Metabolic experts at Mayo Clinic say combining the two in some instances can be an effective way to treat obesity.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:02) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Obesity is a disease, and to overcome it, we need to use all the modalities, or tools, we have available," says Dr. Omar Ghanem, a Mayo Clinic metabolic surgeon.

However, it's not a one-size-fits-all approach.

"Some patients might benefit only from medications, some patients might benefit only from surgery, but a portion of patients might benefit from the combined therapy," Dr. Ghanem says.

He says some patients experience greater weight loss when combining bariatric surgery, also called metabolic surgery, with GLP-1 medications. Ideal candidates include patients who start obesity treatment with a higher body mass index, those who are preparing to undergo a complex surgical procedure, such as a transplant, and patients who need to lose more weight for their overall health or those looking to maintain their weight after metabolic surgery.

"Neither GLP-1s nor bariatric surgery are magic. These are tools, and the patient has to use those tools correctly to be able to overcome obesity," Dr. Ghanem says. "Each case is different. Go to your provider, talk to your specialist, and trust them to help you make the right decision for your health. Our patients have to put a lot of effort to overcome the disease. They're not just choosing the easy way out, they're choosing the healthy way out."

Related posts:

• Bariatric surgery paves way for heart transplant after end-stage heart failure 
• New year, new focus on health: Mayo Clinic expert highlights effective treatment options for obesity

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Postpartum experiences are as unique as the pregnancies that come before them. Because of this, it can be difficult to recognize what's normal and what could be a complication — even if you've given birth before. 

The postpartum period is generally defined as the first six weeks after birth. "Postpartum begins immediately following birth and extends through the time when your body and mind are recovering from pregnancy and delivery," says Dr. Kylie Cooper, a maternal-fetal medicine specialist at Mayo Clinic.

Recovery isn't the same for everyone, and for some people, the postpartum timeline can be longer. While the spectrum of what is considered typical postpartum is wide, there are warning signs of complications you should never ignore.

Dr. Cooper discusses postpartum complications, how to recognize them and when to seek care.

The signs you shouldn't ignore

Dr. Cooper says consistent improvement is the best indicator of typical recovery

"In general, recovery should tend toward improvement. So, if you feel like things are getting worse, or new symptoms come up, we definitely want you to reach out for care."

Dr. Kylie Cooper

The first two weeks after delivery carry the highest risk for serious complications, though they can sometimes occur later. "The most common complications we see in that time frame are high blood pressure, hemorrhage or bleeding complications, infection, anxiety and postpartum depression," says Dr. Cooper.

While many postpartum concerns are common and treatable, some rare but serious complications can develop during this time, which is why new or worsening symptoms should never be ignored.

"These include blood clots, like deep vein thrombosis or pulmonary embolism, as well as postpartum heart issues like cardiomyopathy," says Dr. Cooper.

If you experience any of these symptoms, you should seek care as soon as possible because they can indicate serious complications:

• Worsening pelvic or incision pain, or pain that doesn't improve.
• New, heavy or increased bleeding.
• Headaches that don't improve with medication.
• Confusion or behavior changes.
• Fever or flu-like symptoms.
• Mood changes, anxiety or depression.
• Extreme fatigue that doesn't improve with rest.
• Shortness of breath, trouble breathing or chest pain.

"Symptoms related to pain, mood changes and energy levels can be dismissed as normal postpartum symptoms. While the postpartum time frame can be a challenging time, these symptoms shouldn't be dismissed," says Dr. Cooper.

Mental health-related postpartum complications

After delivery, your body undergoes a significant hormonal shift that can affect your mood and emotions in various ways. While this is expected, symptoms usually improve in a couple of weeks. When these feelings linger or cause depression or anxiety that doesn't improve, it could indicate postpartum depression. In rare cases, a serious and life-threatening condition called postpartum psychosis can develop.

"While 'baby blues' might initially cause people to feel off or be tearful, that should improve, and it should not persist," says Dr. Cooper.

