No need to cut back on red meat? Really?

That's the message from the authors of this paper in the Annals of Internal Medicine.

Their message:  There is no need to cut back on red and processed meat, because it doesn't reduce risk that much, and people like meat a lot.

As you would imagine, there was a lot of pushback when this was published.  There were responses from the Plantrician Project, the True Health Initiative featuring former president of the American College of Cardiology Kim Williams MD,  Neal Barnard of the Physicians Committee, and David Katz, and even one of the co-investigators objected to the final publication.

What are the problems with this study?  I'll summarize here, and more thorough reviews as highlighted above go into more details.

*The methods used here were not suited to studies on nutrition.
*Studies that compared a standard diet to a vegetarian or plant-based diet were not included.
*The authors DID find that red meat increases risk of disease -- they just argued that people like red and processed meat so much that they're not willing to give them up.

Red meat is a known carcinogen, labeled as such by the World Health Organization.  Further, the places in the world where people live the longest, these places have very low meat consumption.

Cardiologist Mom / Maternity Leave

Ava was born on August 10, after a very good and uneventful pregnancy, after years of trying to make her, without success, and getting just plain lucky.

And here she is at 8 days:

And here.  Look at that smile, oh my gosh!

This is my first day back at work at 16 days.  Baby came to the office while I saw patients over a couple of hours.

Why back at work so soon?  Because, it's my practice.  It's hard to step back, and not lose patients.

I did take a full two weeks off.  I had carefully planned over the months of my pregnancy to schedule the majority of follow ups in October and November so that this time wouldn't be so busy.  Also, I was fortunate to have Dr. Alice Perlowski fill in at the office a couple of days, to see patients who had urgent issues and needed to be cared for.

I'm back in the office on a part time basis, for now just the mornings.  Baby is at home with our nanny while I'm at work at this point, she has a bottle of breast milk while I'm gone.  I feed her right before I leave, and right as I get back home from work.

While I love having my own practice, and I don't regret for one second going solo nearly two years ago, this would be one big down side.  I don't have the luxury of being able to take two or three months off completely.  

That said, I've done my best with the situation, to strike a balance between feeding and raising my baby, and keeping my business going.

I don't think that cheese is vegan....

We ordered pizza for a special occasion from a local pizza place.  The restaurant is not all vegan, but they do pride themselves on providing vegan options.  And, I've had their pizza before, and it's been pretty good. 

(Yes I'm a cardiologist, and no I don't eat pizza all too often.  This was a special occasion.)

There were several pizzas with the order, and only one that was ordered as vegan, as I was the only vegan among the group.  Someone had even gone to the effort to write "vegan" on the box, so I didn't think twice when I helped myself to a slice.

Something seemed odd about the pizza, a taste and a consistency that was unfamiliar.  As I continued to eat, I noticed the consistency of the cheese didn't seem like that of the Daiya non-dairy cheese that I'm accustomed to on pizza, and I began to suspect that this might have been dairy.  Rather than say anything, I stopped eating the pizza and helped myself to some salad.

About 30 minutes later, my stomach felt quite upset, and without providing graphic detail, it became clear that all was not well.

From the website of Cruzer, the only all-vegan pizzeria in Los Angeles.  I wish they were closer to where I live.

Maybe I'm just imagining things... and it really was vegan cheese?  So, I brought the leftover pizza home that evening to my lactose-intolerant boyfriend and showed it to him without saying anything.  His response:  "That looks like dairy cheese."

I called the restaurant, and the owner was the one who picked up.  I explained that I think that a vegan pizza that we ordered probably was made with dairy cheese.  She was skeptical, explained that they cater to the vegan community and that would not happen.  I said, "I'm about 99% sure this is dairy."  She asked me to take a photo and send it to her cell phone.

Upon sending the picture, I received a call back almost immediately.  As it turned out, our order came in at the same time as an order that included a vegetable pizza with dairy cheese.  The group that had ordered the vegetable pizza had called earlier, upset about the "funny" cheese on their pizza.  It looks like the pizzas from the two orders had gotten mixed up.

The owner sounded beside herself.  She was very apologetic, wanted to know what she could do to make it up to me.  I said I understood, it was an honest mistake, and the next time we visit, a pizza on the house would be great.

Now, I could see someone getting far more upset over this.  One could have posted a nasty one-star review to Yelp, or a long-winded social media post naming the restaurant and suggesting that vegans should boycott.  

I don't think that would be a good way to deal with this.  Even though the restaurant isn't all vegan, they do have many vegan choices, and as a result I want their business to do well for making the choice to provide vegan pizza.  Further, it does no one any good for vegans to come off as mean and self-righteous.  While I probably won't order from this restaurant again any time soon, I do want them to continue to have vegan offerings and view the vegan community positively.

What would you have done?

Working Out Pregnant -- up to 25 weeks

Big news -- I'm pregnant, and due on August 23!

There are so many misconceptions about exercise and pregnancy, that I want to share what I've learned.  My doctor was a good resource of information, but there is valuable information online as well.

Exercise is Important During Pregnancy
There are so many benefits -- exercise during pregnancy makes the stress of labor easier, decreases lower extremity swelling, and reduces the risk of gestational diabetes and preeclampsia.

My experience:
I have continued to work out, averaging about 5 days a week.  Most workouts are at Barry's Bootcamp, which is less than a mile from my home.  Sometimes I go for a jog on my own, or I go to a spin class, but my favorite workout remains Barry's.  Barry's is a one hour workout, half treadmill running, and half strength training.  It's not easy, especially pregnant.  To keep up with the running, I drop the speeds a bit.  My jogging speed is 4.5 mph instead of 5, and I subtract one mile an hour from any speed that is called out.  If I feel like I can run faster than that one mph handicap that I give myself, I'll pick it up.

