May is Mental Health Awareness Month! If you are someone you know struggles with mental health, point them towards GreenField and our Same Page Program!
GreenField On Call for You 24/7
The clinical team at GreenField is on call for all of our patients 24 hours a day, 7 days a week. That means that if you have any pressing need, question, or concern regarding your health, you can call on us at any time, and a clinician will be available to respond. Call support is available for patients of all ages. This is a benefit that we take pride in offering all GreenField members, and is one way we keep our commitment to reliably serving you. It is also one way we can help limit sometimes unnecessary/expensive/unpleasant trips to urgent care or the ER. Please do not hesitate to call us after/off hours when you need us!
It’s just about that time of year again in the Northwest when we get to enjoy some sunshine. Speaking for ourselves at GreenField, that’s a change we’ve been looking forward to. Not only is a sunny day a pretty sight, but physiologically, we all need some sun exposure. Unmitigated sun exposure is the primary way we produce Vitamin D for ourselves - it takes roughly 15 minutes for a child or adult with healthy skin to produce their requisite daily amount of vitamin D, and this assumes full trunk and arm exposure at peak sun position in the sky during the lighter half of the year. Vitamin D, as you are likely aware, is important for healthy bones, disease prevention, and maintaining balanced moods, among other health benefits.
At the same time, though, we also need to protect ourselves from the sun, especially because of the degradation of protective elements of the atmosphere - including the ozone layer - due to human-induced climate change. Too much sun can cause skin damage, eye damage, and a number of types of cancer.
Statistically, around 50-80% of total lifetime sun exposure is endured before age 18. Therefore, it is important for young adults and children in particular to follow some simple guidelines to prevent excessive exposure. Though please note that these recommendations to apply to adults past age 18 as well!
First, a basic explanation of the three main types of ultraviolet rays in sunlight:
- UVA rays cause skin aging and wrinkling and contribute to skin cancer. They make up the majority of our sun exposure. These penetrate water vapor (as in clouds) and glass as well. UVA rays penetrate the skin more deeply than UVB rays, and thereby cause damage to deeper layers of skin cells. Tanning beds have UVA rays, and a UVA tan does not protect you from additional skin damage.
- UVB rays primarily affect the upper layers of skin, and are largely responsible for sunburns. They also contribute to cataracts and immune system damage, and to a lesser extent than UVA rays, skin cancer. Most UVB rays are absorbed in the ozone layer but some still pass through to us.
- UVC rays are the most damaging but are mostly absorbed by the ozone layer where it remains present.
Unprotected sun exposure is unhealthy for all of us but is most dangerous for people with any of the following characteristics:
· Many moles and/or freckles on the skin (or family members with moles)
· Very fair skin and hair
· Family members with skin cancer (including melanoma)
That said, everybody needs sun protection – even those with darker skin hues.
There are a number of effective ways to protect yourself and those you love from excessive sun exposure.
Avoid the sun’s strongest rays. Some situations and locations require extra sun protection. The sun is stronger at higher altitudes (especially on plateaus and mountains) and closer to the equator, so extra sun protection is needed in these areas. Rays are also stronger near water or snow, since they reflect off of those surfaces. Finally, rays are strongest in the summer and when the sun is highest in the sky (from 10:00 a.m. to 4:00 p.m.). Although the most vitamin D can be produced at these times if sunscreen is not used it is important to limit total exposure given the above risks.
Cover up. Wear clothing that blocks out the sun. You shouldn’t be able to see your hand through clothing. This is especially important for infants who have thinner skin and because sunscreen is generally not recommended for infants under six months. Be mindful that once wet, clothing provides less protection. There are additionally some articles of clothing out there that meet international certification standards specifically for UV ray protection. You can also cover up using an umbrella or a tent.
Use sunscreen. The variety of sunscreens offered is a bit overwhelming. For you and your family the most important thing to look for is the SPF (Sun Protection Factor). The higher the SPF, the longer you can stay in the sun without burning. Choose a sunscreen with SPF 15 or higher. Make sure the sunscreen protects against both UVA and UVB. Apply in a thick layer on all exposed areas of skin. Choose a waterproof sunscreen if your plans include swimming or heavy sweating. Reapply if in the sun for more than 2 hours, as sunscreens do eventually wear off and/or absorb. Check the ingredients, especially if you are one of the many people who are allergic to the sunscreen ingredient PABA. Most sunscreen products have a shelf life of around 3 years, so remember to check expiration dates.
Use protective eye wear. Prolonged sun exposure can lead to burns of the eyes (cornea) and over time can result in cataracts. Purchase sunglasses for you and your children that have 100% UV protection. Sunglasses without this label may not protect against UV damage. Try letting your children choose their own sunglasses: they may be more likely to wear them.
And as always, if you have any questions or would benefit from individual guidance, be in touch with your GreenField provider team.
Pondering Protein: Are There Reliable Plant-Based Sources?
Protein: perhaps the most common nutrition-related question and consideration for us as clinician providers. How much do we need? Are there times when we should consume less? From where should we get it?
Following the National Academy of Sciences’ report in 1943, protein entered the zeitgeist of the healthcare conversation in a way that got the public’s attention. In that report, the NAS recommended for adults - based on some statistical rounding - roughly 10% protein content in the diet by calorie volume. This means that if, theoretically, a person consumes 2000 calories per day, they would ideally get 200 calories from protein. This amounts generally to somewhere around 50 grams of protein per day.