She says these feelings can improve with treatment and support.

If you think you or a loved one are experiencing symptoms of mental health-related postpartum complications, the National Maternal Mental Health Hotline (1-833-TLC-MAMA) and Suicide & Crisis Lifeline (988) offer free and confidential 24/7 resources.

After the six-week postpartum visit

After your six-week postpartum visit, your care will transition back to your primary care team. But this shouldn't mean the end of postpartum care.

"It's becoming increasingly recognized that this is a much longer process, extending up to a year after delivery. I think it's important that we acknowledge that many people are not done recovering at the six-week mark — not by a long shot," says Dr. Cooper.

If you had physical or mental health complications during the postpartum period, this transition is crucial to ensure your long-term wellness. "This is a really important time frame to ensure we help patients establish their preventive care because pregnancy complications can impact long-term health," says Dr. Cooper.

As you continue to monitor your health and well-being during this period, it's important to pay attention to symptoms that may arise or persist beyond the initial recovery phase, as these can often be treated. "Pelvic floor symptoms are often dismissed. For example, there's this misnomer that once you have children, you will have pelvic floor issues. And that's an accepted part of your future, but it shouldn't be," says Dr. Cooper. "These are issues that can be treated and improved."

Getting the support you need postpartum

Support plays an important role in recognizing postpartum complications. Partners, family members and caregivers may notice subtle changes before you do, especially during a time marked by sleep deprivation and physical recovery.

"Sometimes partners or family members are the first to recognize that something isn't right," says Dr. Cooper. "If you notice changes that concern you about your loved one, it's important to speak up and help them seek care."

Dr. Cooper emphasizes that it takes a village to provide postpartum support, and the fetal and maternal care team at Mayo Clinic aims to be part of that village. "In our practice, we have a team approach with obstetric providers, perinatal mood specialists, lactation consultants and pelvic floor physical therapists, and we all work together to make sure that the patient has the care they need."

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DEAR MAYO CLINIC: I’m confused about prebiotics and probiotics. Could you help me understand what they are and how they could benefit my health?

ANSWER: You're not alone in wondering about the health benefits of prebiotics and probiotics. Even the names can be confusing.

The human gastrointestinal tract houses roughly 100 trillion microorganisms (good bacteria). These microorganisms make up what's called the gut microbiome.

These good bacteria fight off bad bacteria to help keep our intestinal tract healthy. 

Probiotics: Promoting digestion, benefiting health

Let's start with probiotics. Probiotics are living organisms, also known as microbes. They're primarily bacteria and yeast whose main role is to aid digestion and improve overall health. Probiotics help strengthen the gut barrier, aid in the absorption of nutrients, and replace less beneficial or harmful microbes. 

Research shows that probiotics can treat and even prevent conditions such as gastrointestinal (GI) tract infections, irritable bowel syndrome (IBS), lactose intolerance, allergies, cystic fibrosis, urogenital infections, diarrhea, high cholesterol, eczema and certain cancers. 

Probiotics also may support dental health by treating and preventing tooth decay, periodontal disease and bad breath. 

In addition to aiding digestion, another essential role of probiotics is promoting a healthy immune system and preventing chronic diseases. 

Some examples of probiotics include fermented foods, such as certain yogurts, many cheeses, pickled vegetables, apple cider vinegar, fermented teas and sauerkraut. Probiotic supplements also are available in pill or powder form. 

Prebiotics: Feeding probiotics

Prebiotics are the food for probiotics. They help feed the probiotics through fermentation and metabolization, which are beneficial to the gut. These microorganisms contribute to a variety of processes, including cell energy, immune function, hormone regulation, anti-inflammatory responses and bowel management. 

Research indicates that high prebiotic consumption may enhance our immune system, help regulate blood sugar levels, reduce the risk of colorectal cancer and increase calcium absorption. When good bacteria (probiotics) are fed an abundance of healthful food (prebiotics), our bodies will be healthier.

