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Announcer: "Health Hacks" with Dr. Troy Madsen on The Scope.

Dr. Madsen: Today's health hack is a simple thing you can do to drop calories from your diet and lose weight. So let's say you're cruising along, you want to lose weight, but you just cannot seem to drop the pounds. Simple trick is look at your diet. If you're having a soda every day for lunch, particularly a large soda, or maybe breakfast, maybe dinner, whenever you might have a soda or several sodas, if you can cut a large soda, one of these gas station soda-sized things from your diet every day, you will lose a pound per week.

This is based on the fact that these large sodas probably have 500 calories. If you're just maintaining that drop right there, 500 calories for a man or a woman, is enough that you should be dropping about a pound of weight per week as long as you're keeping things steady with the rest of your diet. It's a simple thing you can do, just a matter of trying to replace it. Just drink more water, avoid the calories from that soda, and over several weeks, you're going to see the weight start to come off.

Announcer: For more health hacks, check out thescoperadio.com, produced by University of Utah Health.

Scott: How do you tell your doctor what's wrong with you when you can't even yourself really put words to it and communicate what it is? We'll give you some pointers on what you can do so you can get better next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Scott: Dr. Miller I have a feeling that there are a lot of patients out there that maybe aren't feeling 100%. They're not healthy but they really can't describe what their symptoms are.

Dr. Miller: But they're worried about it.

Scott: But they're worried about it or they just want to feel better. Right?

Dr. Miller: You know it's not something that's just happening over one or two days, but maybe it's been going on for several weeks.

Scott: Yeah but they're afraid. It's like when you go to the auto mechanic. By the time you get to the doctor the auto mechanic is going to have to start throwing parts at the problem.

Dr. Miller: It's a little bit overwhelming to come to the doctor's office and enter this large medical system where many things might happen.

Scott: Yeah, and then we're afraid you're going to start throwing tests at this problem and we're never going to find out what's wrong.

Dr. Miller: I think that inhibits people from coming to the doctor. So in reality, Scott, many times the diagnosis can be arrived at through a history and a physical.

Scott: Even If I just have vague symptoms?

Dr. Miller: Absolutely. And I think some people believe that rightly or wrongly they will need imaging. So a CT scan or an MRI or they'll need a lot of blood work or they'll have to get onto a treadmill. They might think a test is going to give them the answer. And that's not true. At least initially.

Scott: Okay.

Dr. Miller: And the other part of that is, or on the opposite side of that, patients might not want to do that because they don't have the funding to do that. They don't have the money to do that and so they're afraid that the physician is going to order many tests that they can't afford and that will just confuse things even more for them. They just want straight talk.

Scott: They want straight talk and then want to feel better and they don't want to have to take a lot of pills or do a lot of tests or come back to your office eight times.

Dr. Miller: Right. So two camps. One camp of patients might want testing that they think will make them better when in fact they don't need specific testing. They need to have a good history and a physical. And the other set of patients might eventually need testing but they are worried at the get go you're going to run up a whole bunch of bills performing tests. And that's not true either. It begins with a history and a physical.

Scott: That's your first line when somebody comes to you with this sort of a problem, you start doing a history. And how?

Dr. Miller: It's an age old approach to taking care of illness and it's still the best way to do it.

Scott: And how?

Dr. Miller: It's absolutely the best way to do it.

Scott: How often do you figure out what's going on just from that first step?

Dr. Miller: Probably 90% of the time we'll figure out what's going on or you'll have a general idea. You can create broad categories of diagnoses and those can be sorted out usually within the first visit for the patient by taking an adequate history.

Scott: So you do that history. What about for the 10% that that doesn't help? What would happen at that point?

Dr. Miller: It depends on what you find out. So that's a little bit hard to sort out. But I think the message here is that patients coming into the office will have some type of an answer by the end of the examination and then a more focused approach to what testing will be needed. And most of the time that testing is not extensive.

Scott: Yeah. Have you ever had a case where you couldn't figure something out?

Dr. Miller: Sure. Sure. It takes a while and sometimes you don't figure it out. That's rare. That's not very common. In general when you can't figure it out or put a name to it, the patient continues to do well. They may have complaints but in general it isn't a life threatening or chronic condition for them.

Scott: So you could take some relief in that.

Dr. Miller: They can and I can and you keep the door open and they keep coming back. If reassurance is important for them then that is an important thing to provide. Reassurance is a very effective treatment sometimes even when you can't find a diagnosis. But you can say, "I don't think this is going to lead to something terrible."

