Lessons Learned: Heather Hammerstedt, MD

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I wish we had some more time to speak with her and just get her pick her brain exactly how she does it. I know she briefly touched on how she tries to implement these changes within two minutes or less, which to me, it's just I'm having difficulty digesting that, but yeah, it was really informative and fun time. I'm excited to kind of pick her brain some more in the future. Yeah, absolutely, man. I think that was like the one thing that I learned over the past years, how all these a lot of EM docs, at least, turn over to lifestyle medicine. For her to keep doing both is that she still does night shifts for EM and then she also has this lifestyle medicine clinic that she runs is very cool to see because she's seeing both ends of the spectrum and I think that essentially can make her a better provider, especially when trying to teach patients those lifestyle techniques. Well, she's using dot phrases. I mean, I know for me, I can't speak for anyone else. It's really tough to do patient education in the hospital, especially the ER. But I think over time when you get that experience, I guess it just comes nationally after a while. Yeah, yeah, ultimately, the better you get, I mean, what do they say that the true mark of somebody who really understands something is when they can kind of simplify and use less words to try to explain it? I think that's where you get the better you get at it. The less time you need to kind of get the message across and you also figure out what kind of cues a different person might respond to and that kind of stuff and that's the art of coaching. Right? So it's really cool. Were there any specific points that stood out to you? I know we touched on, we were jumping around because we had such little time with her they were wanting to do how many things was anything to stuck out to you. Yeah, so I think like the theme I took away from this was really much mindful eating and a lot of the points were kind of broken up into how we can be mindful. But she said this quote, and I'm going to paraphrase here is that when she was talking about eating and choosing when to eat and what to eat, our future decisions are better than the decisions that we make in the moment. And that's just been so true for me, you know, growing up, I really like was food diverse. I didn't eat much and now I've really turned into a foodie. So I really have to be mindful more so and it's so true. I think we all know when we eat that one piece of chocolate that turns into five, ten minutes later, you're like, man, why did I do that? I could have just had one, I would have been fine, right? And so she states that, hey, let's just wait a little bit, give yourself five, ten minutes and really just tune into how you feel. And a guarantee you're going to make a better decision once you wait a little bit. Yeah, I think that the specific question was that I might have asked her how she approaches when her clients and patients have to deal with clinical cravings. She mentioned that she doesn't necessarily love that word. She instead prefers to use urges as a better word and I think she said essentially what you just said kind of, if you delay the action, you know, you just sit in that moment and you try to ask yourself, hey, is this truly hunger that I'm experiencing? And if it is, what kind of hunger is it? Is it body hunger? Is it like a social hunger? I think that's when she gave the example of eating chips and watching the Steelers, right? Because you associate that specific environment with that, you know, whatever the queue is, right? This goes back to atomic habits and that whatever that environmental queue is and that's why you're eating versus emotional hunger, do I need that chocolate? Speaking of chocolate, are you a milk chocolate guy or a dark chocolate guy? I love dark chocolate. I've now turned to, so at Costco, they have Hugh chocolate, the brand HU. I guess it's like short for human. It's like phenomenal chocolate. It's like dairy free, like low sugar. It's what I think most of the dark from milk chocolate. It's, it's, I guess it's similar to milk chocolate without the milk, but then I also do. I love the keto, it's like keto bar chocolate as well, which is more dark chocolate, which I love because it has a little bit like salt in it too. That's, that's where you go to. Yeah, you know what I, it's interesting. I found kind of the sweet spot for the amount of cocoa for dark chocolate. For me is kind of above 80%. That's the point where if I'm at like 80% or a little bit higher, where I can have just enough where it satisfies my quote-unquote urge, but I don't just eat the whole bar. That's three servings. It also gets real chalky once you get past like 80. I feel like I have to eat, and it's tough to eat a whole bar. So, this is a good point. I think the other thing, it's sorry, we're digressing more. That's valuable stuff right there. I mean, yeah, we know that our dark chocolate has benefits as well, but yeah, I think the, the harm will outweigh if you just ate like three servings of 70% because there's still some sugar in there. But what I also like that she talked about the hunger scale. That's the technique she uses for her children, right? And I think her children are relatively young, both of them are less than 10 years old from what I remember. And she says, hey, like are you like, you know, just famished at this point? And it's hard to kind of put that into like it words, but if you can use a scale and say, oh, I have like a five. And so maybe I can eat some more, but you know, or maybe I'm at a nine, and I don't really need to eat. I think that's an easy, easy way to figure out. Obviously, that's something that probably takes some time. That's probably like the pain scale that we often use when some patient will be sitting in