Episode Transcript
Alan Helgeson (host):
Hello and welcome. You’re listening to the “Health and Wellness” podcast, brought to you by Sanford Health. I’m your host, Alan Helgeson, with Sanford Health News.
Our conversation today is about the TikTok and internet nutrition and wellness trends. Are they facts or are they fiction? Our guest today is Dr. Jennifer Schriever with Sanford Weight Management Center. Dr. Schriever, thanks for being with us today.
Dr. Jennifer Schriever (guest):
Oh, thanks for inviting me.
Alan Helgeson (host):
We wanted to go right to the expert and to talk to you today to maybe answer some of those questions, debunk some of that stuff. I’m wondering is there a danger in jumping into some of these nutrition trends online?
Dr. Jennifer Schriever:
Certainly. Because some of them can be harmful, especially if you have some health conditions or on some medications that could affect those treatments. They also tend to not be very well studied. So then how do you know the true safety, and are the ingredients what they say they are? A lot of the supplements and created products like that aren’t well regulated. And so even pill to pill or jar to jar, you don’t know if you’re getting the same ingredients.
Alan Helgeson (host):
Another question we have here too, Dr. Schriever, is how do we identify a fraud or verify if something’s safe for us?
Dr. Jennifer Schriever:
Certainly look for who is giving you that information. Do they have good credentials? So if they’re a dietician, are they a registered dietitian or a licensed dietitian? Do they have a master’s degree in dietetics, nutrition, public health or other related sciences Or are they a doctor, an M.D., a D.O. or a Ph.D.?
And then also look for multiple sources of information. Don’t just trust the first one. Look for other organizations that might support it. Do they have an organization behind them supporting that? Be alarmed or concerned if it is a famous person selling that and telling you it’s great. Is it just an online testimonial that this worked great for me and my friend? Is there any studies behind it and are there multiple studies and can they be reproduced? Those studies, those are things to look for.
And if you aren’t sure, then look for another health system and look at it there to see if they’ve put any information out to confirm is it safe or not.
Alan Helgeson (host):
These are some of the top ones that are showing up and people are wondering about: powdered greens.
Dr. Jennifer Schriever:
Those tend to be supplements that are made from basically ground up and dried fruit and vegetables. So nutritionally they might have a lot of vitamins and things that are helpful. But really you’re best off still eating the fruit and vegetables because you’ve lost out on the fiber content through that processing. And also keep in mind there might be bad ingredients.
So I look for a third party reviewer. If it’s a good company, they’re going to ask an outlying company to review their product for safety and make sure there isn’t any extra contaminants like lead or something else or heavy metals.
The other thing to keep in mind again is if you have any kidney disease or if you are on some medicines such as blood thinners or a blood pressure medicine that might affect your electrolytes, adding some powdered grains could certainly affect levels of certain medications. And so you want to let your pharmacist know or your doctor know.
Alan Helgeson (host):
Here’s a unique one we’re seeing a lot about is tongue scraping.
Dr. Jennifer Schriever:
Yeah, so that’s interesting. As far as weight management, probably not adding much to your health. If you have, in general, good care of your teeth and oral tissues, do you need to add tongue scraping? Not necessarily.
But if we have poor dental health, then we have extra bacteria in our mouth which can cause inflammation. Inflammation can lead to heart disease or stroke. In pregnancy it can cause pregnancy difficulties such as preterm birth and other complications like infection and pneumonias. You’d be at higher risk for pneumonia if you don’t have good dental hygiene. But do you need to add tongue scraping to your typical routine? No.
Alan Helgeson (host):
I know a lot of people like to look at recipes on Pinterest. I like to do that and we’re seeing a common theme here. One of those things that people talk a lot about these days, Dr. Schriever, is drinking bone broth.
Dr. Jennifer Schriever:
You can certainly use it if you want to be sure it’s safe if you’ve made it yourself. You need to be aware of the risk of bacterial and contamination. And make sure you use it up by the expiration date. It’s, I think, touted as a protein source but there’s only nine grams of protein in a cup. Liquid also tends to be very filling. So if you’re using it to help feel full, that’s a good way to do it. So you can certainly use it as a tool to help with fullness and for protein content.
But we look at least needing at least 30 grams at a time to support your muscle health and regrowth. So that’s only nine grams. So you’d need to be aware of what else is in your meal to help balance that out.
Alan Helgeson (host):
What can you tell us about dry scooping?
