114: Women's Health Group with Dr John McHugh

Dr. John McHugh  00:00

I see mainly patients on the on the inpatient side as a hospitalist. So I'm there for labor and delivery. But you know, believe it or not, even in this day and age, there are a lot of women that don't get prenatal care. Their only point of contact with healthcare is when they drop into the hospital at different points in their pregnancy with a complication. I'm often there for a longer shift and I have time to talk to patients. You can't always have time, but sometimes you really do. I see a lot of times in an office practice, doctors are very quick to write a prescription and go on to the next patient. I have time to talk to patients. So some of the most common things that come up that we see hyperemesis, so nausea and vomiting and pregnancy. Acid reflux is very common that we see in patients. High blood pressure in pregnancy is very common. All of these things have a lifestyle medicine component. And luckily, we get the time to start talking about these things without just reading a script and moving on.

Narrator  00:55

Welcome to the Plant Based DFW Podcast weekly show with Dr. Riz and Maya, a show broadcasted from the Dallas Fort Worth area that focuses on lifestyle medicine. This is the use of evidence based lifestyle therapeutic approaches, such as a whole food plant based diet, regular physical exercise, adequate sleep, and stress management to treat, prevent, and oftentimes reverse lifestyle related chronic diseases that are all too prevalent. Every week They feature a guest who speaks on one of these lifestyle medicine pillars. This show is for you, the person who is seeking to improve your overall wellness and quality of life. So whether you are driving, walking, or relaxing at home, we hope this show will provide you one more tool for your wellness toolbox. Let's meet today's podcast guest.

Maya Acosta  01:47

Dr. John Paul McHugh is an OB GYN who has been in practice for many years. He is a fellow of the American College of Obstetrics and Gynecology, a Diplomate of the American College of Lifestyle Medicine and the co-chair of the Women's Health Interest Group for the American College of Lifestyle Medicine. In this episode, we talk about a couple of exciting things that are happening in the women's health interest group for ACLM in case you did not know I am also in this group and my goal has been to help showcase several of the members who speak on women's health. Coming this fall will be the Women's Health Lifestyle Medicine Textbook with Dr. Nancy Eriksen as the lead editor. You may recall that we've had Dr. Eriksen on the show a couple of times. I will add the links to her episodes in the show notes. She and Dr. John McHugh recently spoke at the American College of OBGYN annual meeting with Dr. Nancy Eriksen speaking on postpartum care and Dr. John McHugh addressing physicians about the importance of exercise. The Women's Health Group will have their own workshop for the third year in a row during the lifestyle medicine conference in November, called Living Your Best Life. To learn more about the conference, visit lmconference.org. And to learn more about Dr. John McHugh, his facebook group called Women's Health and Lifestyle Medicine. I will include a link in the show notes. And as always, thanks for listening. So welcome Dr. John Paul McHugh.

Dr. John McHugh  03:22

Great, thank you so much, Maya, I really really appreciate getting this time to talk and share some ideas. And I have to admit, I've been catching up on you and Dr. Riz's podcasts. And it's really wonderful the work that you're doing for the community.

Maya Acosta  03:35

Well, I appreciate that. And actually, I'm looking forward to learning more about your role with the American College of Lifestyle Medicine, you play a very significant role with the women's interest group. Maybe you can kind of tell our listeners a little bit about what the interest group is about. And then we can move on to talking about more your specialty and of course, lifestyle medicine.

Dr. John McHugh  03:56

Thanks so much my. So as you mentioned before, I'm an OB GYN I'm trained I've been in practice for for many years. And I've always been interested more in wellness than an illness. And a lot of my colleagues really feel the same way as well. The hard part that we're stuck with is the system sometimes aren't set up to really provide wellness. Sometimes we as doctors only get involved when there's illness. So I was lucky enough A few years ago, to be invited to have coffee with a woman named Dr. Michelle Tollefson, who's in Denver. And Michelle Tollefson said to me, John, I'm thinking about forming a group in lifestyle medicine really focused on some of the issues that we face. She's more focused on gynecologic issues. And I've been more interested in obstetrics and delivery. And we decided to partner together and she created the women's health lifestyle medicine member interest group. We're now up to about 200 members all across the country, actually all across the world. We have some people in Nigeria and London and whatnot. Joining us as well. And we're really not just about physicians, not just about obgyn, we have people who are health coaches and nutritionists. So members of the general public who were really interested in these issues come and join us as well.

Maya Acosta  05:13

It's a such an important group. And what can you tell us a little bit about what an interest group is? And what is the goal with it all.