front of you chilling and it's like, I'm a 10 out of 10 pain. And so that probably takes some time experience too. Yeah, absolutely no, that was, that was one of the points I took away too. And something that I think I'm going to implement, especially with my fast, because so many times when you're fasting and let's say I'm like 36 hours in, I'm like, okay, my hunger scale is at a 10, but is it really, you know, and then she said, like, could you run a mile and still be fine? You know, if you can, you're probably not at a 10, right? And I, this, this, this kind of reminds me of why a lot of biohackers have been using the glucose, the one, the, the ones that you can stick behind your arm. CGM. CGM. Yeah, CGM. Thank you. That can give you a constant reading, because a lot of times when you're fasting, you're thinking, oh my god, I think I'm getting hypoglycemic, you know, I don't think, and then you look at, and you're like, oh, my blood sugar is at a 90. I'm okay. So a lot of it's mental. And I think that's the biggest thing I took away from, from what Dr. H was saying is, you know, like, like, like we talked about, this emotional attachment to food and how that can really trigger this mental attachment, this mental, emotional state, you know, I don't, I look for, for lack of a better word, that we look at food and we look at the situation we're in, and that's why we turn to it. And that's where this urge is really, you know, coming to play. That's so funny that you bring that CGM, think of, did you see the, the Tweet 10A, is that where you're coming from? No, I didn't know. Oh, it's interesting. You know, Ben Greenfeld tweeted something, and it was actually a really interesting post about, you know, his value, like in terms of his perceived value for a CGM, and he made the case for it. Yeah, it was an interesting read, and yeah, I go back and forth about that. I mean, to me, it's just like, to get that data, it's informed, I'm going to, I'm going to go down a rabbit hole that I really want to go down right now. It's an interesting point that you bring about the hypothetical, I see me, I think, because I think I brought up to you before on that extended fast when I get to by 2022 hours or so. It's, I kind of feel like I have that at late afternoon low, where I'm starting to like crash a little bit more. I don't want to drink too much caffeine later on, because I think it does affect with my sleep, but at the same time, I feel like I need something, and, you know, my extremities get colder too. But yeah, but it's, that's such a complex process though, because that, you know, with the hormones, and especially at Peter Tia, where he talks about the, the insight that he's gotten from a CGM, that his glucose is more affected by the level of cortisol, more so than even, like, especially the fasting glucose. If he had a stressful night the night before, and, you know, he didn't sleep well in the morning, his cortisol can just like bump up the, the glucose levels. Again, again, most people have had, if they've had blood work done, they've had fasting glucose levels checked, where it's typically supposed to be between 70 and 90, and that's normal. Most people will know that. After a certain point, like, 130, we're like, okay, we're concerned about like diabetes and, you know, something's going on. And so for, for those who don't know, CGM is a continuous glucose monitor. It's like a little device that is technically only for diabetics, type one diabetics, because they need to constantly check their blood sugar. But a lot of people, what, what Darcia's talking about, are who don't need it for prescription purposes, because they don't have any disease, just want to do it for, kind of, for their metabolic health, and today, today, at this point, you cannot get it without a doctor's prescription. So I don't really know how they get it, to be honest with you, but, I know there's like, companies out now. I don't like neutral sense and stuff. I don't know if you can just like, yeah, I straight through that, or... No, I think that, I think you still have to kind of sign up and do a doctor consultation with them, and they, secondly, you're still being supervised, because, yeah, no insurance company will give it to you. Yeah, and, yeah, if you, if you don't have like, type one diabetes or some other thing that I can't think of right now, that would be like a covered expense, it's very, very expensive. The ships are very expensive. Yeah. Yeah. Yeah, I definitely want to do it, but it's just not worth the cost. There's other things. Yeah. Because lower-hanging ship than I got to dress, yeah. Exactly. Because right now to pay for those, it's all subscription-based, and it gets very expensive. It's not like, yeah, it was one-time payment. So, yeah. Well, even the ones I actually clicked on the link today, even like the sponsor, for his post today, that he uses Ben Greenfield, it's just $400 for 28 days. Wow. And maybe someday, when I'm, we're making lots and lots of money, he likes... Sure. I don't know if it'll happen this lifetime, but when we're making the attending bucks, we can do that right now, right now. Yeah. Yeah. But, you know, it's... Yeah. Actually, we're talking about glucose, so that's a great point. So, the point that you brought up, actually, that sugar, what was like greater than 70% of the American property is, you know, consuming sugar. And I think that's much more than a day, I think that's funny. Because I think EC's and Kowski actually, one of our recent guests, had talked about it on a recent episode about how the new USDA guidelines are talking about how, you know, we should be consuming less sugar. And I think overall, over the last decade, we have consumed less sugar, but it's still... Yeah. So, American Heart Association said the average human will consume about 70 pounds of sugar in a year. I thought that was a lowball