Dr. Jennifer Schriever:
Gosh, don’t do that. (Laugh). So dry scooping is referring to using pre-workouts I think mainly. And instead of mixing it in water, just throwing it in your mouth and swallowing it, you’re going to certainly place yourself at risk for choking and aspirating, which is not good for your lung health, could lead to infections. And we all know where choking could go, but also consider those tend to have a lot of caffeine in them and if you’re going to swallow it that quickly, you’re going to absorb all that caffeine so quickly it can elevate your heart rate, could certainly cause some heart damage if you’re going to do anything like that to a significant extent. Or frequently you could have chest pain, numbness, tingling, nervous system effects, dizziness, all sorts of just really not feeling well. So as you look at pre-workouts and if you’re going to use them correctly mixed with water and things, try to keep it under 200 milligrams of protein a scoop or a serving.
Alan Helgeson (host):
Dr. Schriever, as you were talking about the dry scooping stuff here and you mentioned pre-workout, well, let’s talk about pre-workout.
Dr. Jennifer Schriever:
A lot of people that work out like to use pre-workouts. They have caffeine as a stimulant and some other herbal things that can be stimulants as well. So try to be really aware of what is in that supplement and if at all possible, be aware of how much caffeine they’re putting in there. Sometimes it can be very difficult to determine and if it’s difficult to determine I choose another product or you can reliably know how much you’re getting.
People find more energy so that they feel like they can do a more intense workout. It might help reduce – depending on the ingredients of your pre-workout – muscle soreness. You might have more energy after. Some of them have B vitamins so then you can improve your energy that way. Some might have nitrous oxide to increase your blood flow for weightlifting or sprinting but you could also just drink some coffee before your workout, and some have a lean protein prior, and get similar benefits.
Alan Helgeson (host):
Alright, let’s talk about internal shower drinks.
Dr. Jennifer Schriever:
(Laugh) Interesting thoughts of what is out there. So that can be using a lot of chia seeds and water to maybe do a colon cleanse or clean you out. Apparently this is actually a replica of a traditional Mexican drink called agua de chia. But if you use chia in moderation and when a tablespoon or two at a time, that can certainly help with regularity of your bowels because it has a lot of fiber in it. But those little seeds absorb a lot of water. So if you’re going to take a lot of chia seeds at once, they’re going to absorb a lot of water and you could actually end up with a bowel obstruction because they absorb so much water and kind of get glue and sticky-like. So, not a great plan.
Alan Helgeson (host):
(Laugh) It doesn’t sound like a lot of fun and I’m running out of room here on my post-it note Dr. Schriever. And the last one I have here is liquid chlorophyll.
Dr. Jennifer Schriever:
From what I could tell, there’s no proven benefit. You could increase your risk of sunburn. Can they truly get enough chlorophyll in that liquid dropper to make a difference? Probably not. There’s no evidence that it’ll improve your health.
You’re better off eating spinach, kale, green beans and peas if you’re interested in getting more chlorophyll naturally. And those have the added benefit of fiber and vitamins.
There are a few other thoughts I had that might be out there online, too, or on the media to bring out one. And a patient did just bring this up the other day, “Well, I heard magnesium could help me lose weight.” There are some studies showing a little bit of benefit but only in certain populations and not significant benefit. So if you do have a magnesium deficiency, if you have insulin resistance, so that means like pre-diabetes or those sort of conditions or obesity, you might lose weight supplementing magnesium, but it’s only at 0.21 of a BMI.
So I’m 5’4”, that would be two pounds. So not a significant benefit to taking magnesium. There are other benefits for magnesium. It can help with bowel regularity. For some it helps with sleep so you can use it for that, but I wouldn’t rely on it to help with your weight a lot.
There’s also off and on a lot of concern about artificial sweeteners. “Are they safe?” “I should drink regular Coke instead,” and I would disagree with that entirely. Certainly we want to eliminate as much sugar from our diet as we can and really most of the studies that I can find and have evaluated against artificial sweeteners such as cancer causing or other long-term risk really aren’t very valid. So I’d rather see you using an artificial sweetener to meet a sweet craving over picking a sugary beverage that is going to have a lot of calories.
So you can certainly flavor your water if you want to, if that helps you drink more water. There is that benefit. Now for people who kind of feel addicted to sugar, if you can gradually over time use less sweetener, that can help you adjust your taste buds so you don’t want so much or desire so many sugary things.
I think that’s one of the things online as well called WaterTok. A fad of drinking a gallon of water a day and flavoring it in all sorts of ways and (laugh) a large variety of recipes. So certainly that’s a great idea if it does help you drink more water. But as long as you’re keeping a balanced diet, you know, if you drink too much water and you’re using that to stay full and you’re not eating, so that’s your diet plan, that’s not a healthy way to lose weight.
And I think some of that comes across in the social media that people desire that to look thinner. So they’re drinking these drinks that taste good and help them stay full and maybe distract them from their hunger. But really if you’re doing that not eating enough, you could throw your electrolytes off by drinking too much water. It can be difficult to do in the short term because you have to override your kidneys, and adult healthy kidneys are going to be able to metabolize your electrolytes and water just fine. But if you have any kidney disease or are on any medications that affect that, and if you do that for too long, you are going to gradually deplete your electrolytes and that can be very harmful.
