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Interviewer: You've decided you want to eat healthier, maybe become more physically active, or quit an unhealthy habit. The next step is to take action.

But Dr. Jennwood Chen says to succeed, don't try to change too much at once.

Dr. Chen: That intention to make a change needs to be realistic. And for some people cutting a whole liter of soda out of their daily routine is not that realistic. So cutting it down to a half liter a day for a while and then weaning yourself off it is a more realistic thing.

Interviewer: Dr. Chen says making even small changes when adopting new health habits can be hard. You will slip up, but strive for progress, not perfection. And be sure to celebrate when you do make progress.

Dr. Chen: You've got to pat yourself on the back and you should, you know, tell your family, you should tell your friends, and you should be proud of yourself really, you know. And that's how we just do . . . that's how we stay on the path.

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Macronutrients or "macros" as you may have heard online are the compounds in our foods that we need to eat a large amount of every day. These macros are fats, carbs, and protein. There are a lot of misconceptions about macronutrients. There are plenty of articles out there making claims about these three macros and how much you should or should not be eating. To help us sort through all the noise, we've brought back nutrition specialist Thunder Jalili to speak about each of these macros in a series we're calling Get to Know Your Macros.

In this episode, we're focusing on protein. What it is, and what it does for your body.

Let's start with the basics. When we eat protein, our digestive system breaks proteins into amino acids. Amino acids are the basic building blocks your cells use to assemble all sorts of compounds and proteins the body needs. For example, amino acids make up connective tissue, muscle fibers, antibodies, as well as enzymes and hormones. You Don't Need to Eat That Much Protein

As men, it seems like every muscle building diet plan you find online focuses heavily on getting a lot of protein every day. Producer Mitch was even doing a plan last summer he found online that was having him eat well over 300 grams of protein every day to help him grow muscle.

According to Thunder, the average person needs a whole lot less protein than that to be healthy and grow muscle. He shares a simple equation he uses for everyone except the most elite of athletes.

(Body weight (in pounds) / 2.2) x 1.2 grams = the number of grams of daily protein

For example, Troy is a pretty active guy and he weighs 155 pounds. According to Thunder's math, Troy only needs around 85 grams of protein every day.

85 grams of protein is a whole lot easier to consume than the amount Mitch was trying to choke down on the plan he found on Reddit. While he was seeing some results, he felt miserable and his food budget was expensive. More Protein Doesn't Mean More Muscle

In spite of the diet plans you see online, eating extra protein every day does not mean that protein goes directly into more muscle growth. In fact, eating extra protein may set you back in your fitness goals. Consuming a large excess of protein increases the total amount of calories you consume in a day, and your body does have a mechanism to turn all that unused protein into fat if conditions are right.

Even a high functioning competitive tri-athlete may need only 2 grams per kilogram of body weight every day during training. But for guys like that, it only comes out to about 140-180 grams of protein a day, not the 300+ grams some forums insist on using. Protein is Protein, but Plant Sources Have Bonus Benefits

According to Thunder, there is no fundamental difference in the way your body utilizes the protein found in animal products or plant sources. One the protein is broken down in the gut, your body will use those amino acids in the same way.

However, it's important to keep in mind that research has shown that a diet very high in animal-based protein may lead to a bevvy of chronic diseases. Meanwhile, plant-based protein sources have the added benefit of containing additional micronutrients and fiber that the animal protein does not. Housekeeping - Who Cares About Mitch's Health 5k

The Who Cares About Mitch's Health Mid-May 5K has started. Morning of May 23rd at Sugarhouse park. Feel free to download a couch to 5k event and join the movement. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot realizes how hard it is to leave the house without his phone and trendsetter Troy starts to wear workout clothes to work. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Dr. Miller: Do you need standard laboratory screening studies during your examination? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi. I'm here with Dr. Jerry Hussong. He is a clinical pathologist and the Chief Value Officer for ARUP Laboratories here at the University of Utah. Jerry, it's pretty typical for most physicians in primary care to order a set of laboratory studies, a full blood panel, a complete metabolic panel and sometimes a lipid panel and we do this almost routinely, reflexively. And I guess for the patients out there, maybe you could tell us what's the value of getting these tests if you are totally healthy? Do you think they're necessary?

Dr. Hussong: So when we think about some of the common laboratory tests that are offered as part of an annual physical exam or for a specialized sort of inquiry into patient's health, there probably are some that we should think about that really should be done once a year. And these would include the complete blood count or CBC, the chemistry panel, even though it can be a limited chemistry panel or metabolic panel as some people may refer to it, as well as urinalysis or UA. Those are the ones that we probably should be thinking about as just sort of routine annual tests. There may be a number of other tests that the physician may want to order to address a specific problem that the patient may have, but as a part of the screening test those are the ones that we want to be thinking about.

