Interview: We Only Get One Body in Life

“We only get one body in life, so it makes sense to treat it well by fueling it with nutritious foods.” An interview with Dr. Lisal Folsom, who discusses optimal health, nutrition, and sustainable weight loss.

Interviewer: Cassie Jewell, LPC

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An Endocrinologist’s Thoughts On Health and Sustainable Weight Loss

On a typical day, what are your patients’ complaints and how do you resolve them?

As an endocrinologist, I care for patients with all types of gland and hormone disorders. The most common reasons patients come to see me include diabetes (both type 1 and type 2), concerns about growth and puberty, thyroid dysfunction, hirsutism (unwanted hair growth), polycystic ovarian syndrome, and adrenal disorders. I also provide gender-affirming hormone therapy for transgender individuals. Depending on the patient’s symptoms and diagnosis, I may order lab tests and/or radiology studies such as thyroid ultrasounds or bone age xrays as part of my evaluation. Once we have a diagnosis, I work with the patient to create a personalized plan for treatment and follow up.

What about common questions or concerns?

Regardless of the reason they’ve come to see me, many patients are concerned about fatigue and weight gain. Everyone loves to blame these symptoms on the thyroid gland, but there are many other possible contributors to both fatigue and weight gain, including lack of quality sleep, sleep apnea, suboptimal eating habits, and infrequent exercise.

How does diet impact health?

A balanced diet and good nutrition are essential for optimal health. The only way to nourish and fuel our bodies is through food, and multiple studies have shown the benefits of good nutrition on health. People who eat a diet composed of fruits and vegetables, whole grains, and lean proteins have lower blood pressure, better cholesterol, and decreased risk of obesity than those who follow a typical Western diet. There is a lot of research going on right now investigating the health effects of switching to a whole foods plant-based diet. A study comparing gut bacteria found that individuals following vegan and vegetarian diets had a more diverse selection of microbes in the intestines, which can lead to better health. Another study published in Clinical Nutrition this year found that people with high cholesterol had improvement in their cholesterol numbers when they followed a whole foods plant-based diet. Their cholesterol worsened when they switched back to a diet containing animal products and refined carbohydrates. We only get one body in life, so it makes sense to treat it well by fueling it with the healthiest, most nutritious foods.

What are the main risk factors for diabetes?

Type 2 diabetes is an acquired metabolic disease associated with insulin resistance and high blood sugars. Until relatively recently this was a disease of adults, but in the past few years more and more children have been diagnosed with type 2 diabetes as well, partly because of the increase in obesity. Risk factors for developing type 2 diabetes include being overweight or obese, carrying extra weight in the abdominal area, lack of regular physical activity, a family history of type 2 diabetes, and being diagnosed with prediabetes. Gestational diabetes during pregnancy is also a risk factor for developing type 2 diabetes later on. A person will not necessarily develop type 2 diabetes just by eating a lot of sugar, but a long-standing pattern of unhealthy eating, lack of exercise, and weight gain will certainly increase the risk of developing type 2 diabetes down the road.

Can diabetes be treated with lifestyle changes?

Lifestyle changes are vital in diabetes treatment! Medicines can help to lower blood sugar, but the underlying cause of type 2 diabetes is insulin resistance, which is exacerbated by weight and lack of regular activity. We know that people who exercise on a regular basis tend to have lower blood pressure, better cholesterol, and are more likely to be at a weight considered to be healthy, than people who don’t exercise often. Part of the reason for this is that exercise improves the body’s sensitivity to insulin. When we exercise, our bodies don’t have to work as hard to turn the food we eat into energy and fuel for our cells. Studies have shown that people with type 2 diabetes who exercise after a meal have lower blood sugar levels than those who don’t. Exercise and a healthy diet are important for everyone, but these elements are especially crucial for people who are looking to improve their health.

Which is worse: Fat or sugar?