Dr. John McHugh  05:21

What has come about with the American College of Lifestyle Medicine, has been that different people have different perspectives and different issues that they're interested in changing. A little bit surprising that women's health came along relatively late in the game, we didn't form this group for a while. Many of the initial issues that came up, were involving diabetes and hypertension. Some of those diseases have some aspects that are identical in women, but some aspects that are very different. And also how these diseases manifest during pregnancy, and menopause are all very different. So we formed this group, but there are about 20 different member interest groups. Here's a group specifically covering lifestyle medicine in the military, we wouldn't we want our troops to really have the best care they could get as well,

Maya Acosta  06:10

Definitely, the majority of our listeners are actually women. And as we know, women sort of tend to take the initiative towards wellness and bring it in meditation, yoga, and things like that into their homes. And so I think it's so important to kind of continue to provide this kind of information for women in terms of knowing how to use lifestyle medicine to prevent conditions or to kind of reverse or halt some of the conditions that they currently may have. So the interest group is like bringing together a lot of different perspectives and resources to see then how we can get this information out to the average person and as well as patients. Right?

Dr. John McHugh  06:50

Exactly true. And, you know, you brought up a really, really good point, I do have to say I'm kind of just at the tail end of writing an editorial for the American Journal of Lifestyle Medicine, on women's health and lifestyle medicine. And myself, and Cindy Guyer, who's the co-chair, we really focused on this issue that you raised, which is women have a very unique role, and that they're very often caregivers for the family, often raising children. And if we can help women understand the benefits of lifestyle medicine, we can really change several generations. And I think that's the goal for all of us.

Maya Acosta  07:23

There are also a lot of resources on the website for the American College of Lifestyle Medicine. Can you get it kind of give us a little bit of an overview I do touch on this sub the subject a lot of the modalities that comprise lifestyle medicine, but can you just kind of review that for us a little bit? 

Dr. John McHugh  07:39

Sure, so I think we want to do is really, always make sure that we talk about all six pillars of lifestyle medicine. So often, if you go online, there's a lot of information. Unfortunately, a lot of false information about diet. There's a lot of information that you can pick up at the gym regarding exercise, but I think we as patients, and even myself, I didn't know what was right and what wasn't right. It's really hard to know what's right. So we talked about diet exercise, I've been really fascinated with sleep, especially sleeping ob gyn. It turns out, I'm very involved with the American College of Obstetrics and Gynecology, we make the prenatal form that almost every woman in America gets when they have a prenatal intake. And there are no questions about sleep. But we know it has a huge impact in pregnancy. And we need to change that.

Maya Acosta  08:25

I continue to hear how important sleep is. And do you find that women during their pregnancies tend to struggle with sleep or just in general?

Dr. John McHugh  08:35

Absolutely. Not only do I find it, but we've written a few papers on the topic. And we find it such an important topic. And unfortunately, we have a cultural bias where we sort of say, well, that's normal, of course, you're not sleeping, you're pregnant. And that's really not true. doesn't need to be that way. There's a lot of things we can do. And a lot of healthy natural things we can do to help women sleep better during pregnancy.

Maya Acosta  08:54

This is so important. I love the whole self care perspective of lifestyle medicine. But I can see how sleep could be an issue for any woman in general. And then as soon as she starts having family then she's again expected to sort of handle all the all the things that are happening in her home. So it's a lot of stress.

Dr. John McHugh  09:14

Absolutely. And that's really an important point. That's one of the pillars as well. I was actually just on a talk, we did a talk for all the OB GYN in the state of California on their own wellness. And this was the chief wellness officer at Kaiser California made a very interesting comment. He said he believes 90% of wellness is mental health. If you have great mental resilience and low stress, all of these other things become easier. If you're less stressed, you eat better if you're less stressed, you sleep better. If you're less stressed, you find time for exercise. So how can we get at that core issue that you addressed is really, really important.

Maya Acosta  09:49

I'd love to come back to that subject a little bit more and hear about women and mental health. You were talking about nutrition, I think exercise and sleep.

Dr. John McHugh  09:59

We should also talk about stress, which is an important issue, we should talk about substance abuse. And it's interesting when I give this talk to physicians, they sort of kind of nod off of, you know, I don't do anything like that. But what is a substance? Right? Is our phone? Do we get addicted to our cell phones sometimes, right? And sometimes do we check them late at night, which wakes us up and stresses us out. So we should look at those addictions. I do have to admit, I do have one addiction, which is coffee, that I can't kick. But we also know that coffee can be something that you can enjoy in moderation, if you use it right now, and it does have some antioxidant properties. So substances stress, and connectedness as well. And that's something that we know the data, I'm sure you know, the data as well, how often someone dies within a year of the death of their spouse or partner, right. So we should really be looking at social connectedness, as it's for its impact on health.

Maya Acosta  10:51

And speaking of mental health, what kind of resources are available for women to kind of cope with that?