Dr. Miller: What in those laboratory studies do you think that we might be looking for that would be important for the patient?

Dr. Hussong: Sure. So when we're thinking about a complete blood count or CBC, we're really looking at it to see if the patient may have anemia, for one, to see if the red blood cell count is adequate or potentially even decreased or increased. We also might look at the white blood cell count, which may be an indication of infection that may be going on or an indication of possibly a leukemic process that could be going on. Some patients will present with low platelet counts, which could be an indication or reason why they're experiencing increased bruising as they might see.

Other things that we see with the metabolic panel or the chemistry panel is things evaluating kidney function such as the BUN or creatinine. We also will monitor glucose as a screen for diabetes and then a number of the other biochemical electrolyte like things such as sodium and chloride.

Dr. Miller: Certainly important when patients have any of these illnesses, but I think what you're saying is that a person who feels very well may have some of these abnormalities, which could be an indication that there is early disease that they might begin to have treated or respond to in a way that would prevent it from being a bigger problem down the road.

Dr. Hussong: Exactly. And this is really just a small number of tests that we use to screen for some sort of wider range of problems that the patient may be having. It's really sort of a truncated panel of all the different types of tests that the physician could order, but really allows us to get a global sense of the overall health of the patient during their physical examination.

Dr. Miller: Now these time-honored tests, and I've ordered them myself and I continue to do so, basically are not terribly expensive. Is that correct?

Dr. Hussong: The tests that we were talking about just now, they're very inexpensive and I think that's important for the patients to realize. There are lots of specialized, newer tests that are out that can cost up to thousands of dollars, but these are very inexpensive tests that can provide a lot of information to the treating physician.

Dr. Miller: And how about a thyroid test? We sometimes order that if we suspect the patient may have a thyroid disorder if they're fatigued or if there's a sudden gain in weight. Do you think that's a useful screening test or should we just maybe order that when there are indications to do on the clinical exam?

Dr. Hussong: I don't think it's a great screening test just overall if someone doesn't have any signs or symptoms that indicate any thyroid disease. I think if there is worry for that it's important to go through sort of a stepwise process ordering a TSH, for instance, to start with and maybe a T4 but not to go to some of the specialized tests for thyroid function analysis unless you have a real indication and have some of these preliminary test results back first.

Dr. Miller: Great. Now the other thing is patients sometimes forget to ask and physicians sometimes forget to tell them whether they need to be fasting for these tests. What's your opinion on that for the series of screening tests you mentioned, the CBC, the complete metabolic panel or cholesterol panel?

Dr. Hussong: So not for these tests, but there are a number of tests that we do in the pathology laboratory that do have special requirements as you say whether it's fasting or other things that they need to do or certain times of test, times of the day when the blood should be drawn whether it's morning or after a meal and so for these basic tests there is no specific requirements to be thinking about to have these routine tests done.

Dr. Miller: What about the cholesterol panel? Sometimes I'll tell people to fast for the cholesterol panel.

Dr. Hussong: It's probably a good idea. You want to get a real indication as far as where the patient sits in regard to their cholesterol levels but, at the same time, you don't want them to just have had a huge meal that may artificially elevate their cholesterol.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: November 20, 2018
originally published: July 7, 2015

Dr. Miller: What does a neonatologist do? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm here today with Mariana Baserga. She is a physician, a pediatrician, and she's also a professor of Pediatrics at the University of Utah. Mariana, if you were at a party and somebody asked you what you did and you told you were a neonatologist, what would you tell them? What does a neonatologist do?

Dr. Baserga: Neonatologist is a specialist that will take care of newborn babies that do not . . .

Dr. Miller: Newborns.

Dr. Baserga: Newborn babies.

Dr. Baserga: Little ones.

Dr. Miller: Tiny ones.

Dr. Baserga: The tiny ones or the not-so-tiny ones that can run into trouble after delivery. So most of the babies that come to the ward don't have a problem transitioning from mom's womb to alive, but when they do, that's where we come in to help.

Dr. Miller: So most of the time, healthy babies, healthy births. But, occasionally, a woman might have an issue with a new baby, and that's where you step in.

Dr. Baserga: Correct. There are about half a million deliveries that are pre-term in this country, and that's by definition of a baby born less than 37 weeks or less than 5 pounds. And those babies are the ones that a neonatologist will be taking care of in the NICU.

Dr. Miller: So if they're less than 5 pounds or less than 37 weeks at gestation, that doesn't necessarily mean that they need to go a neonatology unit, but that you would assess them. That would be part of a routine examination that you would perform on this type of a newborn.