Ooh – tough question. I would say both and neither. Both fats and sugars come in healthy and unhealthy forms. Omega-3, polyunsaturated, and monounsaturated fatty acids help lower cholesterol and decrease the risk of heart disease. These healthy fats are found in nuts, peanut butter, avocados, flaxseed, and olive, canola, and soybean oils. Some eggs contain omega-3 fatty acids as well, depending on whether the chickens that laid them were given supplementation. Unhealthy fats include saturated and trans fats. These types of fats are found in fatty cuts of meat, poultry skin, fried foods, high fat dairy products, processed and prepackaged foods, and solid oils such as shortening and lard.

Healthy sugars include those occurring naturally in fruits and vegetables. A good rule of thumb is to try to choose foods that are as close to their natural state as possible. For example, when you eat an apple, rather than drinking apple juice, you get the added benefits of the fiber from the apple, and vitamins from the skin. These added health benefits of eating whole fruits and vegetables allow the sugars to be absorbed more gradually by your body, and are lost when foods are processed.

What is one food you’d never eat and why?

Cracklins. This southern delicacy consists of fried pieces of pork fat and skin, flavored with Cajun spices. Although I’m sure they’re very tasty, they’re also oozing with saturated and trans fats, contain almost 500 calories per serving, and are high in sodium. You could eat an entire avocado and two slices of whole wheat toast for fewer calories. This alternative snack is not only delicious, it also comes with the added benefits of healthy fats, whole grains, and fiber.

If given the opportunity, is there anything you’d change about the current dietary recommendations?

The current dietary guidelines are a good place to start. They recommend eating a variety of fruits and vegetables, making at least half of our grains whole, and limiting saturated and trans fats, added sugars, and sodium. I wish they went a little further though, by emphasizing the health benefits of whole rather than processed foods, and offering alternative options for people looking to follow a plant-based diet. There are some really great dairy alternatives out there, including nut milks (almond, cashew, macadamia), soymilk, plant protein products, and tofu. Many of these are made without added sugar, and are fortified with calcium and vitamin D, so the nutritional content is quite similar to the animal-based versions.

What are your thoughts on the obesity epidemic in America?

Obesity is a growing problem in our country, and it’s going to keep getting worse unless we as a society make some major changes. Obesity is a multifactorial disease, with many different levels of influence. Personal dietary choices have a role of course, but so does the environment in which people live. If a family lives in a food desert, and the only place to buy groceries is the convenience store where one banana and a 6-pack of ramen noodles each cost $1, parents are veritably forced to choose the less healthy, but inexpensive and filling options to feed their children. Many children in the U.S. eat both breakfast and lunch at school through the federally subsidized National School Lunch Program. This program is underfunded, and as such is unable to provide the highest quality, most nutritious food for the children who need it most. There are so many barriers to optimal health that exist at societal and cultural levels; it’s going to take a lot of work to tackle obesity. It’s possible, but change will need to happen from the top down.

What advice do you give to patients who are trying to lose weight?

At the end of the day it’s all about math: Energy in = energy out. If we put more calories into our bodies than we burn, our weight will go up. Alternatively, if we burn more calories than we eat, our weight will go down. Metabolism plays a role, certainly, and we all know people who can eat a dozen donuts without gaining a pound, which is just not fair, but overall consistent, purposeful, portion control is the key to sustainable weight loss. Exercise helps, but it’s really hard to burn enough calories by exercising to offset what we eat. A typical adult woman walking on a treadmill for 30 minutes burns around 150 calories. As a comparison, a pint of Ben & Jerry’s Chunky Money contains 1,160 calories. You would need to spend nearly 4 hours on the treadmill to burn off that pint of deliciousness, and nobody has time for that. It makes more sense to limit your total calorie intake through portion control and careful meal planning. Everyone should have a treat now and then, just plan for them ahead of time and pay attention to the nutrition label including serving size.

What’s one thing you wish everyone knew about hormones?

It’s probably not your thyroid. Seriously though, endocrinology is an amazing branch of medicine. Since our glands make hormones that then flow into the bloodstream, they have effects on so many different parts of the body. Endocrinologists have to consider the entire person when making a diagnosis, and this makes the field both challenging and exciting.

As an endocrinologist, what are the most useful things you’ve learned?

