Amanda Newman (00:00):
Welcome back to The Healthiest You podcast. In Part Two of our podcast series, we're talking about how the Jefferson Lifestyle Program, a yearlong virtual health program, can help you grow in every area of your health with internal medicine physician and pediatrician Dr. Courtney Pinkham. Transforming your health goes back to the basics, your nutrition, daily movement, good sleep and having supportive relationships. How does the Jefferson Lifestyle Program help reframe your thoughts around diet and boost your confidence in the kitchen?
Courtney Pinkham, MD (00:32):
Oh, that's a really good question. So we will be doing culinary classes, talking about nutrition from the perspective of a registered dietitian, which is fabulous. And I also feel like if you are looking for nutrition information in the abyss that is social media, it feels like it's so confusing – and truly it boils down to eat more plants and how can you cook those and prepare those in ways that bring you joy? And we have how do you approach cooking in general? What are the tools that you need in a kitchen? What are tools that you probably don't need in the kitchen no matter what the internet has told you?
Amanda Newman (01:18):
There are a lot of kitchen gadgets out there.
Courtney Pinkham, MD (01:19):
There are a lot of kitchen gadgets, and then you don't have any space for the food. So we can simplify. How do we take care of our knives? How do you learn how to cut something that you've ... I was not taught how to cut pineapple growing up. How do you learn how to do that, right? So all of these questions are answered in the context of the group visits. And then additional information with grocery store tours and cooking demonstrations, all virtual, are going to be added on to these experiences that we do in addition to the group classes.
Amanda Newman (01:52):
Well, you got me thinking about a really good kitchen gadget that would be something someone should purchase, which is a knife sharpener.
Courtney Pinkham, MD (01:58):
Oh yes.
Amanda Newman (01:58):
You talked about taking care of your knives. Oh my gosh. I love my knife sharpener.
Courtney Pinkham, MD (02:02):
Do you?
Amanda Newman (02:02):
Yes.
Courtney Pinkham, MD (02:02):
I don't love mine. I have a stone, and I don't really know how to do that.
Amanda Newman (02:06):
I have an electric one.
Courtney Pinkham, MD (02:07):
It's better?
Amanda Newman (02:07):
Yes.
Courtney Pinkham, MD (02:07):
We'll exchange information after.
Amanda Newman (02:12):
So another pillar of lifestyle medicine is physical activity. Whether you're short on time or find it challenging to stay consistent with exercise, how will lifestyle medicine experts help you on your fitness journey?
Courtney Pinkham, MD (02:25):
One is figuring out what the biggest barrier is for you. So often I have patients come in and say, "Oh gosh, every time I start being physically active, I hurt my back." And so then we're going to plug you in with the physical therapist. And you're going to work with a physical therapist to figure out what do I need to strengthen so that I don't injure that again. How can I prepare my body in a way? The other thing is I think the entire program, we're coming from a place of curiosity and the desire for growth and meeting people where we're at. And I have had to learn this many times. I am no longer a 15-year-old semi-competitive gymnast. And so if I go do things like I could when I was a 15-year-old semi-competitive gymnast, there will be a lot of pain for a very long time after.
(03:19):
And so if we're like, well, maybe it's not reasonable for you to do those things. What if instead you just found something else that brings you joy, but we just do it, let's tone it way down. Let's start at the basics. And I think having that approach throughout – when you master the basics, great, and then we advance. But we can't run before we walk. So we truly need to start walking. And actually that's fabulous. If you have not walked in a very long time, walking is fabulous. And when you're walking, well, can we add ankle weights? Oh, you can do ankle weights? All right, well, could we do a backpack, a weighted backpack like we had been talking about earlier?
(03:56):
And let's be very kind of intentional about setting up a plan that makes sense for you with your body that doesn't do the thing that so many of us do in January, which is: I'm going to go to the gym. And then we go maybe two or three times and we hurt every part of our body and then we can't do that anymore. We're going to be very intentional about starting small and building intentionally.
Amanda Newman (04:14):
Intentionality when it comes to doing any sort of new exercise is so important. And I feel like my husband reminds me of this too because he's like, "OK, don't go too hard because then you can't end up walking the next day." And then I'm like, "Great, now I'm not going to be able to work out.
Courtney Pinkham, MD (04:29):
Now you're not going to be able to have your goal.
Amanda Newman (04:30):
Yes, yes.
