In this blog post, our Mills-Peninsula research partners in precision medicine at Sutter Health, Walter “Buzz” Stewart, Ph.D., MPH, vice president and chief research officer at Sutter Health, and his colleague, Gregory Tranah, Ph.D., a scientist at Sutter Health’s California Pacific Medical Center Research Institute, discuss the promise of precision medicine and the research that is taking shape in the Sutter Health network and how genomic information and big data are revolutionizing patient care.

What is Precision Medicine?

STEWART: Precision medicine represents the research foundation that leads to better ways of individualizing care for patients. Its prominence today reflects the convergence of unprecedented advances in three areas: our understanding of the biology of health and disease, and the role of genetic and physiologic factors; the rapid growth in patient digital health data; and powerful computing tools that can analyze enormous volumes of data quickly and cost-effectively. These advances are making it possible for researchers to use genetic information, blood and other biologic samples, and electronic health record data to understand disease and disease progression in ways that we only imagined in the past.

What kind of precision medicine is Sutter Health doing?

TRANAH: To have a meaningful impact on our patients in the near term, we are initially focusing on two areas. First, we want to be able to identify which patients with a given condition will progress and which will not. This will allow us to more precisely intensify care for some patients and offer reassurance to the many others whose conditions are likely to remain stable. Our research also has a predictive component, which means using all of this data to identify patterns that can tell us who is likely to develop a disease. Second, we want to improve treatment decision-making. For many conditions, the only way for doctors to determine which available drug or treatment will work best for a given patient is trial and error. Precision medicine can change that. By identifying subtypes of disease at the molecular level, we will begin to understand how each patient will respond to specific treatments so the doctor can choose the best therapy the first time. This will also allow us to repurpose existing drugs in novel ways. Finally, while we are concentrating initially on better use of existing therapies, we also intend to collaborate with other research organizations to accelerate the discovery of new treatments.

Which health issues are you researching?

STEWART: Our first phase of research will examine five health problems where there are significant gaps in our ability to care for patients: multiple sclerosis, early detection of heart failure, Parkinson’s disease, chronic migraine and selected cancers. We are also looking at healthy aging to better understand factors that allow people to function well in older age. These areas also leverage existing expertise and research capabilities in the Sutter Health network.

What is a biobank?

STEWART: A biobank is analogous to a bank. You deposit and withdraw. In our first phase of work, the Sutter biobank will store biological samples such as blood and serum collected over time from 100,000 consenting patients with specific diseases of interest. We can withdraw samples on selected patients to answer questions that arise in our research efforts.

What are the advantages of a health system doing research?

TRANAH: In a health system, data accumulates naturally in the course of patient care. Sutter Health’s electronic health records contain long-term data on millions of ethnically and racially diverse patients that can be de-identified to protect patient confidentiality. So if I want to study multiple sclerosis, for example, I don’t have to recruit 5,000 study participants and follow them for 10 years. I already have the study population and health record data that includes their diagnoses, treatments and outcomes. If I collect blood samples from consenting patients, this dramatically compresses research time and cuts costs. If I collect serial blood samples from patients, the information this provides on biologic changes over time is invaluable. It’s a complete game-changer.

STEWART: Often it takes as many as 10 to 15 years for new discoveries to be put into practice. At Sutter Health, the data that we’re using for research is the data we use to deliver care. So our ability to take discoveries and translate them back into the care settings where we’re treating people is much more rapid and timely.

TRANAH: Because Sutter provides both primary and specialty care, we see patients just as a new disease is emerging. This is where the most important information comes from because we can track changes that occur at the molecular level. This information can then be used to determine who is likely to progress or respond to certain therapies early on, allowing us to develop individualized preventive or management plans.

This is very different from what happens in academic medical centers where this kind of research is typically conducted, but where the patients are more likely to seek care because they are in a later stage of disease that is not responding to treatments.

What about ethical concerns?

TRANAH: Ethics in research are always paramount. We are very thoughtful about the levels of consent and permission that we ask patients to give us. We want to make sure that people understand and consent to all of the different ways we might use their biologic samples and health information. All of our data is scrubbed to remove any personally-identifying information.

When will we see the benefits of Precision Medicine?

STEWART: It’s hard to answer such a question with certainty because our business is about exploring the unknown. But we’re hoping to begin having an impact in the next five years.