Scott: Is there something that the patient can do before they come to visit you for that first time to prepare for that kind of history probing that you're going to do?

Dr. Miller: Well we talked about this in another interview and I think that main thing for them is to write down a set of questions before they get to the doctor's office because many times patients sort of lose their words by the time they get in to see the doctor. They are a little bit anxious and they don't remember all the questions that they wanted to ask. So writing down those questions before they come in is important.

Scott: And those specific symptoms?

Dr. Miller: Right and sometimes bringing a family member to double check what they are seeing and thinking. Especially in the older patients it might be very helpful. Especially if there's issues of memory and forgetfulness associated with how they're acting and feeling.

Scott: So bottom line. If somebody is not feeling well they really should just come to see you because odds are you're going to be able to figure it out in that one visit.

Dr. Miller: Right, they should be able to go and see a primary care physician or a provider who provides primary care and ask questions. Spend some time having a physical and history and that's the beginning of the process of learning what is going on. I would say the majority of times, it's not usually something that is seriously wrong.

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Interviewer: You just had a surgery. You might be wondering when can you get back to your life, the things you enjoy doing, your activities? We're going to find out next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: How long after surgery until you can kind of get back to your life the way it was before surgery? That's a question a lot of people have. We're with Dr. Jeff Campsen. He's a surgeon at the University of Utah Hospital. So, when can you get back to your life after surgery?

Dr. Jeff Campsen: Well, it depends on the type of surgery you have. Anytime you have some sort of incision that goes intra-abdominal, you have to heal that incision. Depending on your state of health, it can be shorter or longer. An average time length that a lot of people say with an abdominal incision is about one to two months or even just six weeks to where you really want to let it heal and you try not to put too much pressure on your abdomen during that time.

Interviewer: Is it the skin that's the issue, that that's going to break apart, or is there muscular things underneath that need to heal as well?

Dr. Jeff Campsen: That's exactly right. It's the deeper tissues, what's called the fascia. The fascia needs to heal, and that's what you would get a hernia through. The skin heals fairly quickly, but the deeper tissues take a little bit longer to heal. That's what takes one or two months. Those tissues are basically what make up your abdominal wall. They're sewn back together, but then the stitches that we use, the deep sutures, will only hold up so long. Most of the time over time they get absorbed, so it's really your body reforming that abdominal wall.

Interviewer: Oh, so after surgery there's multiple stitches. There's the stitches inside of me, and then the stitches I see on my skin.

Dr. Jeff Campsen: That's right. You can have internal sutures or external sutures on the skin, but it's the deep sutures that are really what's prohibitive to getting back to your normal daily activities. Basically, lifting anything greater than 10 pounds, putting any kind of stress on you abdomen.

Interviewer: Wow. That's not a lot of weight. I mean, you can't go grocery shopping without lifting something that's 10 pounds.

Dr. Jeff Campsen: You can't. Most children are greater than 10 pounds, which really puts a damper on a lot of people and just daily activities puts you in that position. But it's worthwhile waiting for it and letting yourself heal because then the end result is that you tear through those sutures or don't heal, and eventually you get an abdominal wall hernia, which then can be life-threatening and will need to be fixed at some point, adding another surgery onto what you've already had.

Interviewer: Wow. So it's very serious stuff.

Dr. Jeffrey Campsen: It can be.

Interviewer: Yeah.

Dr. Jeffrey Campsen: It can be extremely serious, and this is the one thing where it's a good idea to pay attention to your doctor.

Interviewer: All right. So what types of activities are OK and not OK?

Dr. Jeffrey Campsen: I think as you get further and further out, the activities open up more. In the first two weeks you have to be very conservative. You want to walk, because getting out of bed opens up your lungs and pumps blood back from your legs to your heart, so it keeps you from getting a pneumonia or blood clots. So you definitely want to get up, walk, and do activities around the house. You can still do desk work and different things like that. You need to be active to allow healing.

After about two weeks, at two to four weeks you can start doing a little bit more physical activities. What I tell my patients is there's a little voice in your head that's probably saying, "Eh, that's not a good idea," and if that pops up, you should back away from it. Then after a month, you should start to push it a little bit. If it feels bad, don't do it. Wait a couple days. Try it again. If it feels good, move forward, because I'm not there with you, and you're going to be, basically, living this every second and you need to sort of use a lot of common sense on what to do and not to do, and basically really listen to yourself. The mantra is, "If it doesn't feel right, maybe give it a few more days."