Courtney Pinkham, MD (04:31):
I sometimes will share with patients that I, in medical school, had the opportunity to participate in adult gymnastics class. And I love gymnastics so much. And I actually woke up not being able to breathe because all of my intercostals were so sore that I was splinting and not breathing overnight as I was sleeping. And that's a good reminder that even as a 20-something, you can't necessarily do what you could when you were in peak conditioning. And so you need to start.
Amanda Newman (04:58):
That's so relatable. Because I did competitive dance, and things are a little different now.
Courtney Pinkham, MD (05:03):
They're different now. I know. They're so different.
Amanda Newman (05:05):
You just have to accept it.
Courtney Pinkham, MD (05:06):
I know. It's kind of fine. It's going to be fine.
Amanda Newman (05:11):
Something else this program focuses on is sleep, which many people struggle with, especially myself. It's not surprising that one third of adults are sleep deprived, according to the CDC. What are some ways sleep problems are addressed throughout the year?
Courtney Pinkham, MD (05:25):
So first is figuring out what the sleep problem is. Do we have risk factors or untreated sleep apnea? Nothing's going to get better if every time you go to sleep, your body's suffocating. We got to fix that. And so then we'll get you in front of the right people to help with the tools to help you fix that. We then have to decide, or kind of get to the point of, is this a behavioral problem, for lack of a better word? Meaning everyone in the house goes to bed, you need a minute by yourself and that minute ends up being an hour, so you're not going to bed until 1 or 2 in the morning, but you have to get up at 6. So kind of be mindful of that versus if you have a truly disordered insomnia-type problem. And all of those things are handled differently, and we have resources for each. For each.
(06:17):
So in the course of the group visit, we're going to talk about those things. In the one-on-one visit, if we find, oh, actually there's some insomnia here, we're going to get you plugged in with someone who is trained in cognitive behavioral therapy for insomnia. So you could have the formal, I believe it's a six- to 12-week intervention – don't quote me on the exact number of weeks – but it's not supposed to be for forever that you do the intervention. And people have really good long-term outcomes. And I think the other thing that's important to note here is that this is not the turn off all the lights an hour before you go to bed. And kind of the things that we've all heard a million times. And you're like, "Well, I already do those things and they're not working for me."
(06:59):
So the lifestyle medicine training helps us take into account, well, when is your last meal of the day? What is the component? What is the nutrient profile of that last meal of the day? What, are you getting sunlight exposure? So many people having the opportunity to work from home aren't leaving the house. And as it turns out, sun exposure is really important to maintaining our circadian rhythm. So I think just having someone who can say, yes, yeah, I think we all know you shouldn't be actively doing things up until the moment you go to bed. But let's be much more pragmatic and not just the sleep hygiene things that you have heard before. How can we add to those things?
Amanda Newman (07:45):
Yeah, especially considering what you eat before bed and also what time. Because sometimes dinner doesn't always happen probably when it should. And then is that impacting your sleep? Probably.
Courtney Pinkham, MD (07:56):
Yes. And on the other end too. So people end up waking up and they're like, "Oh, well, I'm up. I might as well get the day started." And I don't think most people realize by choosing to have that cup of coffee or the cup of tea or breakfast when you woke up at 5, if your desired wake-up time isn't until 6 or 6:30, you've just told your body we get up now. And it's going to be way harder to wake up at 6 o'clock next week if you ate breakfast at 5 o'clock in the morning every day this week.
Amanda Newman (08:27):
That's what your body's getting used to then. And that's the rhythm, then, that you have, and then it's hard to break.
Courtney Pinkham, MD (08:32):
Yes, yes. And then the other thing I think that we will talk about more, and this is kind of in the cognitive behavioral therapy for insomnia, but can be super helpful as just a practical tip is: If you wake up overnight and you feel like you cannot go back to bed, leave your bed, leave it, do something boring. A book that you kind of like to take or leave, something that is even silly cat videos, something that is not going to make you super anxious, something that is not going to make you super productive. Set a timer on your phone for 30 minutes. After that timer goes off, lay back down, try it again. And the idea with that is that we generate about 30 minutes worth of sleep debt for every hour that we're awake during the day, but overnight it's closer to a one-to-one correspondence.
(09:22):
So for 30 minutes that you're awake overnight, you've accumulated 30 minutes of sleep debt. And if we think about what typically happens, and I think almost every person at some point in our life can appreciate that I woke up and now I'm like, "Oh, the clock says 1. I have to get up at 6. If I go to bed right now, I'm going to get five hours of sleep." Now it says 2. And if I go to bed right now, I'm going to have four hours." Now you're just anxious. You're not going to bed.
