Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH, FACN, FACPM

Can Your Waiting Room Become a ‘Game Changer’?

Introduction

“You can lead a horse to water” – but how? On reading screening recommendations such as those by the US Preventive Services Task Force findings, or when studying a Cochrane Review, or attending a federal agency briefing, conclusions often point to the basics: eat fruits and vegetables, get sleep, and keep active, for example. And it’s those basics that can be especially hard to achieve. In this Townsend Letter focusing on men’s health, I invite you to consider trivia questions as a clinical tool.

‘Questioning’

Health Behavior Change

Quiz style questions might engage an adult learner’s interest, buttressing conventional reminders about whole grains, phytonutrients, and fried foods. Here are some of the reasons that quiz style questions are effective.

• Questions have been shown to be an effective tool to educate adults, especially when they may be falsely confident about a subject matter. People are making their decisions every day based on incorrect information. Adults for the most part think that they know what healthful nutrition choices are, but a closer look shows that they might not. Misunderstandings can stem from lack of education, lack of interest, and truth presented less than evenhandedly. The net result is the same. Men in America today make daily decisions about their health less than fully informed. The risk-benefit ratios that they perceive don’t line up well with reality. Trivia questions can gently expose incorrect assumptions.

• Game-show style questions infuse nutrition with fun. Nutrition works, but it is often found boring and left untried. That’s why a dose of fun can increase the uptake of positive health behaviors.

• Questions such as the examples below link healthful foods with everyday objects. Health reminders can be delivered while spotting an Arkansas quarter at the car wash, sitting by the flamingo pool at the zoo, or extracting an egg slicer from the jammed kitchen drawer.

• Quiz questions make health messaging less like a health evaluation. Nutrition certainly involves personal responsibility, but not as much as we usually think. Take, for example, the lipid profile. When I’ve presented patients with their improved lipid profile, I’ve often been struck by how personally people take the results. When positive, they feel proud of their accomplishments but seldom attribute the successfully lowered cholesterol to their team: the spouse who changed the dinner menu, the doctor who diagnosed and treated sleep apnea, or the boss who advocated for the newly installed workplace gym. Similarly, when results are unfavorable, patients tend to view it so personally that their response can block effective behavior changes.

Recently I presented NutriBee, our Johns Hopkins research project, at a prominent national convention. I tried different ways of inviting visitors to our exhibit booth. The most effective method was, “Hi, may I tell you about our game show?” My question prompted nods and surprised looks.

Do you think this may be because attendees:

1. think I look nothing like Alex Trebek;

2. find game shows and nutrition discordant;

3. are relieved that a medical doctor is asking them about trivia;

4. all of the above?

I’d be interested in knowing which you chose.

Try a Few

Wild rice might be jingling in your pocket. Which US state or territory quarter features this indigenous American crop?

1. Arkansas

2. Samoan Islands

3. Alaska

Flamingo feathers are pink, salmon is salmon-colored, and carrots are orange because of which plant nutrient?

1. anthocyanins

2. beta-carotene

3. lycopene

Twang plang plung [sound an egg slicer makes when the wires are plucked]. This kitchen tool is used to prepare something that has been:

1. Boiled

2. Baked

3. Fried

Answers

: A, B, A

Bringing the Game Show to Your Waiting Room

Maybe you’ve considered an upgrade to your waiting room. If your reasons include enhancing efficiency, promoting health behavior changes, complying with federal guidelines, or making the experience more enjoyable, a game show might be for you. Or you may simply want to have a few trivia questions around. We recommend a PowerPoint presentation on a digital display frame.

You might refer to the November 2013 Townsend Letter and my column “Sea 4 Yourself.” I’ve developed some sample quiz questions from it.

To replenish magnesium:

1. Drink milk.

2. Microwave the filet mignon from last night’s dinner.

3. Bath in Epsom salts.

4. Take calcium supplements with magnesium.

What’s the best fish to eat for your health?

1. barracuda

2. reef fish

3. sardines

4. tuna

The USDA has a program called Fight BAC, which helps remind us how to keep shellfish safe. It recommends which of the following:

1. Refrigerate at 31 degrees Fahrenheit.

2. Refrigerate at 31 degrees Celsius.

3. Separate shellfish from other foods.

Seaweed is a group of foods sometimes called sea vegetables. Scientists classify them as

1. green water plants

2. fungi, like mushrooms

3. members of the kingdom Protista

As with the first three questions, the answer to this question is (C): eat seaweed and add an entire Kingdom to your diet. Nutritionally, this is not an esoteric point. Seaweed is a source of vitamin B12 unlike plants and it is richer in protein and minerals than most plants. While plants are immersed in air, seaweed grows immersed in water and is therefore well adapted to processing high volumes of minerals and metal toxicants. Similar to vegetables, seaweed is alkalinizing, which helps counteract the acidifying properties of the mineral-rich salt that accompanies it.

Be the Salt

One of the most confusing health messages of our time is about salt. Read a sports magazine and you think it’s good for you. Read a health magazine and you think it’s the leading cause of ill health. Who’s really trying to reconcile these two seemingly contradictory states from the lay public’s perspective? You might consider adding a quiz question of your own. It could be, guess what this is? as you display a large rock of salt serving as a paperweight for your quiz question.

The following excerpt from the November 2013 column mentioned above begins to provide a bit more background for reconciling the health messages around salt.

The rock that you can drink is worth drinking, but carefully. The American diet contains far too much salt. Salt in processed food is generally noniodized table salt, the salt with the most downsides. While sea salt is preferable to table salt because it has a favorable diversity of minerals, salt from seafood such as anchovies and seaweed shouldn’t be overlooked as significant sources of dietary intake. Sea salt is becoming an advertising ploy. Processed foods flavored with sea salt are not necessarily more healthful.

One of the health challenges with salt is that it is acidifying. To be consumed more safely, it should be combined with alkalinizing foods such as fruits, vegetables, and seaweed. Salt of any kind, even the finest sea salt with the most minerals, should be avoided on a burger and fries meal. To rehydrate, add sea salt to water along with a tablespoon of lime juice. Citrus is acidic in its physical chemistry as measured with litmus paper, but biochemically it produces bicarbonate through the citric acid cycle, which makes it highly alkalinizing and therefore able to offset the acid load of salt.

In Summary

When it comes to men’s health, behavior changes in the areas of food selection, optimizing metabolism, and other aspects of nutrition are effective but underutilized. New ways to incentivize health behavior change could therefore have a big impact. Using quiz-style questions in the format and genre of shows, bees, and trivia games is an innovative tool backed by science. In other words, your waiting room could be a real game changer.

Ingrid Kohlstadt, MD, MPH, FACN, FACPM, is the founder of INGRIDients Inc., where she has edited Advancing Medicine with Food and Nutrients, 2nd edition (CRC Press; 2012). On the faculty of Johns Hopkins Bloomberg School of Public Health, Dr. Kohlstadt is researching an approach to leverage nutrition more fully in disease prevention.