Weight loss is hard, but possible. Diabetes sucks, but you are strong, so don’t let it take over your life. Everybody loves to talk about food. Patients and physicians work best as a team. Good health is priceless.


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Dr. Lisal Folsom is a board-certified physician who specializes in endocrinology, diabetes, and metabolism. She also provides gender-affirming hormone therapy for transgender individuals. Dr. Folsom’s medical research has been published in the academic journals Endocrine Practice, The Journal of the South Carolina Medical Association, Current Osteoporosis Reports, Journal of Adolescent Health, and Endocrinology & Metabolism Clinics. She has been practicing for nine years.

Interview: Breakfast Beers, Bloating, and Blackouts

“Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work.” This was the daily routine for JMS, who wore his alcoholism as a badge and didn’t plan to live past 30. In this interview, a recovering alcoholic discusses addiction, sobriety, what everyone should know about alcoholism, and why you might be a jerk if you believe a common myth.

Interviewer: Cassie Jewell, LPC

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JMS, a recovering alcoholic, has been sober for nearly six years. He started drinking at the age of 13. He continued to drink throughout his 20s, a “dark and miserable existence,” and didn’t think he’d live to be 30. In 2012, a suicide attempt nearly claimed his life. He woke up in a psych unit, having no memory of what happened, and decided he wasn’t ready to die.

JMS’s “official” recovery date is July 5, 2012. The following is an interview about how he got sober, why AA isn’t for everyone, and why you’re a shitty person if you believe addiction is a choice.


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What’s your definition of recovery?

JMS: I don’t see recovery as an end goal. To me, recovery is a path towards my end goal, which is contentment. I have found that I will never be content and happy with my life if I am using some sort of substance. For me, recovery is complete sobriety from all mentally and physically altering substances. I have tried and learned that I cannot pick and choose what to use. It does not work for me. More than just abstinence, recovery is a way of life. It is about being accountable for your actions, admitting when you are wrong, trying your best, and letting things go. Just trying to be a better person than I was yesterday.

  

Is alcoholism a disease?

It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.

JMS: I feel the word “disease” can be quite polarizing when discussing addiction. Alcoholism is chronic, progressive, and fatal. Much like diabetes, alcoholism is a relapsing disorder that needs a lifetime of monitoring and treatment. Based on these facts, yes, alcoholism is a disease. I feel this is a difficult idea for people to swallow. Much of addiction has been seen as a moral issue or a failing of willpower. It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.Obesity holds a similar stigma, though fat shaming has started to catch a bad rap.



When did you realize you had a drinking problem?

I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old

JMS: Hmm, that’s a tough question to answer. My gut response here is to say when I went to jail for my 3rd DUI in 2010, which is when I started to actually try to get sober. But if I am honest with myself, I was well aware that there was a problem years before that. I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old.I lived a really dark and miserable existence for most of my 20s. I could identify story after story about when I should have realized that there was a problem. Destroyed friendships, arrests, hospital visits, blackouts, poor choices, breakfast beers, etc. The truth is, I knew that I drank differently from my friends when I was a kid. When we would wake up hung over after a party, I was the one that would sneak vodka shots. So, I think somewhere in there, I was always aware that it was a problem. I come from a family of alcoholics. My father, his sisters, and his parents are/were all alcoholics. So it was almost a badge of honor to be another alcoholic [last name].



In active addiction, how did alcohol affect your health and appearance?

I learned that it is not normal to have diarrhea everyday for 10+ years.

JMS: I lost 60 lbs. when I stopped drinking. I changed absolutely nothing other than cutting out beer and dropped 60 lbs. I looked and felt a lot less bloated. I also learned that it is not normal to have diarrhea everyday for 10+ years. Honestly, the biggest physical change I experienced, that I am still grateful for today, is acid reflux. While drinking, I kept TUMS in business. I never went anywhere without them. Today, I need to eat some TUMS when I eat pizza or spicy food… you know, like a normal person. I never noticed the impact that drinking had on my sleep until I was no longer drinking. The first few months I really struggled to sleep well since I never had healthy sleep hygiene. Allow me to paint you a picture. Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work. Shower or not, I always reeked of alcohol, so showering was not a top priority. I always thought that I never got hangovers, but once sober I realized that I only thought that because being hung-over was my normal and I was experiencing them every morning. Ugh, the physical impact that had on my life is really something I do not miss.