Interviewer: Got you. When you say feel bad, you're talking about pain? Is that what you mean by feel bad?

Dr. Jeffrey Campsen: Pain, pressure. You know, you don't want to hear somebody call in and say, "I lifted something and I didn't listen to you, and I heard a pop."

Interviewer: Oh.

Dr. Jeffrey Campsen: What you want to do is not get to that point, and so you're basically. . . If you're pushing yourself a little bit, you're starting to lift something heavy, you're starting to do some exercise, all the good things that we actually do want you to do, and you start to feel pressure on your belly, maybe back away and give it a little bit of a rest.

Interviewer: So, it sounds like if you just kind of pay attention to your body, you're going to have a fairly good idea of what is appropriate or not. Or should you do far less than what you feel is appropriate?

Dr. Jeffrey Campsen: No, I think if you pay attention to your body, you can pretty much do what's appropriate. It's just you really have to use some good common sense and listen to yourself and not push it too far.

Interviewer: Anything else that we should talk about? Anything that might surprise somebody about this topic? Anything that you feel like we forgot, or feel compelled to say?

Dr. Jeffrey Campsen: I think one whole different aspect is this also comes into the realm of when can I drive after surgery? I think driving comes back into your abdominal wall healing. It's not so much your ability to turn the steering wheel and press the gas pedal. It really comes down to: Is your abdominal wall healed enough to where you can stomp on the brake? You obviously need to be off your pain medications, because you can't drive on pain medications, but if you can stand straight up after surgery, whatever many days later, and take your brake foot and stomp on the ground really hard and it doesn't hurt your belly so bad that you are writhing in pain, then you can proceed to drive.

The reason that is, is that most people can drive around. They can push on the gas pedal. They can work the clutch, all that kind of stuff, but if they get into a situation where they've got to stomp on the brake to stop their car rapidly, and they can't because it's painful to them, then they're going to get into a wreck.

This kind of goes into when is your abdominal wall healed enough that you can handle that? Everybody heals a little bit differently, and so it kind of comes into common sense. So, if you can do that test before you ever get into the car, and you're successful, chances are you're going to be fine.

Interviewer: Should you avoid twisting, turning motions?

Dr. Jeffrey Campsen: This gets into. . . You know, it's springtime in Utah, and a lot of people are golfers. What we basically say to that is very similar to lifting and all the other things. You can turn and twist, but if it starts to put too much pressure on your belly, you need to wait. As you get two, four, six week out, you can do more and more.

The analogy with a golf club is maybe in the first two weeks just sort of use your putter, and in the two to four weeks, you can sort of use an iron and just do a half of a backswing. Then, maybe after six weeks to eight weeks, you can really do that full golf swing that you want to do. I think that sort of relates to, basically, what do you do with your abdominal wall, and any of that twisting and turning you can do more and more as you get further out from the sugary, but also the rule, again, is if I feel like it's painful, if it's putting too much stress on my abdominal wall, back off. Give it a couple days to rest, and then try it again in three or four days.

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: June 29, 2018
originally published: June 25, 2014

Interviewer: Sometimes when you start eating healthier, you feel worse at first. Today, common negative reactions, which are short-term, to eating healthier. Is it normal when someone goes from not eating to eating healthy to feel some negative side effects?

Staci McIntosh: It depends on where you're coming from and where you're going. What did you eat before and how much did you change that? The more you change your diet, the more adjustment time will be necessary

Interviewer: How about from not too healthy to really healthy?

Staci McIntosh: Expect a couple of weeks. It's going to take some adjustment for sure.

Interviewer: What about some specific symptoms?

Staci McIntosh: So a lot of times our gut is populated with bacteria . . . Well, it's always populated with bacteria, and it gets specific to the types of foods that we're eating. When you change that and you're eating more fruits or vegetables then the type of bacteria that populates your gut is going to change with it, and that takes an adjustment period, and that will result in gas, and bloating, and a change of the population of that bacteria.

Interviewer: If you already said this, I'm sorry, but so the bacteria probably helps you digest, and you need to get the right kind for the food.

Staci McIntosh: Exactly, we all have bacteria in our gut, and it's part of our happy gut flora, and there's a healthy population of a variety of bacteria, and then there's not so much of a healthy population.

Interviewer: So you've got to get rid of the fast food bacteria and get some fresh fruit bacteria in there?

Staci McIntosh: You're introducing the good bacteria as you eat more fruits and vegetables, and then that's going to start changing the whole flora.