“When should we try to fix and when should we not?” asks Atul Gawande, M.D., MPH, in his latest bestselling book, Being Mortal: Medicine and What Matters in the End. Dr. Gawande is a practicing surgeon at Brigham and Women’s Hospital in Boston, a professor at Harvard Medical School and the Harvard School of Public Health, a staff writer for The New Yorker and executive director of Ariadne Labs, a global health care innovation center.

Being Mortal is his fourth bestselling book. It’s a physician’s personal journey toward a better understanding of aging, serious illness and what it means to balance prolonging life with preserving the treasured priorities that mean the most to each human being as that life draws to a close.

Dr. Gawande is also the featured speaker at Mills-Peninsula’s Community Health Dinner and Lecture and the annual Mills-Peninsula Luncheon and Lecture in April 2016, benefiting the Mills-Peninsula Palliative Care Program and breast health programs.

In anticipation of his April visit to speak at our Mills-Peninsula events, we asked Dr. Gawande to share his insights about how doctors, patients and family members can partner together to help loved ones live a life that is meaningful to them all the way to the end of life.

Q: What were the key takeaways you learned from researching and writing Being Mortal?
DR. GAWANDE: I ended up interviewing more than 200 patients and family members about their experiences with serious illness and infirmity. I also interviewed scores of clinicians including palliative care physicians, hospice teams, nursing home aides and directors. The people who were really great at what they were doing had learned several key things.

First was that people have priorities for their lives that they want their health care providers to serve besides just living longer. We all have purposes larger than ourselves. The most reliable way to learn about a patient’s priorities is to ask…and we don’t ask. When we don’t ask, we end up in a situation where the care that we give is often out of alignment with what people’s priorities actually are for their lives.

Suffering comes from finding out that the medical evasion of mortality results in a focus on disease, instead of a focus on you, the patient, and what matters most in your life no matter how long or short it is.

So what I was able to learn was how to change that story by asking the right questions.

Q: How has this new awareness changed how you practice medicine now?
DR. GAWANDE: Up to this point, my thinking was that being good at managing difficult conversations about a patient’s end of life meant being really direct about the facts and options. “There are options A, B and C. Here are the benefits and here are the risks of each of them. Now, what do you want to do?”

One of my palliative care colleagues said to me, “You know what your problem is? You’re an explainaholic.”

The point he was making was that people come to better decisions by being able to tell you what matters most to them. And to put in their own words their understanding of where they are with their illnesses.

So the practical thing I learned was how to ask questions like: “What’s your understanding of where you are with your illness at this time? What are your fears and worries for the future? What are your goals if time is short? What are you willing to sacrifice and what are you not willing to sacrifice for the sake of more time?”

Q: What did that look like in practice?
DR. GAWANDE: I have a colleague whose father told her when she asked these questions, “I’m willing to go through a lot as long as I can still watch football on television and eat chocolate ice cream.”

So when my dad became ill, I told him that story. He said, “No way.” Football and ice cream were not what mattered to him. My dad was willing to go through a lot as long as he could be at home, sit at the family dinner table, and enjoy his food and the company and interaction of other people. “If that’s no longer possible,” he said, “just give me the pain medicine and let me go.”

My conversations with my patients used to be, “Well, you can do nothing or we can try something.” Now my questions have shifted to, “Tell me what really matters most in your life, what you’re willing to go through and what you’re not willing to go through for the sake of more time. And then, based on what is important to you, I can recommend to you what’s our best shot at getting that or tell you if it’s not really on the table.”

I feel like that’s what I learned and it was transformative.

Q: What is the most important advice you would give to patients facing end-of-life decisions?
DR. GAWANDE: As soon as people need help in their lives, whether they need a wheelchair or a home care worker, it’s important for them to be clear right from the beginning about what really matters to them. And the only way to do that is to talk about it before the crisis ever comes.

These questions are not ones that only clinicians can ask. It’s the conversation I had with my dad. What are your biggest fears and worries if your health worsens? If your health declines, what does living a good life mean to you? What is a life still worth living? And how do we make sure we preserve that?

One person I wrote about said to me, “Safety is what we want for those we love. Autonomy is what we want for ourselves.” And I think for those of us who have aging parents or people going through serious illness around us, we want them to survive and be safe above all. But for ourselves? There are things we live for that are bigger than ourselves and that’s where we get our purpose in life. And recognizing that the people we love also have their own purpose in life, that’s the trick.

This blog post was excerpted from a Mills-Peninsula interview with Dr. Gawande in Mills-Peninsula’s “healthpoint” magazine.