Let’s also touch a little bit on CBD. As far as weight management, there isn’t great human studies on how helpful that could be. There is some evidence that initially it can maybe contribute to weight gain but then can contribute to weight loss. But there’s nothing reliable to show any proven benefit. Some people do use CBD for other health conditions and if that’s such as chronic pain, that’s a very stressful condition. Stress interrupts your weight management. So that could indirectly maybe benefit you as far as your weight management journey, helping you adjust your lifestyle to improve, but nothing to support actual benefits for weight loss currently based on studies.
Alan Helgeson (host):
Dr. Schriever, those were some great tips about some of these things and there’s just so many it would take days to get through them all. Let’s jump in on something you touched a little bit on: cleanses and detoxes. Do these things work?
Dr. Jennifer Schriever:
There’s really no benefit to doing a cleanse or a detox. And again it goes back to are you on medications? Do you have health problems that could make that risky and you throw your potassium off based on a medication you’re on? Certainly in the short term, if you’re going to clean out you might lose a few pounds, but in the long term you’re just going to start eating again and gain it back. If you are struggling with your bowels, then I would certainly talk to a doctor about how to correct that and help you through that rather than risk going through one of these cleanses.
And some of them you also aren’t going to know what are the ingredients and why are they working? Could you cause a colon issue or hemorrhoids or heart disease or something else? If you have diabetes, are you going to throw your blood sugar or weight off or get severe diarrhea and make yourself really dehydrated? Just doesn’t sound very fun or pleasant to do anyway.
Alan Helgeson (host):
Not at all. Dr. Schriever, as you meet with patients on a regular basis, sometimes you have to kind of boil things down to what are those golden rules or what are some of those two or three or four or five, sometimes more, things that you want to share or leave people with or questions to ask. So I’m going to kind of throw that out to you. Do you have any golden rules or maybe questions to take away to ask when seeing a new fad or trend?
Dr. Jennifer Schriever:
Sure. Well certainly is it too good to be true? Does it promise short-term weight loss, or is it even sustainable? Is it something you can do long-term? Typically any, most things you do in the short term, and you return to your typical habits, the weight’s going to just likely come right back. So are they claiming it’s the best kept secret or just one person is claiming it worked for them? You know, someone famous is saying it. So it’s back to going, is it legitimate? You know, if it’s on a website, is it a dot-edu or dot-org? Is that the organization presenting it? Because those are more reliable than dot-com or dot-net.
Alan Helgeson (host):
Yeah. And talk a little bit about how this approach is different.
Dr. Jennifer Schriever:
So we have studied the science behind helping people manage their weight, and we take a full health history throughout life. We know we ask you your weight history and what’s contributed so that we can guide you to a lifestyle change that is sustainable to lose weight, feel good, and help you reach your goals.
We use all the tools – they’re called pillars of obesity medicine. So that includes nutrition guidance, physical activity, behavioral – that might be emotional or stress eating – and then medications if needed to help you. Obesity was re-diagnosed as a chronic disease or finally recognized as such in 2012 or so. So you know, we recognized that it isn’t your fault or the patient’s fault that they have got to that point and we’re ready to help you through the ups and downs and through the difficult times and to help you improve your weight in the right way and maintain it.
Alan Helgeson (host):
Why does this approach work?
Dr. Jennifer Schriever:
We do use the most up-to-date information, and we’re constantly adjusting and all of us are listening to what is new, even in nutrition exercise, and of course the medications. We do use a body composition scale and I think that’s helpful for us, but also very helpful for the patient. Because it shows your muscle health, body fat content, water content, and we can explain progress through that. Your muscle mass is very important to your metabolism. So we help patients understand on the inside what is going on so that they can progress through their healthy lifestyle and understand the importance of protein intake and strength training and other just general movement.
We also provide a lot of support. So there are physicians and nurse practitioners to help guide you. We have dietitians, we have a health coach and we have a counselor to help you through all the angles of weight management. We are also helping to guide you through good exercise options that fit your lifestyle, your comfort level, and also finances. But so, and we’re also looking at adding in support from Sanford Wellness and how can we include that to help our patients as well.
Alan Helgeson (host):
Could you share a little bit about your clinical background in treating overweight patients?
Dr. Jennifer Schriever:
I’ve cared about my own health and nutrition for a really long time and certainly had a passion to try and help patients. But until I did the obesity medicine certification, I really didn’t know very well how to educate patients as well. So during COVID, found the online continuing education I could do to get board certified in obesity medicine. So I did that and so did a couple of my partners and really learned a lot that was very helpful in learning how to talk to patients, how to educate them, what is the science behind helping people lose weight and the science behind obesity to understand that, how it happened in the first place so that we can explain what happens physiologically and metabolically to patients. So did that training in 2021.