How (and why) did you get sober? Who and/or what helped? Also, share about some things that were not helpful to you.

JMS: I got sober because I did not want to die. I tried to kill myself the last time that I drank. I do not remember what happened, but I remember waking up in a psych unit in the hospital. There are a bunch of people that were integral to the success of my sobriety at this time. My family is number one. They never gave up on me, despite the hell I put them through. I moved back into my mom’s house when I got out of the hospital. She and my siblings were nothing but supportive of me then and still to this day. I do not know if I would be sober today without their unconditional love and support.There are four other people that I owe my life to at this point. My therapist, my addiction counselor, Bob, my friend Alex, and my friend Jon.  I had been working with my therapist for a few years prior to my last drinking adventure. She has always been willing to challenge me and has been a safe space for me to work through some of my biggest fears. She has really helped me understand the nature of my addictions and helped me reframe my thinking and processing of my emotions.

I didn’t buy into [AA].

I have been through multiple addiction treatment programs in my life and none of them stuck. I always approached them with a cynical eye and was just going through the motions to get my family or the courts off my back. A condition of my discharge from the hospital was to enroll in an intensive outpatient program. This is where I met Bob. I figured this was another bullshit program that I was going to have to work through to keep people off my back. Bob was different. He encouraged us to go to 12-step meetings. Of course, I refused. I didn’t buy into those programs. Bob challenged me here. He asked that I attend one meeting in the coming week and write a list of everything that I hated in the meeting. I gladly did this and came back and an entire 8.5×11 sheet of paper full of my gripes. Bob listened to my list and challenged me to go to another one the next week and make a new list with different complaints. I rose to this challenge and did it again, glad to prove my point that AA was stupid and not for me. Bob again listened to my list (without arguing against any complaints) and provided another challenge. Bob asked me to go to another meeting and make a list of the things that I liked from the meeting. I did and, as any alcoholic can tell you, you are bound to hear things in an AA meeting that resonate with you, whether you buy in to the program or not. Bob continued to challenge me to go to meetings, not to go and drink the kool-aid and say some prayers, but to see what I can find that I like. There were other aspects of Bob that I couldn’t figure out why I liked him until one day, I walked into an AA meeting and he was sitting at the front table leading the meeting. Bob is an alcoholic. In that moment I knew that he understood my struggle. Bob was sober and doing meaningful work. Bob was ok. I wanted to be like Bob.

I owe my life to Alex.

I met Alex in the IOP [program] that Bob ran. Alex and I came from different worlds (he was smoking crack on the streets in Baltimore [and] I was drinking in bars in DC), but we had the same reality of sobriety or death. Alex went with me to those AA meetings [around the time that] Bob was challenging me. Alex also brought me to the meeting that would become my home group and introduced me to the people that would soon be my AA family. I owe my life to Alex. I would be remiss not to pay homage to Alex. Alex was murdered in an Oxford house a year in to our sobriety. Alex died sober, which was something he never believed would happen. I miss him every single day.

Finally, my friend Jon; he and I started drinking together as kids. He and I lived together after college and blossomed into the full fledged alcoholics we became. And he and I got sober around the same time on different coasts of the country. When I got out of the hospital, Jon moved back east from California and moved into my mom’s basement. He and I went to AA meetings daily, often more than just one each day. We then spent that first year of sobriety living together trying to figure out how to live.

I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter.

What was not helpful? Counselors who tried to tell me about sobriety that clearly did not understand addiction. Ultimatums also did not help. I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter. Probation was useless. The biggest impact the state had on my drinking was when I was sent to jail.



What prevents you from going back to drinking?

There is nothing in your life that a drink can’t make worse.