In this blog post, Christopher Woods, M.D., Ph.D., an electrophysiologist at Mills-Peninsula Health Services, explains AFib and answers commonly asked questions about the disorder.

AFib progresses gradually in most people. “Early on, patients go in and out of normal rhythm, and that usually causes very noticeable symptoms,” Dr. Woods says. “But once they are in persistent AFib, they may no longer feel that contrast. They get used to being tired all the time and don’t realize how much they have changed their lives to accommodate their disease. Because of this gradual progression, AFib an insidious disease – it steals a person’s lifestyle a little bit at a time.”

What causes AFib?

AFib is generally linked with increasing age, although it can also be caused by heart disease, high blood pressure, sleep apnea and other conditions.

 How is AFib treated?

AFib can be treated with medications that have a moderate success rate, through a minimally invasive procedure called catheter ablation, or sometimes with both.

Is treating AFib with medication effective?

Antiarrhythmic drugs can help return the heart to a normal rhythm. While medication is easy to take, there may be side effects, and the medications generally become less effective over time.

What is an ablation?

An ablation is a minimally invasive procedure in which an electrophysiologist threads a catheter up through a blood vessel in the leg into the heart, and uses precise bursts of radiofrequency energy to destroy the tissue that is producing the abnormal electrical signals. Ablation eliminates the triggers of AFib. While ablation has a fairly high success rate, more than one procedure may be necessary, and sometimes medications are still needed.

Why is it important to treat AFib early?

As AFib progresses, the chance for a cure declines. AFib scars the heart. Once it scars, AFib is harder to treat with any modality. And so the longer the person has been in AFib, the less likely any treatment, including ablation, will be successful.

Watch patients and Dr. Woods partner on innovative procedure to beat AFib:

Facts about AFib from the American Heart Association

• It’s the most common “serious” heart rhythm abnormality in people over the age of 65 years.
• Untreated, AFib doubles the risk of heart-related deaths and leads to a 4-to-5-fold increase in risk for stroke.
• Many patients are unaware that AFib is a serious condition.
• One in three people will suffer from AFib by the time they reach 80.

 Christopher Woods, M.D., Ph.D., is an electrophysiologist at Mills-Peninsula Health Services.

Palliative care is a medical specialty that helps people who are facing a serious health crisis, whether chronic or terminal, at any stage. The word palliative comes from the Latin verb “palliare,” which means to put a cloak around someone — a simple gesture offering physical comfort and support.

“In the purest sense, the concept of palliative care is to be present, attentive and emotionally supportive, physically providing comfort and accepting a person for who and where they are,” says Suzanne Pertsch, M.D., medical director of Palliative Care at Mills-Peninsula.

Difficult Conversations
A palliative care consultation typically begins with a discussion with the sick person and his or her family to clarify the person’s wishes and goals of care, talk about the illness trajectory and prognosis, explore options for care and the need for pain management, and discuss other aspects of care that affect a person’s quality of life.

Depending on the severity of illness, palliative care teams also help families sort through questions about who will provide care, how to choose a surrogate decision-maker if needed for the future and how to fill out paperwork, such as an advance directive or a POLST (Physician Orders for Life- Sustaining Treatment) form.

“These conversations are not easy to have, but they need to happen and most patients and families want this information,” says Sharon Tapper, M.D., palliative care medical director at the Palo Alto Medical Foundation. “Most patients and their families know when they are getting sicker. They want to know their choices so they can make informed decisions.”

It’s a team effort — palliative care programs typically include a board-certified palliative care doctor, a nurse practitioner, a social worker, a care coordinator, a chaplain, a physical therapist and others with specialized training.

Dr. Pertsch describes a typical palliative care consultation: talking to a person who has just been diagnosed with advanced cancer.

“People and families are often reeling from rapid changes and aren’t ready to accept what is happening,” Dr. Pertsch says. “Our team helps them assimilate the information and come to terms. We break it down to the basic concerns — what are your options, what is meaningful to you — and provide psychological and social support as needed.”

Powerful Medicine
A three-year study published in 2010 by The New England Journal of Medicine suggests that palliative care is powerful medicine. The study found that people with advanced lung cancer who received palliative care early after diagnosis along with cancer treatment lived more than two months longer. They also experienced less clinical depression and a better quality of life than those who received treatment alone.

A misconception about palliative care is that it consists of end-of-life comfort care only.  Although often paired with hospice, which is defined as care in the last six months of life, palliative care can be used to aid treatment for any serious health issue at any point in life and can be provided in conjunction with curative treatment.