Interviewer: What about constipation and diarrhea is that the same thing going on there?

Staci McIntosh: Some of it will be. Some of it may be that you've gone from a low fiber diet to a pretty high fiber diet without a transition period, and without enough water during that time. So I always recommend that if someone's going from a pretty low fiber diet, so the average American eats 13 grams of fiber a day, and the average recommendation is between 25 and 38 grams a day.

Interviewer: Wow so almost half.

Staci McIntosh: So we're a pretty low fiber community in general so if we're going from a low fiber diet to a high fiber diet, we need a little transition period, and we need to increase the amount of water and activity that we're doing so that it helps get things healthy and not result in constipation.

Interviewer: Is that another enzyme issue?

Staci McIntosh: It's not an enzyme issue. Because we don't digest fiber so there's no enzyme to digest fiber, but it's just a matter of the fiber sucks in water and that's what helps make an easier stool to pass, but if you don't have the extra water for it to suck in then it becomes constipation.

Interviewer: All right, what about like brain fog? I feel like when I start my new diet sometimes I get brain fog. I'm not as sharp as I used to be. What could be going on there?

Staci McIntosh: You know I would have to find out more about what you were eating before and then what you changed to. I would expect, I expect to hear those kind of questions sometimes when I have a patient who's going to a low carbohydrate diet, or going to a paleo diet, or going to some extreme diet where they don't have enough carbohydrates intake, and then it will make you feel like a brain fog because you don't have enough basic glucose in the brain.

Interviewer: So you can eliminate too many carbohydrates?

Staci McIntosh: Absolutely.

Interviewer: What about fatigue and low energy is that a carbohydrate issue again?

Staci McIntosh: Yeah your basic, your primary source of fuel for every cell in the body is glucose.

Interviewer: Could it be just more calories could be the solution for something like that or does it need to be carbs?

Staci McIntosh: It needs to be glucose, you're going to use glucose for your brain, you're going to use glucose for energy for every cell in the body, and you can get that glucose from breaking down glycerol from fatty acids, or from turning amino acids into glucose, but that's just another step that your body has to go through.

Interviewer: Got you.

Staci McIntosh: So if it has available glucose then you have available energy for the cells.

Interviewer: What about headaches what could cause that if you're changing from one philosophy of eating to another?

Staci McIntosh: A lot of different things. So sometimes if people are going into using a lot of non-nutritive sugar replacements, so saccharin, aspartame, all those type things. If you would normally drink soda and then you go to a diet soda that can give people headaches a lot of times, and also if you're going to a really low carbohydrate diet your brain uses glucose, and every cell in your brain uses glucose, and it wants glucose, and if you don't have enough glucose available if you're on either a very low calorie diet, you're not getting enough fluids, or you're not getting enough glucose regardless of the calorie amount that would be a typical recipe for a headache.

Interviewer: Okay, how about extreme cravings? Now all of a sudden I want everything that's not good for me anymore.

Staci McIntosh: That's human nature.

Interviewer: Is that what that is?

Staci McIntosh: Yeah that's human nature. As soon as you say you can never have chocolate again that's all you're going to think about.

Interviewer: Yeah, so that's why it's probably good to maybe allow yourself a little.

Staci McIntosh: That's why everything in moderation.

Interviewer: A little taste, all right. What about going through withdrawals of things like caffeine, or sugar, are there withdrawal symptoms to those types of things?

Staci McIntosh: Absolutely, when you look at someone's MRI scan, for example, and you look at the result that it has on the brain for sugar versus nicotine it's the same area of the brain that gets stimulated so it does trigger, certainly not an addiction like nicotine would, but it's triggering the same areas of the brain so you can experience those withdrawals.

Interviewer: All right and some headaches might be caused by getting rid of the bad stuff and you're actually going through withdrawals, like . . . wow.

Staci McIntosh: Sure.

Interviewer: When somebody goes on a new diet what words of advice do you have for them to get through this process, because I imagine some of these things actually stop people from eating better?

Staci McIntosh: Absolutely, I say one step at a time, don't change everything overnight, if you have gained excess weight you gained it one gram at a time let's think about losing it one gram at time not changing everything all at once, and keeping in mind that eating is a basic enjoyment of life. If you're changing to a diet that is really not that enjoyable then why do that? Why not just start on something that you plan to do the rest of your life because it's healthy, and it's enjoyable, and you and your entire family can do it?

updated: February 17, 2023
originally published: February 26, 2014