as well. You know, Dr. H thought it was. I thought it would be higher, maybe 90 to 100, but still 70 pounds of sugar, right? There's 52 weeks, if you're thinking about a pound, that's more than a pound of sugar per week. Yeah. And I think just to get people a mental image, right, of a pound of sugar, think about buying one of those big, good at Costco, getting like a, you know, a big bag of sugar, essentially. Yeah. So, that's a lot of sugar, you know, in a week. So it's definitely less though, because I remember from Rob Lustig, who's kind of been one of the big proponents of, you know, antifructose and their carbohydrate insulin model. Like his, I think the secrets of sugar was a gut documentary. It's actually something really cool to check out on YouTube. It was like 2014. I want to say at that time, the number was over 100 annually. So, I mean, so we're doing better. I mean, yeah. Yeah. Let me call that a win. Yeah. It's definitely definitely positive. Yeah. But what I liked about like her response to it, though, like, you know, we're talking about how complex that the physiology in that regard is, right? How we, how essentially, again, one of his books, I talked about Rob Lustig is, I think it's called the hijacking of the American mind, where he talking about how sugar just kind of floods the brain. And, you know, we get this massive serotonin and neurotransmitter response. And we know serotonins that feel good hormone. And that's where the drugs ecstasy and, and, you know, come in because it makes people feel awesome. So, dopamine, we've recently had this conversation about this. We talked about this pretty extensively, it's a kind of reward pathway, right? That people are, the dopamine hits and gets you high. And then when that levels crash, you want more and more and more because you want that dopamine whole over again, and it kind of just reinforces the reward pathway. So, it can be very challenging to break that habit. I liked how she said, you know, if that does tend to happen when she sees clients and patients, you know, it's really a difficult conversation, but a necessary conversation that, hey, it's not necessarily the person's fault. And it's not a willpower problem versus a skill power problem. Right. I love that she said that. And that's been her mission. That's kind of been our mission to kind of empower people and educate people to give them the tools. So, they have the skills to be a bit of. I think at some level, though, you do need to have some willpower, right? You can have all the knowledge, but if you don't implement it, it's not going to work. But I think a lot of times, especially with sugar and foods and nutrition, there's so much misinformation out there, and there's people kind of just, people like us who already quote unquote, we're not experts, we're still learning, but people smarter than us are fighting back and forth. What's the best way to do it? And then the people who are suffering are the people who need the most help. I have to admit, it was one of my points as well, having self-love, right? I think we talked about it with Jody Patel, talking about, again, it's not you, right? It's the chemicals and the brain that are causing you to have this response for these urges and cravings, but it's understanding those cravings, so having that knowledge and not using it as an excuse, not necessarily saying, oh, well, this isn't me, so I can keep going. I can have some of what you're going to want, right? So it takes me back to my third year of rotation in medical school when I did geriatrics and the doctor that I was with always was telling us, when you get older, your brain starts to atrophy a little bit, things change, vascular turn, whatnot, neuroplasticity, and when you see these changes in adults that drink less water or don't get as hungry or personality changes, you can't blame that 80-year-old, that 90-year-old, right? It's the brain, it's not them. And so it kind of just brought me back to that and saying that, hey, if we have the knowledge and if we understand that it's not necessarily you, but it's something within you, then we can break that cycle and then we can get healthier because of that. Yeah, that's awesome. I mean, that's, that's sage advice right there. So speaking of behavior change, that brings me to my next point, something that really stuck with me because you know I'm reading this book right now is we're talking about behavior change and how to make it sustainable. And we all talked about the why, right? You know, one of the, you told me that you had already checked this book out called Start With You. Right. And Simon said, I talked about, you always have to start about what the purpose is. And you know, what kind of resonated with me, what thing she said was, you know, we don't, we get on a phone call with somebody who wants to work with us. And if their why isn't good enough, like what is the reason that you want to do this? Why are you making this change? If the why isn't good enough, they don't even work with them. Right. I like that. I mean, it sounds, it's not, I'm sure they're not dismissive about it and, you know, people who need help, they're willing to help. But at the same time, I recently had a conversation with this kind of reminds me of the close friend who was like, oh, yeah, you know, what about like you should do something, put a product or something like, you know, four weeks to this and, you know, and then reminded me about what EC talks about when it comes to nutrition. It's like a four week diet, a six week diet, that's, that's not, that's not what we're talking about here. We're talking about sustainable change. We're talking about long-term sustainable change. If you want to make any incremental just, you know, improvement in health, that's we have to do. Yeah, it's, it's, it's, it's honestly a huge reason why I chose the field of physiatry and