Today, at 25 weeks of pregnancy, I ran successive 30-second sprints at 10.2, 10.3, and 10.4 mph.

What I've Noticed:

Up to week 8 -- Working out was a bit tougher.  But doable.

Weeks 9-13 -- Morning sickness!  Fatigue definitely set in, but worse than that was the nausea.  I'd have to stop periodically to dry-heave, but once that would pass, I could keep going

Weeks 14-25 -- The morning sickness let up by about week 16.  With a few modifications, I can still keep up with class.

This is me with trainer Scott Haddock, whose leg classes I take on Tuesdays and Thursdays.  I finished off a "Face Yourself Challenge" by taking 19 classes in 30 days.  A tough feat, more challenging doing it during second trimester of pregnancy.  The card sort-of covers my growing belly.

What I've Learned:

There's so much nonsense online.  I look to sources like this, from ACOG, the American College of OB-GYN, for good information.

It's safe to get your heart rate up.  Even as recent as a couple years ago, pregnant women were told not to get their heart rate above 140 beats per minute.  This is no longer the case.   As a vigorous exerciser, I continue to push my limits when I run on the treadmill.

You can do sit-ups.  I made the mistake of trusting Google before talking to my doctor.  All sorts of articles caution about sit-ups, some going as far as to say a sit-up should never be done during pregnancy, for fear of a condition called diastasis recti, or separation of the abdominal muscles along the midline.  As this is my first pregnancy, my doctor didn't feel that I am at significant risk with doing abdominal exercises.  She advised me that I can do sit ups until my belly is too big.  Even now at 25 weeks, I find myself still able to do full sit ups.

You can lift weights.  Data is mixed.  There's a suggestion that lifting heavy can lead to pre-term birth and intrauterine growth restriction.  This study from Denmark suggests slight increased risk of preterm labor in those who lift more than 20 kg more than ten times a day.  At Barry's, the workouts are with higher repetitions, and prior to pregnancy my "heavy" weights would be two 20-lb dumbbells.  I've stuck with this weight.

Be careful lying on your back.  When lying flat, the uterus compresses the inferior vena cava, the vein responsible for returning fluid to the heart.   There's no real exact guideline of how long you can lie on your back.   If there's a flat exercise where I'm lying on my back for longer than a minute, I'll sit up for a few seconds an then lie back down and continue.

This girl is jumping on my bladder!  The uterus compresses the bladder as well.  I definitely can't make it through an hour class without stopping in the restroom (embarrassingly, at least once....)

And finally... workout clothes!!!
I had to invest in some new sports bras around week 9, and then again around week 16.  Pants were fine... up until recently.  Now they squeeze my belly too much.  I found a great pair of workout pants on Amazon.  And, I've continued to wear some of my stretchier tops

As I get more pregnant, I'll post more about working out.  I'm hoping to do Barry's, and run at Barry's, as long as I can.  But I anticipate transitioning to more walking and water workouts.

The Veganification of Fast Food

The market for vegan food has never been better -- according to Nielsen, 6% of Americans consider themselves vegetarian, 3% consider themselves vegan, and 39% are looking to eat more plant-based.
 
This is great news for the animals, and should be good news for our health.  And it's great news for those of us looking for vegan food options.

Vegan options now abound at fast food restaurants:
Carl's Jr now carries the Beyond Burger.  But, be sure that when you order your "Beyond Famous Star" that you hold the mayo and the cheese.  I've been amused by the social media posts of various vegan friends who have never stepped foot in a Carl's Jr but suddenly have the urge.  I've heard good reviews.
Del Taco now makes Beyond Tacos with Beyond Meat.  They're only available at select locations for now.  My father is a connoisseur of Del Taco and eagerly awaits the arrival of the Beyond Taco in the Conejo Valley.
Taco Bell is rolling out a vegetarian menu.  It's been well known for years amongst the vegan community that Taco Bell is an easy place to eat vegan -- just sub the beans for meat in any item, ask for it "Fresca style" which means you get a salsa-type topping instead of cheese, and you have a vegan meal!

In addition, Chipotle has beans that are vegan, both black beans and pinto beans, much thanks to a class-action lawsuit, along with Sofritas which is a marinated spicy tofu blend.  Subway offers a Veggie Delite sub with veggies and Italian dressing which is vegan.  Many pizzerias, even chains like Blaze Pizza or Pieology, offer vegan cheese as an option.  Just about every restaurant has a vegan option on the menu, and if there isn't something obviously vegan then there's likely something that can easily be made vegan.

That makes it easier to find food options when we're dining out..... but it won't necessarily make use healthier.  Meat and cheese aren't health foods, but neither are the vegan analogues of meat and cheese. 

I'm not a purist when it comes to diet -- I advocate whole, plant-based foods for my patients, and for the most part that's how I eat.  But, I do go out for a restaurant meal, usually once or twice on the weekend, and I expect that many people like me will enjoy an occasional restaurant meal.

I worry that there will be a new generation of fast-food vegans, those who eat vegan for the sake of the animals, but don't necessarily think much about their health.  These fast-food vegans may down the road end up with the same health issues that we associate with a meat-laden diet.  And then, people will look at us vegans and say, oh your diet isn't so healthy after all, now is it?  When the perception of vegan is not a healthy one, then fewer people will gravitate to a vegan or plant-based diet, and the animals will suffer.

In the meantime, I'm looking forward to trying out a vegan Carl's Jr "Beyond Meat Star" since I'm curious.