Dr. John McHugh  10:56

You know, it's a very, very difficult, difficult process to get involved in. And I think step one is, just as you said, admitting the issue, right? We find that a lot of times, women feel the need to be supermom, and feel like if they if they bring up an issue, something's wrong with them, someone else can do it even better. What did I hear some woman say one time, we can't all be Martha Stewart and kind of make all of our arts and crafts at home all day long, right? We have to at some point, admit that there's an issue, one of the ones that I find is really important is, after you admit the issue, is it possible to bring in some help and bring in some support. And I find a lot of people don't do that. A good friend of mine who's a business executive, actually hired a plant based chef for her, she didn't have the time to actually do cook the meals and she was finding she and her son were both not eating well, and she brought in some support for herself. Sometimes you can bring in family members or partners do that. We also find that meditation has a really, really powerful impact. And unfortunately, I can't speak for everyone, but I can speak for myself. I feel like every time I do it, I'm doing it wrong. But when I look at it in the aggregate, I find that I am getting benefit from it at the same time, even if it's not perfect. I will commend a book that is on the ACLM website. And there is actually a masterclass as well by a man named Matthew Walker, called Why We Sleep. And I think it's really important. There are sections on caffeine and alcohol. And I think it's important for us to be cognizant of these impacts. If we're having any problems sleeping,

Maya Acosta  12:24

It's become sort of tricky, especially the I want to say, the last year and a half or less, we're going into the second year of being a little bit isolated. So I'm curious about your work. How did you know that you wanted to choose this field of Obstetrics and Gynecology?

Dr. John McHugh  12:43

That's a great, great question. I had been, my parents were both teachers, both school teachers. And I had been dead set on being a teacher. In fact, I was going to join the Peace Corps and travel the world and teach and I when I got out of college, I taught high school for a couple years. I also set up a little bit of a tutoring service. So I was doing some tutoring on the side for the pre meds that my undergrad. And they were getting into Yale and Johns Hopkins. And I thought, Boy, I wonder what medical school I would get into because I'm the guy tutoring these guys. So I kind of went into medicine, really with the interest of being a teacher. And I had loved teaching young adults. I realized once I was in medical school that my focus was wellness, not illness. So I tried to think about what can I do with young adults that's focused on wellness. And that's what brought me into ob gyn, ultimately. And it's been an interesting road going along with that.

Maya Acosta  13:41

Are you still currently seeing patients?

Dr. John McHugh  13:43

I am Yeah, I work as a hospitalist. So laborist really do patient care about three or four times a month. 

Maya Acosta  13:50

I have all these ideas in my mind about what women go through during pregnancy. But I also wonder how much support did women receive, especially last year when a lot of them had to deliver without their loved ones around?

Dr. John McHugh  14:04

Really tough here and I think part of it was a tough year because so much was unknown. In fact, I think even now as we hopefully the pandemic is going down and we're talking about vaccination again, so much is unknown. And it's a kind of a tough, tough place to be in. But I do think we're ultimately very lucky in that influenza tends to target young, healthy women. Women who are pregnant and get influenza have about a 500% higher chance of dying than a non pregnant woman. So influenza really goes after pregnant women. Luckily, COVID doesn't seem to be that severe for pregnant women. We are starting to see some data complications, but it doesn't seem to be as severe as we had thought originally. I think it was very it was the uncertainty though that was very scary for patients. I'm starting to see relaxed, guidelines relaxed a little bit. So we're having more partners and family members that can have contact. A good friend of mine delivered. And he had to be isolated from the grandparents for about four months, the grandparents have finally been able to hold their grandchild, right. So that's really tough on them. Especially Also, if you think about the new mom, without having her family to help with the baby, that's really tough on her as well. I think these are challenging times. That's that's really what I can say. But it looks as though we're getting further to the end than the beginning.

Maya Acosta  15:28

That's great news to hear. I mean, like I said, I couldn't imagine what it would have been like for women to be, you know, in the hospital by themselves, which is normally such a moment to be celebrated. What kind of complications Do you tend to see in during a woman's pregnancy?

Dr. John McHugh  15:45

I see mainly patients on the on the inpatient side as a hospitalist. So I'm there for labor and delivery. But you know, believe it or not, even in this day and age, there are a lot of women that don't get prenatal care, they're only point of contact with healthcare is when they drop into the hospital at different points in their pregnancy with a complication. So the luxury I have, that a lot of my outpatient colleagues don't have is, I often have time, I'm often there for a longer shift, and I have time to talk to patients. You can't always have time, but sometimes you really do. I see a lot of times in an office practice, doctors are very quick to write a prescription and go on to the next patient. I have time to talk to patients. So some of the most common things that come up that we see hyperemesis. So nausea and vomiting and pregnancy. Acid reflux is very common that we see in patients, high blood pressure in pregnancy is very common. All of these things have a lifestyle medicine component. And luckily, we get the time to start talking about these things without just reading a script and moving on.

Maya Acosta  16:49

Uur mutual friend, Dr. Nancy Eriksen, who speaks very highly of you kind of walked me through her work as well. And she kind of is more she's involved from the time of conception, through the time of delivery, and yourself as hospitalist you sort of pick up from labor and delivery. And then do you continue to stay in touch with your patients? Is that what you're saying that you have more time for that?

Dr. John McHugh  17:13

No, it's actually during that acute hospital visit, I've had a number of times patients with anemia, who only thought they had to take their iron pills three times a day, I do have to tell you one patient quite severe. The iron pills were causing such reflux, she actually tore her esophagus from the vomiting of that, yeah, really severe should a bleed in her esophagus. And I worked with her for a while. During that admission, she was in the hospital for several days, really trying to talk about natural whole food plant based sources of iron and folate that she could have. She still needed the pills, but she was able to taper off them, and then get away from the side effects.