“Making that choice to pursue palliative care does not mean you’ve given up,” says Deborah Griffith, whose husband Jeffery received palliative care before passing away from cancer in 2015. “You’ve chosen to live another way and some of that way is without fear. Palliative care provides the physical and emotional support you need. It was exactly what he needed to be comfortable and at peace.”

It is said that an apple a day keeps the doctor away. But for disease prevention and to achieve optimal health, you may want to eat the apple and cultivate a close relationship with your doctor. “As doctors we can advise people on health issues, but achieving a good outcome is a partnership,” Natalya Denissov, M.D., a Mills- Peninsula family medicine doctor, says. “To me, it is important to meet a patient where he or she is, build a relationship first and come to an agreement on a goal or treatment. Then the person needs to take an active role in the treatment and maintenance.”

The basic building blocks for good health – eating a healthy diet, staying active and avoiding  smoking – should be coupled with regular visits to your doctor for exams, screenings, vaccinations and to address any changes in your health.

“A lot of prevention is connected to lifestyle: what we eat, how often we eat, whether we get enough exercise and enough sunshine and vitamin D,” Dr. Denissov says. Regular checkups with your doctor are important to keep tabs on health measures connected to chronic diseases and to ensure you are on a healthy path.

To-Do List for Top Health

• Keep Preventive Care Up-to-Date: Ask your doctor which screening tests and immunizations are right for you and when they are due.
• Know Your Body: If you notice a change that is persistent or of concern, talk to your doctor. If you don’t have a primary care doctor yet, go to mills-peninsula.org to find one.
• Eat Your Way Healthy: Know your target body mass index (BMI) and maintain a healthy weight. Avoid processed food and eat more foods high in calcium and fiber. Enjoy plenty of fruits and vegetables. “Food is medicine,” Dr. Denissov says.
• No Butts: Avoid smoking and inhaling others’ tobacco smoke. If you need support quitting, talk to your doctor.
• Get Moving: Get your heart rate up and enjoy 30 minutes of exercise every day. “Movement and exercise are great for easing stress and preventing disease,” Dr. Denissov says.
• Create Balance: Aim for life/work balance. Reduce stress and make the most of each day. Meditate or try yoga.
• Play It Safe: Use sunblock, wear a bike helmet, fasten your seatbelt and use the right size car seat for your child.
• Maintain Your Mind: Seek out community and supportive relationships. “Psychological health is really important. When you have good support, you just feel better,” Dr. Denissov says. If you need help managing depression or mood changes, seek your doctor’s help.

Natalya Denissov, M.D., is a family medicine doctor at Mills- Peninsula Health Services.

Too often, doctors and families are unable to honor patients’ or loved ones’ wishes for care during a serious illness because the patient has not made his or her health care wishes known in advance. Within Mills-Peninsula’s support and coaching program for older adults leaving the hospital, called Peninsula Circle of Care, nurses see this situation frequently.

“Many people that we work with have thought about their wishes,” Yvonne Chan, R.N., MSN, GCNS-BC, program manager for the Peninsula Circle of Care, says. “But few of them put that information into an advance health care directive document that can be referenced in case a medical situation arises if they are unable to speak for themselves.”

Waiting until a serious illness or accident occurs to do this type of planning is problematic, Chan says. Sometimes when people are hospitalized for serious illness, they are unable to communicate their wishes or are overwhelmed with the anxiety that comes with a serious diagnosis. “At that time, a person is not always able to make clear decisions about their personal health care wishes,” she says.

“Changes can happen in your life very suddenly,” Patricia Firenze, R.N., M.A., says. Firenze is a nurse care manager with the Peninsula Circle of Care who helps seniors fill out advance care directives. “You don’t want to put your family in the position of having to guess at your wishes for your medical care. And although documenting your wishes can feel overwhelming, remember that it doesn’t need to be done all at once and you can always make changes to the document later on if needed.”

Partnering With Community

To help educate people about the importance of advance care planning, Mills-Peninsula and the Peninsula Circle of Care are offering free workshops at Mills-Peninsula Medical Center in Burlingame:

Jan. 12, 2016, 11 a.m. to 1 p.m.

Jan. 19, 2016, 2 to 4 p.m.

Jan. 21, 2016, 10 a.m. to noon

Jan. 29, 2016, 4 to 6 p.m.

Register for any one of these sessions by calling 650-696-3660. Refreshments will be provided.