Amanda Newman (09:43):
I try not to look at it because I know if I look, I'm going to be like, "Oh my gosh, OK, I only have three more hours." I know. How am I going to get to sleep? And then I'm sitting there thinking about the clock.
Courtney Pinkham, MD (09:52):
Yes. Get out of your bed. Nothing good is happening during that exchange. You're just getting more anxious, and anxiety doesn't help us fall asleep. And so leaving the bedroom. I mean, really practically setting the ambient temperature lower, ditching your thick, heavy quilts and getting a cotton blanket so that you're not sweating at 3 o'clock in the morning. We need our core temperature to drop if you've ever noticed prior to bed. I just think this is so funny for me personally because my patients on a regular basis will comment on how cold my hands are. And I will sometimes go to give my husband a hug and he will leap across the room because my hands are so cold. But not at bedtime because we are supposed to shunt blood flow into the periphery while we are sleeping and that needs to be warm, but our central body temperature needs to be cold.
(10:43):
And so many of us with these thick, heavy blankets, we wake up because we're hot. That's an easy fix. Just let's not be hot overnight. So there's some really kind of easy things that we can talk about too for sleep.
Amanda Newman (10:56):
And poor sleep affects so many areas of your health. When you're running on less fuel, you may crave sweets and feel more stressed due to the higher cortisol levels. What kinds of stress management strategies will be covered in the program?
Courtney Pinkham, MD (11:12):
Mindfulness is the act of paying attention on purpose nonjudgmentally to the present moment. The idea being that so often the things that bring us discomfort in our lives are things that we are ruminating about in the past. What could I have said differently? How could I have handled that differently? What if this happened? What if this happened? Or things that are going to happen in the future? Will this move happen? Will this career advancement happen? What's going to happen with my loved one who is sick? And simply just being, just being in the moment is so helpful. So we talked about, and I think this is where the lifestyle medicine program is valuable and then figuring out how to tie these practices into your life. So I have patients who, while they brush their teeth are standing on one foot, but I also have patients who are just practicing what does it feel like to brush my teeth?
(12:08):
I am just brushing my teeth. And then when your brain says, "Well, what time are you going to be at work if we do that?" You say, "Oh brain, I know you're trying to be helpful right now. I'm just brushing my teeth." And figuring out what are those opportunities for us to practice truly being nonjudgmental in the present moment, allowing us to be curious, allowing us to approach life with a little bit more ease and a little bit more patience. And being able to choose how we respond, as opposed to reacting in all manner of our life, whether it be in interactions with our co-workers, interactions with our families, interactions in our car, right? Just when can we choose to respond as opposed to react?
Amanda Newman (13:00):
Do you have any examples of a strategy that our listeners could take away?
Courtney Pinkham, MD (13:07):
Oh, for mindfulness, something to do right now? I'm not sure what's best for everyone else, so I'm going to share what's best for me. Setting a timer on my phone, and the increment of that timer has changed over time, and either in my bed while the fan is on or outside when it's a little windy, just really trying to focus on what that feels like on my face for 30 seconds, for a minute. There are two other ones that I often talk about with patients. One is that five, four, three, two, one grounding. So five things you can see, four things you can hear, three things you can touch, two things you can smell, one thing you can taste – as that kind of practice of being grounded and kind of bringing you to where we are right now.
(14:00):
The other thing I'll sometimes talk about is square breathing, which is really easy to do. So I'll say, OK, let's put our feet firmly on the ground and let's sit. And if you feel comfortable to close your eyes, I invite you to close your eyes. And then I'm going to have you take a big breath in and we're just going to count in for a count of four. We're going to hold for a count of four and we're going to breathe out for a count of four. We're going to hold for a count of four, and then we can just do it. So let's breathe in two, three, four, hold, two, three, four, breathe out, two, three, four, hold, two, three, four. Wouldn't you love if I just did that for another hour? Be a super-exciting podcast. But even just doing that for one minute.
(14:53):
So that's one way to access mindfulness. Now, the other thing I will sometimes say to patients, and this comes up when we're talking about changing habits, and I use it a time when we're talking about smoking cessation. Hey, the next time that you want to smoke, what would happen if you did three minutes of jumping jacks? What does your brain want to do then? And again, that's a small way to redirect your brain to being in the present moment because it's really hard to be thinking of other things while you're out of breath being physically active. So that's kind of something else I think about in terms of a. ... Mindfulness is really this paying attention on purpose to the present moment.