Maya Acosta  17:52

So you were talking about hypertension and other complications, they acid reflux reflex, all of these can be prevented with lifestyle, but improving lifestyle choices. And so you are and you continue to be an educator in this way. Do you give lectures or talks for in general, for groups of women?

Dr. John McHugh  18:10

So I'm working on a number of things. And you know, I Nancy Eriksen's a fantastic example of somebody who, with our member interest group, we were able to connect her with a couple of projects, that she's just a star when I have to say, she's the lead editor, I just want to make this announcement to everybody, this fall will be the first textbook of women's health, lifestyle medicine. And Nancy, it's the lead editor on that. So really be a reference people all around the world can use to turn to instead of going quickly to a pillar procedure for patients and really think about the lifestyle courses that they can do. Nancy and myself are both going to be speaking at the American College of ob gyn annual meeting, she's going to talk about postpartum care. And I'm going to talk directly to doctors about the importance of exercise. So we're going to be putting on like a TED talk kind of performance.

Maya Acosta  19:00

Oh, my goodness, that is awesome. So just to kind of remind some of our listeners, Dr. Nancy Eriksen is in Houston. And she actually came out to Dallas and spoke to a group of women here. And she's basically answered all sorts of questions that women have about, you know, everything from pregnancy to how to manage menopause. And she was so well received. So anything that she does, I'm interested in so so we talked about and I've mentioned here on the podcast that there is the possibility that the American College of Lifestyle Medicine's, Lifestyle Medicine Conference will happen, not far from us, probably about 50 miles from us here in Dallas. What is that looking like? Will you be one of the speakers for that as well?

Dr. John McHugh  19:45

So we're going to now have our women's health group for the third year in a row, have our own workshop. So the meeting will be happening. over several days we'll be doing a specifically a women's health workshop, and I've spoken in the past this year. I'm going to be the organizer. And the emcee was Cindy Guyer of the meeting. But in the past, we've often focused on topics that are, I guess I would say a little bit more academic, like epigenetics and how fetal cells are programmed. This year, what we're really going to focus on is Living Your Best Life really talking to women about issues that come up where they'd really like to make their life even better, and how the power of lifestyle medicine can help those issues. Dr. Jessica Crant is coming from New York City, she is one of the only board certified dermatologists in lifestyle medicine. So she's going to be really talking about how improving your diet sleeping better, can really improve a lot of dermatologic issues for patients. It's gonna be wonderful. Dr. Amy Commander from Mass General is going to come and speak about cancer prevention. She's got a whole program for breast cancer survivors at Mass General in Boston. And talking about that as well.

Maya Acosta  20:54

I am just so excited, you know, so I'm a lay person, but it's, uh, it's amazing how excited I am about medicine, especially the approach of lifestyle medicine, I was always interested in trying to see how I can improve my health. And out of all the things that I tried holistic and natural kind of remedies and things like that food was not on the top of my list. Can you believe that?

Dr. John McHugh  21:17

Happens to all of us, right? We think we know, things that we don't know. And we learn.

Maya Acosta  21:21

And so this conference is open to everyone, pretty much although we're going to see a lot of physicians, dieticians, experts in the field health coaches, and I've attended, I attended 2019 is that when you also became board certified.

Dr. John McHugh  21:35

I became board certified in 2019. And I think I've been going for a couple years before that. Yeah.

Maya Acosta  21:39

Okay. So I had I attended my husband and I decided to split up so that we can get as much exposure to the different workshops, but I attended the exercise as medicine one along with a variety, one called achy guy, but I learned so much. And then of course, I come back and I want to share the information with other people. So I'm really looking forward to the women's health one.

Dr. John McHugh  22:04

I did want to make sure I there are two more speakers I really wanted to mention. And I think one of them you may know is Dr. Rashmi Kudesia. Do you know her as well? Yeah, I don't know if she's been on your program. But she'd be wonderful to speak as an infertility specialist. There's so much we can do if you know someone in your life who wants to get pregnant things that they can do in preparation for that to really optimize your chances.

Maya Acosta  22:26

Yes, you know, when we've had endocrinologist on the show, those episodes do so well. Dr. Kudesia is a fertility endocrinologist are specialists. Whereas the other individual that I spoke with specializes in thyroid issues and diabetes. I feel also that when we have experts like yourself physicians who really are trained in lifestyle medicine and the power of nutrition, people are more likely to then reach out either to you or to a physician and feel a little bit more comfortable about the questions that they should ask and things like that. Which actually brings me to to ask you, what are some of the things you wish your patients knew ahead of time,

Dr. John McHugh  23:08

I think the most important thing is exactly as you said, to come prepared to the visit. I think sometimes what we have seen or that we the doctors get caught up in the time constraints and maybe a specific issue. And sometimes there's things that we don't take the time to talk about. And I think, unfortunately, with the way office practice works, sometimes we don't have all the time, but we could at least address the top priorities, and maybe make another visit to go over some of the other issues. But what we wouldn't want to do is kind of sweep things under the rug and miss out on really important things that we need to talk about.

