommended by a Nurse Practitioner in the group.

However, some of the respondents in the group said don't read anything! "Too many opinions, too much to think about. Just go with the flow and trust your instincts." In fact, this sentiment was written by a family medicine doctor and colleague of mine, and it was echoed by another family medicine doctor.

This "read nothing" approach is an interesting take on the subject, but I second guess their thrust here because they have a significant amount of medical knowledge and practical experience in taking care of pregnant women and their infants. Most lay people and non-doctors lack this knowledge and experience, and that's why non-doctors gravitate towards reading books about pregnancy, child-bearing, and child-rearing: the unknown can be frightening! And some of that fright can be alleviated by reading and learning from the experiences of others. 

Finally, people mentioned subscribing to daily/weekly emails or downloading certain apps. This was best described by a friend on social media: "I read a few different books (i.e. What to Expect), but I found that subscribing to receive emails was most useful (what to expect, the bump). They gave quick summaries of important issues. Also, pregnancy apps have tons of good info and daily updates on what's going on in your pregnancy at that time." Another person recommended the BabyCenter app and the BabyCenter website.

My recommendation? As I said, I haven't read any of these books, used any of these apps, or carried a child to full term myself, so take this cum grano salis: pick 2 - 3 resources and enjoy the experience of pregnancy!

Thanks for reading and thanks to the community of moms, parents, and grandparents that responded!

- Paul Thomas, MD