Starting the Conversation

Since families often gather over holidays, this can sometimes be a good time to discuss your wishes for medical care with loved ones face-to-face. The Coalition for Compassionate Care website offers a useful guide with tips to help you think about ways to start talking with your loved ones about what care you want during serious illness or for end-of-life care.

You can learn more about advance care planning and download a free advance care planning form on the Mills-Peninsula website. Useful checklists and a video about advance care planning are also available at acpdecisions.org.

Terms to Know When Documenting Your Wishes

Advance Health Care Directive (AHCD)

This is an official form recognized as a legal document in the United States when signed in the presence of witnesses or a notary. The form allows you to name a person that will make health care decisions for you in the event you cannot make or express your decisions for yourself and allows you to describe specifically what actions should or should not be taken at that time. Make sure you give a copy of your AHCD to your doctor, keep a copy at home and provide copies to family members. You can download the form in English and Spanish from the California Hospital Association website.

Do Not Resuscitate (DNR) Order

This is an official California state document developed by the California Emergency Medical Services Authority and the California Medical Association that allows you to refuse certain resuscitative measures that may keep you alive if your heart or breathing stops. A person with a completed DNR may choose to wear a DNR medallion that medical personnel can easily see in an emergency situation. Unlike the AHCD, this form needs your physician’s signature to become valid.

Physician Orders for Life-Sustaining Treatment (POLST)

This is similar to a DNR form but contains additional information that covers situations that may arise if Emergency Medical Services come to your home to assist you or if you are in a hospital. Like the DNR form, your physician needs to sign it to make it valid. After January 1, 2016, a change in California law will allow nurse practitioners and physician assistants to also sign a POLST form for you.

For people with an addiction, the holidays may pose a particularly challenging set of circumstances that can make their situation worse. These include:

Loneliness: Social isolation can be deeply felt during holidays that emphasize relationships and family.

Family stress: As families come together for the holidays, conflicts between family members can become more intense.

Relaxing of social constraints: Holiday parties and the general celebratory mood loosen normal social codes about how to behave. Overindulgence, whether in food or alcohol, is more common.

Financial stress: The holidays can be very expensive, and someone worried about how they will afford all of the gift and parties of the season may turn to substances to lessen the stress.

If you notice signs of addiction in someone you love this holiday season, or at anytime throughout the year, consider getting help and counsel from an addiction specialist on how to intervene effectively. For a free phone consultation with a Mills-Peninsula Drug and Alcohol Treatment Program intake counselor, call 650-696-4666. Visit the Mills-Peninsula Behavioral Health website for more information on behavioral health services, programs and resources and the mentalhealth.gov website.

Read more on our blog about getting help when someone you love is suffering from addiction.

When someone you care about is suffering from addiction, it can be emotionally wrenching because the addicted person will often blame his or her problem on the nearest people and situations, Philip Kolski, a licensed clinical social worker at the Mills-Peninsula Behavioral Health Center, says. This, of course, pushes the people who are trying to help away.

“The addict is not in control any longer,” he says. “The person’s sole focus is to relieve the pain inside. As a result, addiction is a very lonely disease because often the addict has no support  system left.”

A Family Affair
When treating an addict, one of the first things Kolski and his staff attempt to do is partner with family and loved ones remaining in the patient’s life.

“We view it as a family problem,” he says. “That means we need to get everyone on the same page to treat it.”

Feelings of shame sometimes make people hesitate to seek help for someone they care about. But addiction is not a situation that is likely to resolve on its own. It’s a complex chronic illness that requires expert treatment, especially if the addict also has a mental health issue.

Getting Help
“The important thing to remember is that there is help available,” Dan Becker, M.D., medical director of the Mills-Peninsula Behavioral Health Center, says. Just as treatment programs emphasize to addicts that they are not alone, people who care about someone struggling with addiction are also not alone. If you are trying to get help for an addict, there are a few things you can do, Kolski says:

• Seek out support: Addiction is tough on the whole family. So as addicts join support groups during treatment, it’s advised that their families do so too.
• Confront the person with the consequences of his or her behavior, including possible health costs. “Until the results of the person’s behavior become serious enough to force them to change, they won’t seek treatment,” he says.
• Talk to your doctor or contact addiction disorder experts directly if you need help. They can often connect you with resources both for the person you wish to help and for yourself.

Visit the Mills-Peninsula Behavioral Health website for information, services and resources, or call the Mills-Peninsula Drug and Alcohol Treatment Program at 650-696-4666.