Maya Acosta  23:43

Have you ever noticed the difference between some patients that are very involved in their health and know where they stand and the things they need to do? And then other patients that, you know, may not have a single idea of what questions to ask and what the next step is towards improving their health.

Dr. John McHugh  24:00

And you know, it's really, really hard to address it. And unfortunately, part of the problem is, there's so much bad information out there. There's so much I guess what I call is clickbait out there in the internet. So how do we get people to have a source where they could get some good information, and then come up with questions that will really help their health.

Maya Acosta  24:17

So what are some of the things that women can do to really optimize their pregnancy to feel good during those nine months? And what form of exercise can they do during a pregnancy?

Dr. John McHugh  24:29

You know, one of the I'll start with exercise because I think it's really really important we actually a paper that we're working on, we looked on some data where they actually surveyed OBGYn's and the OB GYN didn't know the recommendations for exercise and pregnancy. And they certainly we when we think about us, us as OBGYN's we're probably like not getting sleep, we're not exercising well and maybe not eating a good diet ourselves. And, you know, we know that patients respond to those cues. We know that they can kind of take a look at me The lines under our eyes and, and know that we're not sleeping ourselves. So I think that's something that we really have to change if we can. You know, I wish that more patients that the CDC recommendations are that pregnant women get 150 minutes a week of moderate exercise. And we find that probably only about 15, or 20% of women are actually doing that right now.

Maya Acosta  25:23

I wonder why that is.

Dr. John McHugh  25:25

But I think part of it is the doctors and part of it is cultural pressures. Often, there are family members or who are really, they think that they're making the pregnancy better by having the patient rest. And unfortunately, there are some outmoded medical recommendations for some conditions. Women's exercise, and women's activity doesn't seem to make the pregnancy outcomes any worse.

Maya Acosta  25:45

Right. I wonder if there are any kind of support groups or Facebook groups where women gather you know, power walked or did yoga together? Pregnant women, that is I there probably are some groups like that.

Dr. John McHugh  25:57

And I believe you did you have it? Was it? Am I pronouncing right Dr. David Sabgir on who Walk With A Doc group recently. And what he's done has been a fantastic thing across the country, the Walk With A Doc group. And I think that would be something that could fit in really, really well. I will tell you, I'm not sure about your community, but here in Southern California, Zumba classes for pregnant women have been very popular. And I think that's a great way to get some exercising.

Maya Acosta  26:21

Well look at that. I wasn't familiar. There was a time when I lived in San Diego. So I'm very familiar. I was very outdoorsy, very involved in cycling and hiking in you know, it really the surroundings really affect how we live our lives. So they but I'm also very blessed to be there a green area where I power walk, because that's my thing. I love to be in nature. As you can see I my book there, for his bathing is my my thing to do as well, to really call my energy because I tend to, you know, stress. So And what about am foods during a pregnancy? Do you have any kind of recommendations? Well, a couple things

Dr. John McHugh  26:58

I would say, you know, one of the little bit of a maybe a pet peeve I have sometimes is I've seen some of my less educated patients come in with a bag of Doritos and a Diet Coke. And they say to me, but Doc, I'm taking my vitamin everyday right? Isn't that enough? And I think it's really, really unfortunate. To really correct that Miss misperception, we know that the most important nutrients are in whole plant based foods. We know that. And so that's something we really need to encourage. We also know that 91% of Americans don't get the very meager CDC recommendations of two cups of fruits and three cups of vegetables a day. So that's really the foundation of course that we need to start with is trying to see that our patients can get adequate supplies of fruits and vegetables. We encourage a lot of women for a variety of reasons to take folic acid. But we know that plant based folate is a better source of the nutrients that we need to prevent birth defects and complications in pregnancy.

Maya Acosta  27:57

Is there anything a woman can do to kind of minimize that? Morning sickness?

Dr. John McHugh  28:02

Yeah, so that's really important, you know, are you probably in your your audience is probably pretty aware of Dr. Michael Greger the work that he's done. And he has a whole set of videos on his on his website nutritionfacts.org. He does a fascinating talk about hyperemesis and it does seem as though hyperemesis is really related to meat consumption. It's kind of a natural almost, I would say, a biological defense because we know that meat is the easiest way to get a bacterial infection in your body in pregnancy to protect the woman and to protect the fetus. women seem to kind of push back a little bit. I've often when I've talked to patients about that nausea, that morning sickness. And by the way, we've had patients so severe, my it's really intense. They've had to be on chemo therapeutic levels of anti nausea medications in pregnancy. Yeah, it's gotten that severe where they've really gotten emaciated and dehydrated from the hyperemesis. But often when I talk to them about that, they'll say to me, boy, come to think of it. It's when I smell meat that really starts to trigger that, that response. So trying to kind of alter their diet to more whole plant based foods, I think does help. Obviously, with lifestyle medicine, when you need medication, we can certainly provide medications, but patients, one thing I did want to come back to is the most important thing in pregnancy is to stay hydrated. It's really, really critically important. Right? all the foods and the pills. Sometimes we can do away with those, but we can never get away from the hydration.