A number of panels comprised of scientific experts have since reviewed this recommendation, and agreed with it. As of 2019, this process recurred at least 14 times.
So let’s take for granted that on average, that this recommendation roughly meets the needs of most adults. What sources can we get our protein from?
Many Americans get their protein from animal products - meats of all kinds (including fish and poultry), dairy, and eggs. However, there is a growing body of evidence that suggests these sources are highly risky for a variety of health outcomes-related reasons. Although that discussion is beyond the scope of this particular mini-piece on the subject, it will suffice to say for now that one can indeed get enough protein from unprocessed plant-based sources alone. In fact, two of our very own providers, Dr. Matt Van Auken (writer of this piece) and Jessica Barbosa, PA-C, do just that!
Getting enough protein from plant-based foods is simpler than one might think. And given the growing popularity of plant-based diets and interventions, it seems prudent to summarize some key points here.
Legumes. Rich in iron, fiber, and a variety of other nutrients, these foods are protein powerhouses. A single serving of navy beans (that’s about ½ cup cooked), for example, contains about 15 grams of protein, and almost 10 grams of fiber at the same time - a genuinely incredible combination. But all legumes are excellent for health - chickpeas, lentils, split peas, English peas, and any variety of bean. Legumes should ideally be extra-well-cooked to optimize their digestibility. Pressure cookers make this process incredibly easy. Prepare them however you like! Stewed, souped, blended into a dip (e.g. hummus), etc.
Choose soy. A complete protein unto itself, soy is incredibly versatile. It is actually a legume, but is so unique it gets its own mention. A number of soy foods fall into the whole/unprocessed/minimally processed category, including tofu, tempeh, and edamame. In addition to protein, these foods are rich in folate, vitamin K1, and thiamine, and a number of minerals including copper, phosphorus, and manganese. Soy was maligned for a long time due to theoretical increased risk of breast cancer from phytoestrogen content. However, as it turns out, people with breast tissue who include the highest relative whole soy food content in their diets actually have lower breast cancer risk. Even people who have under gone treatment for breast cancer and are in remission have lower risk of the cancer coming back when eating more soy foods! Roughly one (1) serving of whole soy food per day is enough to provide ~54 mg of isoflavones, which in studies has shown to reduce perimenopause hot flash severity and frequency by up to 50%. There may be some anti-prostate cancer benefit to soy, as well.
Interested? Consider using tempeh in cutlets to make an Italian-style Parmesan (bonus points if you use homemade cashew cream instead of cheese), or crumbling tempeh into your chili instead of the ground beef or turkey. Or scramble tofu for your breakfast meal instead of eggs. So many possibilities!
Nuts and seeds. Examples include almonds, pecans, walnuts, cashews, pumpkin seeds, flax seeds, hemp seeds, and so on. Most nuts and seeds contain between 4 and 10 grams of protein per ¼ cup serving - fairly impressive considering they also come packed with healthy fats. Their fatty acid profiles are so wholesome, in fact, that a single serving of these foods daily (nuts in particular) have been shown to independently lower heart disease risk (assuming that they are unroasted and unsalted). Moreover, some reviews of the data suggest that nut (and possibly seed) consumption may actually reduce the risk of death from multiple causes beyond heart disease alone - pretty good stuff!
Whole grains. With anywhere between 4 grams and 10 grams of protein content per cup cooked, grains are also an excellent source of protein. The more processed they are (e.g. into flour for pastas and breads), the less protein and fiber content they contain, so we recommend cooking the grains as you can see them with the naked eye. Your gluten-containing grains include wheat and relatives (kamut, farro), as well as barley. And there are known health benefits to gluten, so long as you can tolerate it well! There are many gluten-free options as well, though: brown rice of all varieties, sorghum, buckwheat, steel-cut oats, millet, teff, wild rice, and so on.
Some vegetables and fungi are high in protein, too! Mushrooms on average contain 4.4 grams of protein per 1 cup cooked serving-size, and multiple varieties have noteworthy antioxidant and anticancer properties. 1.5 cups of artichoke (about a single large artichoke) contain about 4 grams of protein. Spinach contains 2.6 grams of protein per 1 cup cooked serving. Nutritional yeast contains 6 grams of protein in a measly 2 tablespoons! Even less-packed examples of many vegetables contain 0.5-1.5 grams of protein per serving. Just by consuming enough in the way of your veggie meals and side dishes, you are getting more than you think! Eat up.
Honorable mention: fruit. Don’t sleep on fruit, either! For example, a single mango can contain a gram of protein. A medium-sized apple on average contains 0.5 grams of protein. Not half bad.
Questions about this topic or anything nutrition-related? Check in with your GreenField lifestyle team! Dr. Matt Van Auken and Jessica Barbosa, PA-C are both lifestyle medicine board-certified providers, and our fabulous nutritionist is Katie Rogers.
Your GreenField Integrative Physician, Dr. Matt Van Auken
And the entire team at GreenField Health
Y. Bao, J. Han, F. B. Hu, E. L. Giovannucci, M. J. Stampfer, W. C. Willett, C. S. Fuchs. Association of nut consumption with total and cause-specific mortality. N. Engl. J. Med. 2013 369(21):2001 - 2011.