pain in our, you know, I wanted to work with patients who are motivated and willing to get back on their feet and get functional and having people meet me halfway because again, you can't, you can't change someone who's not willing to be changed, right? So yeah, that was, that was, that was a really good point. Yeah. I think this is kind of where the art of motivational interview comes in. It's deeper than this, but at the, at the core of it, they keep asking the question, why? When somebody comes to you and like, well, hey, I'd like to eat better and exercise more. Okay. Well, why? Why is that important? Why do you want to do that? Well, so I can lose X amount of weight, okay? Why is losing this amount of weight important to you? Yeah. Because I have a wedding coming up. Okay. Why is it important that you are 30 pounds lighter for X amount? You know what I mean? You keep going until you identify exactly what it is and then you can kind of hang your hat on that. Yeah. What's interesting is it's so Dean Graziosi has a book called the Millionaire Success Habits and he has that in his book. It's called Seven Reasons or Seven Layers Deep. You know, pretty much ask, you keep asking why? And for any of my med students out there listening to this episode, you'll know that's exactly what I implement with every single one of my students when it comes to writing a personal statement and figuring out why you're choosing medicine because you don't want to keep it to that superficial level of like two Ys. Like, why do you want to go into meds? I want to help people. Okay. Why do you want to help people? Well, ever since I was younger, I saw my grandma, okay, well, why does that matter? And as you keep going, that's where you really, you know, it hits the soul and then you'll never forget about it. And that's going to be your motivation, that driving factor as you keep moving forward. I love that. What's it called again? What's the name of the book? It's called the Millionaire Success Habits. Millionaire Success Habits. Cool. Yeah. Yeah, I'll have to shift that on myself actually. I got to put that on the list here. Okay. What else? What else do you remember, man? I mean, I think that it was awesome. I mean, like, definitely a lot of, you know, 30,000 foot overview, we jumped around a little bit and we're definitely hopeful that we're going to have her back. I think actually the plan is to kind of have her back and dive a little bit deeper into some of these topics. We talk about the mechanistic changes and some of the physiology as well as dive deeper into how the, what the actionable tips are that people can take away and making sustainable change and dealing with, you know, see, these complex things such as urges, you know, we kept it pretty high level, but hopefully we'll dive deeper into it next. But I, you know, the one thing that her parting words, I really love that. I mean, it's not much I didn't love, but her parting words, I think that she kind of left is basically at the end of the day, we have to control what we can control, right? And what can we control? I think she said something to the effect of, you know, how much do we move, right? That's exercise and exercise doesn't, again, I think when we say exercise, people like oh, it's training with barbells or dumbbells or stuff or running or on a treadmill, people have that notion that's exercise, but I like, I liked it the way she, or I like it the way she phrased it, right? How much you move and that's just getting up and walking, getting a walk going for a walk outside, maybe not staying on the desk for five hours straight, maybe getting up, you know, every 30 minutes and maybe taking a lap around the office or whatever, just activity that you can incorporate throughout the day, what we put into our bodies, right? That's forced food and nutrition essential, but also exogenous substances like supplements and medications and all those kinds of things. And then the last thing that she had said was our thoughts in her state. I mean, this is something that you are exceptional at or definitely better than me at, but that's kind of the building, the distress tolerance, right? And how do we do that? We do that with mindfulness. We do it with our social connections, right? We do it with just working on our emotional or reactivity and that kind of stuff. I'll add one more thing to it. It's basically how we recover and that's kind of like the bedrock of all of these. And to me, that's where sleep is, you know, the foundation of all that. What Matthew Walker calls the Archimedes lever or what Charles do, he would say is the kind of like the keystone habit, at least for me it is. So yeah, so that's what I want to add. Absolutely. Awesome. Well, everyone, I think this is definitely an episode you should check out. I'm excited to have Dr. H in the near future again, exactly like you said, ultimately, going into some deeper stuff here into the science, maybe, of addiction and gut health and mindful eating and gut brain connection and a bunch of other stuff. But this was just a great overview. Right on. All right. All right. Yep. Okay, before we end, don't forget to reach out to MedEVol. For those of us who know how hard it is to build and maintain a sustainable business, we understand that bringing the right solutions to achieve our goals is key. Go to www.DrPodcastnetwork.com, 4-slash MedEVol. And get on the path to transparency, automation and accountability in your revenue cycle. Okay, guys, everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing medical advice. No physician-patient relationship is formed and anything discussed in this podcast does not represent the view of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health-related issues. And again, as always, if you enjoyed this episode, please, please, please feel free to rate, review, share and subscribe until next time.