Maya Acosta  29:34

Well, I'll tell you what, I'm glad you brought that up because I was recently listening to another talk. This individual who was also a physician, talked about two things that she struggled with when she breastfed what one was dehydration and constipation

Dr. John McHugh  29:49

is a really, really interesting and important issues and I'll make a little bit of a side note. You know, the recommendation for all of us to drink more water does exist but there is caveat, we often eat processed foods, which have most of the water and all, almost all of the fiber removed. If we get back to whole plant based foods, we probably the average person doesn't need to drink six to eight glasses of water a day, if you're eating fresh Whole Foods. And we also know that 97% of Americans don't get enough fiber. Right. So if we can correct those issues, I think we'll minimize many of the other issues as well. But I would encourage you breastfeeding women absolutely to stay well hydrated.

Maya Acosta  30:31

So stay hydrated, make sure you consume enough fiber, because you can probably be prone to having, you know, struggling with constipation. What about? So you've mentioned, preeclampsia? Can you tell us a little bit more about what that is? And I don't know if it could be related. But can you talk about complications that may come as a result of having weight issues during a pregnancy?

Dr. John McHugh  30:55

Absolutely, you know, we know that most of us in America, unfortunately, are unhealthy. And when we enter prenatal care, we often are just like anyone else, we bring that that lack of health into our prenatal care. preeclampsia does seem to be strongly related to our diet and to our weight. And it's quite common, we, in some studies, up to one in seven pregnant women will develop it. What I sometimes tell patients is if we let pregnancies go on long enough, that incidence of preeclampsia will just keep going up and up and up. So it can be quite quite severe for patients. We have had patients have to go into intensive care for their preeclampsia as well. One of the things I find interesting when I look at the Medical recommendations about preeclampsia, it very quickly goes to pills and procedures. But we do know that getting better sleep can help with preeclampsia. In fact, there was a fascinating study I saw recently, are you aware of what c pap is. It's a breathing machine for patients. And it's more often commonly needed. In obese men. Often we kind of overlook the fact that there are many women who actually got me as well. But they did a trial on women who were at high risk of developing preeclampsia. And they showed that with C-pap, they could prevent preeclampsia. So something about that airway obstruction at night seems to cause the blood pressure to spike up. And that development of preeclampsia. And c pap is perfectly safe and effective in pregnancy. It's really just keeping the airway open. The other is fiber. There have been a number of studies looking at dietary fiber, preventing preeclampsia. And we think that has something to do with the ability of fiber to sweep out some of the toxins from our body and keep us healthy.

Maya Acosta  32:43

I was wondering about that is it when so if you're struggling with preeclampsia, what is happening to the body? And is there like tremendous inflammation happening as well.

Dr. John McHugh  32:53

We wish we knew if you and I can answer that today, go get the Nobel Prize in Stockholm tomorrow. No one has what we do know about both preeclampsia. And I'll mention as a side disease, gestational diabetes, is it something happens with the placenta during pregnancy, that indicates that That woman is at risk of developing those diseases later in life. So we do know that roughly half of women who have preeclampsia within the next five years, will develop chronic hypertensive tension and need to be on meds. So it gives us a tremendous opportunity to start the lifestyle changes and stave off the disease for the future. It's almost like that Jimmy Stewart movie, it's a wonderful life, we can know the future. And we can go back to the present fix things.

Maya Acosta  33:40

Right. You know, we always like to talk about prevention as well. So I guess one of the major goals for women who are planning to have children is to maybe optimize their health at the beginning so that you can have a wonderful pregnancy and prevent some of these complications, especially you mentioned gestational diabetes.

Dr. John McHugh  33:59

Absolutely, yeah. So one of the groups that I'm very, very happy we got reinvigorated is the California preconception health care Council. So we have in every state in America, there's a group working on what we call preconception health. We know that if we had really good preconception health, getting people optimized both men and women before pregnancy, we could probably have as much impact as all the prenatal care that we do today. So we'd love to really kind of optimize that for patients. We've also we're working on right now, what we call our inter conception care guidelines. So that is, often will have recognized something in the pregnancy, the woman's going through her postpartum care. And unfortunately, sometimes we don't see those women for the next two or three years, until they're pregnant again. And again, we missed a window to really help that woman come into the next pregnancy with optimal health. So these are both really, really important issues that we need to address. I hope I answered your question. I know I went Oh

Maya Acosta  34:59

No, I love that. You brought up the the preconception area, I think you had already the preconception health care Council. And so does that mean then that they have a website with resources? So how do you outreach to women to provide this information?