Dr. Baserga: Correct. Babies that come out early may need help with breathing, may need help with giving them sugar because they can't feed well. They can have an increase in sense of infections. And in those cases, they cannot be in the regular well-baby nursery and they have to be in the neonatal intensive care unit.

Dr. Miller: So the great thing about this specialty is that you're available in there in case you're needed. So it's almost like every baby that is born could be seen by a neonatologist and evaluated. And then what percent of the time might they end up going to a unit that cares for these little tiny babies?

Dr. Baserga: So premature babies less than 34 weeks gestation all will come to our neonatal intensive care unit. And there is a mid-ground, and those babies that are between 34 and 37 weeks, what we call "late pre-term babies," that can go either way. It depends on how the baby does. So I would say half of those babies may need to be in the intensive care. And depending on the hospital, they can be in a specialized well-baby nursery.

Dr. Miller: So do you think that most expecting mothers, mothers who are near delivery, know that a neonatologist might be involved in the care of their child if needed? Are they aware of your specialty, do you think?

Dr. Baserga: I would say half about, especially in the United States, most people are aware of the possible need that the baby will need help after being born. But we still in Utah, for example, see a lot of deliveries that happen at home, and everything goes well. So the times where we may need to transport babies into the NICU are when those deliveries don't go well.

Dr. Miller: How long do these babies typically spend in the unit?

Dr. Baserga: They can spend from one day to a year. It depends on how sick they are. Babies that are born at 23, 24 weeks gestation. . .

Dr. Miller: These are really tiny babies.

Dr. Baserga: Those babies are about a pound or half a kilo. And those babies may stay with us three, four month sometimes.

Dr. Miller: But usually what would you think, maybe several days for most babies that are not in that weight range?

Dr. Baserga: Yeah. The NICU has one of the longest stays in the hospital because babies need help for a longer period of time because they have to mature, they have to learn to eat. So what we tell families, when they're getting ready to go home and that's a question they like to ask, is, "When can I take my baby home?" Baby has to be able to control their own temperature. That means no need for an isolette.

And particularly when they're about three pounds, not before that, it's rarely to see the baby outside of an isolette. They have to be able to be taking all feedings by mouth without any tubes to help them gain weight. And they have to be breathing on their own without having what we call "prematurity apnea". And in those cases when the babies are still having apnea. . .

Dr. Miller: Apnea is the. . .

Dr. Baserga: Stop of breathing.

Dr. Miller: Stopping breathing.

Dr. Baserga: They kind of, what we say, forget to breathe because their brain is not mature, and those babies need to be in the hospital.

Dr. Miller: So what would be the more common reasons that little babies would end up under your care?

Dr. Baserga: Most cases are prematurity, being born early.

Dr. Miller: And what would follow that? So inability to breathe is one of the things you've said.

Dr. Baserga: Yeah, so secondary would be sepsis or infection. They need to be in the intensive care. And then we have a big group of babies that are born with congenital malformations, and will. . .

Dr. Miller: Usually cardiac or different kinds?

Dr. Baserga: There are different kinds. We have cardiac malformations. We can have brain malformations, what we call "abdominal wall defects," such as gastroschisis. Those babies all will need intensive care in the NICU. And in most case scenarios, we are aware that this is the case, and we have what we call "antenatal consultations" with these families. And by the time the baby is born, they know that the baby will need intensive care.

Dr. Miller: Now, another thing is that you have an entire team of specialists, including nurses and nutritionists. Can you talk a little bit about the team that surrounds the care of the newborn that goes to your unit?

Dr. Baserga: So the NICU is a big family. We have the neonatologists with the doctors, and then we have specialized nurses. We also have nurse practitioners that are specialized in neonatology. We have respiratory therapists that deal with the airway and ventilators and respirators. We have occupational therapists that are the ones that are dedicated to the development of these babies. And these babies are in an isolette. They don't move much around. And they assist them with neurological development, as well as starting feedings, because they are very immature in their skills to eat. So this is a big team that will help them . . .

Dr. Miller: Just like a big village taking care of these little babies, right?

Dr. Baserga: Yes, it is.

Dr. Miller: So for an expecting mother or families of an expecting mother, one thing that they might wonder about is . . . Well, if their baby is in the neonatal intensive care unit, are they able to visit? I think there may be some fears that they won't be able to see the babies or visit the babies.

Dr. Baserga: So our intensive care unit is family-oriented. It's family-centered and we are open 24/7. There are no visitation hours. The summertime, we even allow siblings and little toddlers to come.

Dr. Miller: You have no visitation hours. You don't . . .

Dr. Baserga: No restriction on visitation hours. So we don't have a policy that limits the time the parents can be at the bedside. Having said that, they're even invited to be present during nurses' sign out. We used to not allow families at that time and now we're an open unit so that they can always be at the bedside. They even hear the report nurses are giving to each other.

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