JMS: My life now. I love the person I am today. When I was drinking, I hated myself. I never want to be that person again, and I don’t have to be as long as I don’t drink. I have come to the realization that my worst day sober is infinitely better than my best day drinking. I don’t attend AA meetings anymore, but many of the slogans still bounce around in my head. The most important one I ever heard was, “There is nothing in your life that a drink can’t make worse.” I’m not going to lie and say that now I am sober, life is easy and happy and super fun all the time. It’s not. However, I am better equipped to handle the bullshit in life with a clear head. I would be lying to say that I don’t experience cravings but I know that a drink is not the solution to life’s problems.



What’s something you wish you had known before you became addicted to alcohol? (If you could go back in time and have a word with your younger self, what would you say?)

JMS: I feel like most people will expect me to say something like, “I would slap that first drink out of my hand!” That is not true for me at all.I am the person I am today because of my history with drinking. I am proud of the person I have become and I am not sure I would be who I am without the struggles I went through. I would want to assure myself that it was going to turn out okay and that I would not be that miserable forever. I do wish I had understood and cared about (at the time) the severity of the pain and worry I put my mom and siblings through.



What something you wish everyone knew about alcoholism?

JMS: It is not a choice. Alcoholics don’t drink the way they do because they don’t care about you or their families. They drink the way they do because they cannot control the cravings and urges and are overcome by guilt/shame/fear/pain. I am fairly confident that if every alcoholic could “just stop drinking” they would. Alcoholism is exhausting.

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What are your thoughts on AA?

JMS: AA can save lives. I attribute my sobriety to the teachings of, and people I met in, AA. That being said, AA does not work for everyone. I like to [view] AA [as] a religion. AA meetings are akin to going to church, the Big Book is the bible, and sobriety is heaven. Some people need to go to church daily to find their way to heaven. Others only need to read the text to understand the tenets of the religion to find their way there. And some people find their way into heaven following other religious texts or none at all. There is no wrong way to get sober. I do have complaints about AA and I feel there are aspects of it that prevent people from finding their way to sobriety. The focus on actual religion in AA is a major turn-off for people. While AA espouses that it is non-denominational and that we alcoholics are welcome to choose the God of our understanding, we are then thrown into a prayer circle to recite the Lord’s Prayer at the end of the meeting. For a low-bottom newly sober person, it is difficult to believe that there is a God that would allow us to sink so low and experience so much pain. But as I mentioned above in my story about Bob, he challenged me to find what I hated (and you better believe that GOD was written in huge letters on that first sheet of paper) and taught me to focus on what I liked.

If you are struggling, try it.

So, my thoughts? If you are struggling, try it. Ignore the God part for now. Listen to other people tell your story and see that it is possible to get better.

How do you feel when people drink around you?

JMS: In a word, annoyed. Slurred speech, glassy eyes, stumbling, and repetitive stories are not a cute look for anyone. I often feel embarrassed for the people I am around as well. It is always a nice reminder of why I don’t drink. I see absolutely nothing attractive to it and I am glad I don’t do that to myself anymore.

What’s the worst thing about being in recovery? The best?

JMS: The worst part [about] being in recovery is trying to explain to people that they don’t have to behave differently around me once they find out. I can’t count the number of times people have asked me if it is okay to drink around me or warned me that there was going to be alcohol at their house. You don’t ask a person with Diabetes if it is okay if you eat a Twinkie, you don’t have to ask me if it is ok for you to have a beer.

There is just an indescribable freedom that comes along with [sobriety].

The best part is being free. I was a slave to my addictions for years. I do not have that struggle anymore. I do not have to worry about where I will find money to buy alcohol. It is a huge struggle in my life that does not exist anymore. There is just an indescribable freedom that comes along with it.

In your opinion, what’s the biggest misconception out there about addiction?

[If you believe addiction is a choice], that just makes you a shitty person.

JMS: I mentioned it above; that addiction is a choice. That idea is closed-minded and short-sighted. And I think it speaks volumes about the person [who] believes that. I cannot fathom believing that someone would do this voluntarily. It is not fun, it does not feel good, and does not make us proud. In my eyes, the belief that this is a choice tells me that you could choose to behave in this manner if you wanted to, and that just makes you a shitty person.

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Please share your thoughts on addiction and recovery in a comment!