Dr. John McHugh  35:15

Yes, we do have a website, every woman California, one can go to. And we have this information released. We have handouts, for, we have about 20 of the most common conditions that come up. Anything from preeclampsia to smoking cessation. We have both patient facing handouts in English and Spanish. And we also have handouts for providers as well. What we often find is that women are in low resource settings when they come and they have questions. So if anybody involved the social worker, you know, maybe a family member could give the woman some of this information, we find that we can help them a lot.

Maya Acosta  35:53

This is great stuff. I'm so glad that you're bringing it up. And I'll make sure I'll include the links in the show notes. And how important is it to then have the postpartum visits,

Dr. John McHugh  36:03

it's really, really important. Unfortunately, it's also a really high stress time for patients, right? They have a newborn baby, sometimes their family issues at home, they sometimes have other children. And I think it becomes really tough for women sometimes to make those postpartum visits, I don't have a magic answer as to how to get everybody back to the postpartum visit. But it's really an important concern. I can tell you, the American College of ob gyn has refined its guidelines for women postpartum, some women just need one visit, some women need a whole year's worth of care to address maybe substance abuse or depression. And we're really expanding the kind of care that we give now.

Maya Acosta  36:42

That's what I was wondering about the visits, it's sort of like your, you want to kind of evaluate whether a patient is after the delivery, just like you said, you know, there might be some mental health issues, or maybe just checking in on how she's managing, connecting with her child as well, is that does that come in as well,

Dr. John McHugh  37:01

Those are really, really important visits. And I think one real gap in care, because I've worked a little bit we did a publication with some of our pediatric colleagues, is that transition of care, and family practitioners often will see the whole family. And I think in the right setting, that can be the ideal visit, because he can be talking about the mother and baby. And if we can, our hope is, if we can address some of the diet and lifestyle changes at the preconception visit, it'll carry through, and maybe the whole family will change their care.

Maya Acosta  37:31

Yeah, the transition of care what you just said, kind of reminded me of, I was an elementary school teacher. And so you invest a whole school year with these children, 20-25 students, and you know, you're invested in them, you're guiding them, and then you have to transition them out to another grade right to another educator, another teacher, and then you're just hoping that they'll catch those things that you've noticed are very important, so that the individual can continue to grow. And sometimes just in medicine, in general, it just kind of a lot of information gets lost from one position to the other.

Dr. John McHugh  38:07

I gotta tell you my one of the things I was thinking of just now when you and I were talking, I remember when I was in second grade, towards the end of the year, the third grade teacher popped her head in and just said hi to us. And it's just just making things better. So I worked in a community clinic in San Diego for a while. And we would have the pediatricians working side by side with us. And sometimes we bring them into the postpartum visit, just say hi.

Maya Acosta  38:31

Well look at that. That's great. That's exactly what I think we need as patients in general. Is there anything else I know, I want to make sure that we cover a few things. You mentioned the textbook that's coming out in in the fall. Very exciting. That's something to look forward to. And then oh, you there's the women's workshop. I don't know if we living your best life. That's the one that's coming up for the conference.

Dr. John McHugh  38:56

I've got one more plug, I just realized one more speaker and this might be the most important speaker of all, Dr. Michelle Tollefson from Denver is going to be speaking as well. And she is doing a talk on sex and lifestyle medicine. So so often, either we don't talk about these things or when we do to take pills or maybe you know, we can't work but we know that plants and better sleep and you know diet can really help these things. So she's going to give us all the evidence and educate us on these issues.

Maya Acosta  39:26

You know, we are affected by the foods that we eat and whether we're good enough, you know, enough rest so I can see how our sex life is impacted. What other things can we look forward to in terms of the conference?

Dr. John McHugh  39:37

Well, the conference I think is going to be great. There are going to be all night I couldn't say all but several of the former US Surgeon Generals are going to be speaking conference. So we're really getting I don't know if you were there was it last year Prince Charles himself gave us a video address at the lifestyle medicine conference. We give importance of lifestyle medicine in Britain is becoming in increasing growing, so I thought, boy, how are we going to tap Prince Charles next year? And I think about five of the former US Surgeon General's Well, well, it'll get up there. I don't know, everybody might have their preferences only gonna be I think lifestyle medicine is really entering the mainstream, and it's really changing healthcare. There's a doc I work with very frequently used Kaiser in California was probably the biggest health care provider in California. And that is the single greatest collection of lifestyle medicine. Doc's in the country is in Kaiser. I think they're really changing their care model right now.

Maya Acosta  40:32

So Dr. McHugh, a lot of times I post questions in several other Facebook groups that I'm part of, in terms of I want to gather questions from the average individual, what would you ask a cardiologist? What would you ask a, an endocrinologist and things like that? And what I find impresses me I always have to tell my husband, this is so many individuals are really becoming informed. Yeah, yeah. So when content is put out by physicians, when videos are put out, people are teaching each other and they're becoming self empowered in terms of taking control of their health. So if I were to ask a group of people on Facebook, what you do to reduce your hypertension, they know what Dr. Greger has said about it. They know what Dr. Barnard has said. So, so many people are understanding the power of nutrition, but also like you just said, lifestyle medicine, and which is why it's so exciting for myself, say as a lay person to be part of it all, because it helps me I'm educating myself, but then I'm helping to also share the message that there are many things that we can do to empower ourselves and lifestyle medicine, American College of lifestyle medicine offers so many resources, and also there's a directory, what sort of information can a person who's not a member obtain? And why would we want to encourage people to become members of the American College of lifestyle medicine.