Sanford was very helpful and let me start a pilot clinic with my two partners. By half a day a week we expanded then to a full-time nurse, a practitioner, and now have two nurse practitioners as well, as well as three of us physicians working here, two of us part-time and I’m full-time.
Alan Helgeson (host):
How can patients be seen within your clinic? Do they need a physician referral? Do they call just to get in? What, what is the right pathway in?
Dr. Jennifer Schriever:
You can certainly have your physician send a referral. You can also call the number yourself and make a self-referral. We will evaluate your weight and height to make sure you qualify. We have certain guidelines that we take, but generally, we understand patients really want to come here, so we’ll work really hard to make sure you’re accepted if you’re within our BMI guidelines. And currently we take ages 16 and above.
(Adults who qualify for services at the clinic must have a BMI of 30 or above, or BMI of 27 to 29.9 with obesity-associated conditions. The BMI definition for children is based on percentiles.)
Alan Helgeson (host):
You’re doing some great things in your clinic, Dr. Schriever, and I probably should have asked this earlier. But in this technology world, we’re never more than a few arms’ lengths away from our phone and having that in our hands. I’m guessing there are probably some apps that you might even recommend for people, depending on where they’re at in their journey. But are there a few apps that you might share that people could trust as they’re looking into their weight journey?
Dr. Jennifer Schriever:
It can be very helpful if you’re ready and willing to do so to do some food tracking. So we will suggest various apps. You can use MyFitnessPal, Lifesum, Lose It!, MyNetDiary’s kind of nice because it grades your food. Bitesnap, you can actually take photos of your food. And then that’ll help you suggest portions. We will guide you though on your calorie goal and your protein goal, so don’t rely on the app for those things.
But otherwise those are great resources to journal your food if you’d like to. Studies will show that people that do some monitoring of their own intake do better, but it doesn’t have to be a hundred percent of the time. Some people benefit from journal apps or self-care apps. A couple of those are Finch and Habit Tracker. You can also benefit sometimes from meditation apps like Insight Timer, Calm, or Headspace are other ideas I collected from our staff too.
Alan Helgeson (host):
Dr. Schreiver, I feel like you know where I’m going and what I’m thinking, which is awesome because the next question I wanted to ask is, for so many people that with a weight loss journey or have experienced being overweight, that there’s so much of a mental piece to it. How can we move through that journey and better our health and fitness without maybe feeling bad about ourself? And I know that’s probably a whole different discussion for another episode, but maybe just a few things or just a few high level thoughts from you.
Dr. Jennifer Schriever:
And I do love the opportunity to talk about that. I think patients have a very difficult time coming to their first appointment here, and that’s pretty evident sometimes. They’ll say so or be in tears because they feel shamed or fear or embarrassment.
And a lot of patients have experienced weight stigma throughout their life or bias. Did people make comments to them about how much they ate or their weight while growing up or even in life? And even in health care, family, friends, health care providers can say the wrong thing that makes them feel bad about themselves. And once you hear something like that, you internalize it. So even though someone might not be saying something to you about your weight, you’re thinking you don’t deserve better or that you’re down on yourself for these things.
So what we need people to know, first of all, just coming here, we’re not going to judge you. We know obesity is a chronic disease. There are a lot of things that have changed on the inside over time that make it very difficult to lose weight and it’s out of your control. So unless you have good guidance, it can be very challenging. And you can’t lose weight based on willpower alone or diet and exercise typically only gets you a small percentage of weight loss. And willpower only lasts so long. So also, if obesity is a chronic disease, it’s relapsing and remitting. So certainly we’re all going to be successful for weight loss for a timeframe depending on what we choose. But then our body is going to start to think we’re starving and it might make us more hungry and then make it more challenging to continue the program we’ve selected to work on our weight loss.
Alan Helgeson (host):
Such great information. Dr. Schriever, any final thoughts to share on our episode today?
Dr. Jennifer Schriever:
I think people are surprised about how good they feel as we adjust them through their nutrition and exercise and those sort of things. Certainly the joint pain improves fairly quickly. For every pound you lose, it’s like taking four pounds off your joints, particularly your knees. People have more energy, they’re less tired. Just by altering nutrition in the right direction, also adding more protein helps them feel full. So at least as you adjust those sorts of feedback occur fairly quickly. So it is also a challenge. We don’t anticipate patients to absorb all our information the first time.
Alan Helgeson (host):
Well, Dr. Schriever, I want to say thank you for taking time to talk to us today. This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on Apple, Spotify, and news.sanfordhealth.org. I’m Alan Helgeson, and thank you for listening.
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Posted In Family Medicine, Healthy Living, Heart, Internal Medicine, Nutrition, Symptom Management, Weight Loss