Read more about addiction topics on the Mills blog:

Pain Killer Addiction: What to Know

Chemical Dependency and Aging

Mills-Peninsula Introduces Unique Residential-Based Rehab Program

Special holiday meals don’t have to be laden with fat, sugar and far too many calories.

“Create healthier holiday meals by letting the words ‘substitute, reduce and omit’ guide you when you are preparing a special holiday dish,” Carolyn McCune, a Mills-Peninsula registered dietitian and certified diabetes educator, says. “Think of it as giving the gift of a healthier holiday season to yourself, your family and your guests.”

Here are a few of McCune’s top tips for creating healthier holiday dishes:

• Try using lower fat ingredients in your holiday recipes such as fruit purees instead of sugar, evaporated milk instead of cream and plain yogurt instead of sour cream and mayonnaise in dips and sauces.
• Offer low-fat protein such as turkey or chicken rather than ham or red meat. Skip the skin and choose the white meat to save extra calories.
• Reduce the amount of oil and butter you use. Use a cooking spray or just brush pans or dishes lightly with oil.
• Use spices, fresh herbs and lemon zest to add flavor to dishes instead of butter, cream and extra salt.
• Create holiday dishes with more fresh vegetables, fruits, beans and whole grains to bring healthier options to the table. Enjoy the delicious flavor of fresh green beans rather than a casserole with full-fat canned mushroom soup and fried onions.
• Use low-fat chicken broth instead of butter for dishes such as stuffing and mashed potatoes.

See more tips on our blog to help you enjoy your favorite holiday foods without sacrificing your waistline and good health.

Carolyn McCune is a registered dietitian and certified diabetes educator at Mills-Peninsula Health Services.

The holiday season – it’s the most delicious time of the year! But all those tasty treats and traditional holiday foods can also mean lots of extra sugar, fat and calories.

According to the National Institutes of Health, American adults gain about one pound between Thanksgiving and the New Year. And people who are already overweight may gain up to five pounds. Although a single pound might not sound like much, most of us don’t lose the added weight. Over the years, the continuous weight gain can lead to serious health consequences including diabetes, heart disease and obesity.

“It’s definitely worth having strategies in place before the start of the holiday season to curb any potential weight gain,” says Carolyn McCune, R.D.,  a registered dietitian and certified diabetes educator at Mills-Peninsula. “It’s not so much what you eat on a single holiday – it’s the accumulation of treats we consume between Halloween and the New Year that really adds up.”

McCune offers the following tips to help you enjoy your favorite holiday foods without sacrificing your waistline and good health.

• Eat before a party. Don’t skip meals, as this will only lead to overindulging later. Have a healthy, protein-containing snack such as a small handful of almonds or a piece of fruit and a small slice of low-fat cheese before any holiday get-together.
•  Watch your drinks. Sip water with a slice of lemon or unsweetened tea and choose a wine spritzer rather than a straight glass of wine. Calories from special holiday drinks like eggnog or fruity cocktails add up quickly and alcohol can increase your appetite.
• Pick a favorite. Rather than helping yourself to everything at a holiday meal or party, choose one special food that you really like. That way you’ll get to enjoy the treat without the calorie overload.
• Minimize the extras. Stick to a drizzle of salad dressing, gravy or sauce, or a small dollop of low-fat sour cream on your potato.
• Eat mindfully. Don’t rush through a meal. Savor each bite slowly and be fully aware of the taste.
• Choose your location. Placement at a party or holiday event is key. Don’t sit or stand near the buffet or snack table. The closer you are to the food, the greater the temptation to graze and overeat. And keeping a glass of water in hand at all times also makes it much more difficult to fill a plate with nibbles.
• Make a healthy contribution. Bring a healthy item, such as a fresh green salad or veggie platter, to a potluck or meal. That will ensure that there is a healthy food choice for you and all the guests.
• Keep treats away. Don’t be tempted to load up your pantry with everyone’s favorite holiday candies and cookies. Instead, keep plenty of fresh fruit available for your family to snack on and give them the gift of vitamin C and fiber for best health.
• Get moving. Keep up your regular exercise routine as the busy holiday season rolls on. Exercise not only relieves holiday stress, but will help you keep unwanted pounds at bay. Incorporate some active fun into your holiday traditions – go for a walk or bike ride, try ice skating together, play a ball game at the park or have a spontaneous dance party to your favorite holiday tunes.

Carolyn McCune, R.D., is a registered dietitian and certified diabetes educator at Mills-Peninsula Health Services.