Dr. John McHugh  41:58

So I think there's a lot of growth and transition happening right now within the college, I think it's taking off so to speak. What we are working on in women's health is we're working on patient facing handouts for a variety of conditions. And we're going to make those available to the public. I believe the the organization has said patient facing handouts will make them free and available to everyone, provider facing handouts, we'll make that a resource for our members. So as I talked about our fall workshop, we're talking about dermatology, sexuality, fertility and cancer, I'm going to ask each of those speakers to make a patient facing handout. And we're going to make those freely available for anybody. So this is something you could either have for yourself. Or if you have a friend who might have an issue, you can pass it on to your friend. We've already made a whole food plant based my plate, both for adults and for children, so that you can look at my plate that really represents the best food ever, and use that to change your dietary patterns.

Maya Acosta  43:00

I love it. I think that many patients are willing to make a change if they're just kind of taught step by step what it is that they need to do, and maybe not try to do too much. Because I know sometimes when I even speak to a family member of mine about all the components, the pillars of lifestyle medicine, they may they may think that you're asking too much of yourself, this is way too much. But no, I think it's just take what you can begin wherever you can, if it's you know, exercising first walking for a mile, or just start to incorporate more plant based foods, eat more plants, but not try to do too much. Because then you're back to square one. Square One, which is you're overwhelmed. Well,

Dr. John McHugh  43:40

I think I think this is in large part due to people like yourself and Dr. Riz, right? I mean, you're out there giving people information they can trust. And I when I hear a lot from patients is they don't know who to trust. You know, they're hearing about somebody going keto at the gym and cutting out fruit if they're diabetic. But I think if you're giving people the right information, and they find a source they can trust. That's how we're going to change things.

Maya Acosta  44:01

Absolutely. And then and trust happens like this through conversations like this. I mean, when I'm looking for a physician myself, I want to do a little bit of research. I want to hear that individual speak. I want to see what knowledge they have. And so the more that we learn about certain physicians, the more we're likely to kind of you know, trust them see, you know, seek their advice and things like that. Dr. McHugh Is there anything else you'd like to share with our listeners?

Dr. John McHugh  44:27

No, I think this is great. I really, really appreciate the opportunity. And I'm so glad you're having Dr. Commander Come on your show. I love women's health to be a big part of your show. So let me know we can we can give your patients and your audience more information.

Maya Acosta  44:42

Definitely. You know, we have listeners from Mexico in the UK and Australia. People listen from all over and of course we know that lifestyle medicine is huge. It's everywhere. The goal is to kind of continue to share this information and feature experts like yourself so that people And then know how to reach out. And by the way, that reminds me. How can people learn more about you? Do you have social media? Do you have a website?

Dr. John McHugh  45:08

Yeah. So we have a couple things going on right now. We did create the Facebook group, just it's called women's health, lifestyle medicine all one long run one word, anybody can join that group or Google for that group. We're creating that as an as an open group. I also have a Twitter account, which is lifestyle med doc MD D, OC. People can follow I post information on there. When I can, we're working on Instagram, we do have a women's health, lifestyle medicine on Instagram, and we'd love to share more content there as well. Again, our goal is to really give people evidence base good information that's out there for to help them make decisions.

Maya Acosta  45:46

Awesome. This Facebook group for the women's lifestyle medicine, I'm a member of what can if anybody can join, what could they expect to find in that Facebook group?

Dr. John McHugh  45:55

You know, what we're trying to do is we're returning to find recent studies that come out, that really give them a sort of a more straightforward approach. Sometimes studies are covered in Time Magazine, or AP or something like that, that can give people something that they can digest and take home. But we're really only going to focus on evidence based lifestyle medicine for people that can help them make some change in their lives.

Maya Acosta  46:20

Wonderful. Wow, this has been so informative. Thank you so much, is there kind of a final message that you'd like to give our listeners or maybe one step how they can get started towards a healthier lifestyle?

Dr. John McHugh  46:32

I guess I'd say that the most important thing is that there's an old, I think it's an old Chinese quote, that a journey of 1000 miles begins with one step. And I've just seen so much change, and I'm sure you've seen so much change, and everybody has gone through change. I myself lost about 90 pounds over a few years. It really took a long time. didn't think I could do it. Of course, I was going the wrong direction originally. But that was just taking one step at a time towards that progress. And, you know, I think sometimes now and you probably see it as well. When you look around and see people who've made these changes, you know, their skin is growing. They're feeling better, they're happier. And this can all be a future that's possible for everybody.

Maya Acosta  47:11

Thank you again, Dr. John McHugh,

Dr. John McHugh  47:13

Thank you so much Maya. I really appreciate your time.

Maya Acosta  47:16

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