Amanda Newman (15:32):
Well, thanks for sharing those tips. Those are some really great strategies. I feel like I need to do the box breathing.
Courtney Pinkham, MD (15:37):
It's so good. I know. It's fabulous.
Amanda Newman (15:41):
I love that this program is also highlighting something we often underestimate the value of, which is social connection. Having people in your corner who are working toward similar goals is powerful. How do relationships impact our physical and mental health and how does this virtual program help people grow in community?
Courtney Pinkham, MD (16:02):
So in so many ways. I think having a group that you are meeting with once a week for one hour and talking about what have I done that I've been successful in? How have you been successful doing this thing? And having it be people that are coming from a similar perspective is all really valuable. And knowing at this set time once a week, we are going to be in this community, and then we are taking this one step further and saying, hey, this group, we're going to have you be also able to access this Facebook group and now you can maintain this connection. You can choose whether it's going to stay virtual or whether it's going to be in person. And knowing that you have a group that supports you, that's cheering for you is so valuable. And that's part of why we designed this program that way.
(16:59):
Additionally, all of the people currently involved in teaching these classes, seeing patients one-on-one, they're just such incredible humans, and they're the type of human that are just cheering for every single person who goes through this program to be successful in whatever way that they deem to be successful. And we're all so excited to be here. And I think you really feel that too, that this is really everyone is rooting for you and for the entire group that you find yourself with.
Amanda Newman (17:30):
And that's exactly what you want and need.
Courtney Pinkham, MD (17:32):
Yeah. Oh, for sure. We all need that. It's so hard to hold ourselves accountable when there's a million other things on your to-do list.
Amanda Newman (17:39):
Is there anything else you'd like to share about the program? And do you have any words of encouragement to share with our listeners today?
Courtney Pinkham, MD (17:46):
If you are thinking about whether or not you have the time to participate in a program like this, I would ask you to reflect on: Is there anything in your life – trying to be very mindful about how I say this – there are times when this is not probably the best program to take on. I'm thinking about you maybe just had a newborn and there's a million things, or the families I have that are working two and three jobs. I want to be very tactful about how I'm phrasing this, but I also feel like there's many of us who say, "I don't have the time for me to do that." And what that often means is my kid needs to go to soccer and my kid needs to go to dance and my family members need me to do this, this and this.
(18:42):
And just as a reminder, if your health is not present, you cannot do all of the things that people need of you. So being very respectful of the fact that there truly are times in people's lives where you actually do not have time for this program. This does require an investment of your time. That definitely is true. I also want to honor or ask people to think about what are the actual barriers versus when are we not valuing our health in a way that we would want our children to value their health? And very much as a parent, I think about if I am not modeling to my children that it is important to protect time for sleep, who else is going to teach them that it is valuable to protect their time for sleep? And if I don't teach them that adults exercise too.
(19:42):
OK. Full discretion. I am the person at soccer practice with a band around my legs and I'm doing the squats because – guess what – this is the time I have to do it. I don't care if I look silly. Let's do it together because I don't want to just watch my kid be physically active and not be physically active. And so I always, when I'm talking with parents in particular, talk about how if we would say we would want this for our children, if we would want for our loved one to be caring for their health, we deserve that too. And not only do we deserve it, we must have it to be able to take good care of the people that we love.
(20:17):
And then anything else I want to share, I think lifestyle medicine is what I wish all of medicine could be. And the American College of Lifestyle Medicine has a ton of resources and tools for people with every type of background, whether your background is in medicine or outside of medicine, a lot of very practical tips. There are people who genuinely care about taking care of other people and wanting people to have access to these tools. And I would encourage people to go to either Jefferson's website, to the Lifestyle Medicine website that we have, or to the American College of Lifestyle Medicine website to learn more about what is actually rooted in evidence and what are the things that you can do just today to start.
Amanda Newman (21:07):
Well, Dr. Pinkham, thank you so much for joining us today and sharing such wonderful information with our listeners.
Courtney Pinkham, MD (21:14):
Thank you so much. It was a pleasure.
Amanda Newman (21:16):
If you're ready to reset your health and build better habits, you can sign up for the Jefferson Lifestyle Program on JeffersonHealth.org/lifestyle or talk with your clinician today. Remember to leave us a review and subscribe or follow The Healthiest You wherever you get your podcasts, so you never miss an episode. And remember, be safe, be smart and be the healthiest you.