Prebiotics are found in foods that contain:

• Dietary fibers, which the body doesn't fully digest.
• Resistant starches, which are a form of carbohydrate that isn't digested in the small intestine. Instead, it ferments in the large intestine. 

The most common prebiotics are inulin, oligosaccharides and pectin, which are found in fibrous foods. Foods containing prebiotics include most fruits and vegetables — especially green bananas, asparagus and onions — as well as garlic, nuts, seeds, oats, barley, potatoes, and legumes such as soybeans, dried beans, peas and lentils.

Adding probiotics and prebiotics to your diet

Food composition changes with cooking, so to get the most benefit from prebiotics and probiotics, it's important to pay attention to cooking methods. For example, boiling potatoes is better than baking them. When potatoes are boiled and then chilled, they develop a white starchy film, which is the most beneficial part. Serving beans and legumes hot increases their starch content, which is good for your gut.

Eating most fruits and vegetables while they are fresh and raw will provide healthful prebiotics. 

Researchers suggest gradually introducing these foods into your diet. Adding a lot of new foods containing prebiotics and probiotics may produce gas, cause bloating and lead to gut discomfort.

Anne Harguth, Nutrition, Mayo Clinic Health System, Waseca, Minnesota

The post Mayo Clinic Q&A: What are prebiotics and probiotics? appeared first on Mayo Clinic News Network.

Mayo Clinic expert explains why it is important to act before perimenopause

JACKSONVILLE, Fla. — Weight gain is common in women during perimenopause and after menopause, but the physical changes underlying it start much earlier in adulthood. Daniela Hurtado Andrade, M.D., Ph.D., an endocrinologist and obesity expert at Mayo Clinic in Jacksonville, explains why it is important to start counteracting those changes before perimenopause arrives.  

"Weight changes are not only characteristic of midlife or menopause. Data have shown that weight gain starts early in adulthood," Dr. Hurtado says. "Around age 30, your muscle mass starts decreasing gradually as part of the natural aging process, and this is exacerbated in midlife due to menopause."

The decreasing muscle mass will lead to a lower metabolism, a risk factor for weight gain, Dr. Hurtado says.

Adding to the challenge of achieving a healthy weight before and after menopause are many of the features of modern life, Dr. Hurtado says. For example, an abundance of processed foods high in sugar and fat; technology such as escalators, elevators and cars that allows people to move from place to place without walking; and the difficulty of unplugging from devices that keep people connected to work and sedentary for longer hours, with less time spent on physical activity. 

Being aware that weight-related physical changes start earlier than midlife may help people be mindful about the importance of establishing and maintaining a healthy lifestyle, including adequate diet and exercise (at least 150 minutes per week), well ahead of menopause, Dr. Hurtado says. It may help to track what and how much you eat, to understand how much you need to eat to feel satisfied and avoid overeating, she adds.

To mitigate muscle mass loss that occurs with aging, a healthy diet should include enough protein and exercise should include resistance training and possibly high-intensity interval training, Dr. Hurtado says.  

"And this is even more important if we are engaging in a weight-loss intervention because we know that weight-loss interventions are also associated with muscle mass loss, which can have a significant impact on the weight-loss outcomes," she says. "One of the reasons why we hit a plateau when we are losing weight is because we are losing muscle mass and our metabolism slows down."

While a healthy lifestyle is essential, it may only get someone so far in pursuit of a healthy weight, Dr. Hurtado says. The body is genetically programmed to survive, so losing weight is perceived as  negative and our bodies will try to fight it. Some people can sustain low-calorie diets for a period of time and lose weight, but eventually they may start feeling hungry, eating more and gaining weight.

"As soon as some people even think about losing weight or restricting their calories, their brain overrides those thoughts: 'No, you're actually hungry, so you're going to eat as much as you need to make sure that you do not lose weight,'" Dr. Hurtado says. "There is a proportion of people in whom diet and exercise alone will work, but for the majority, they will not due to the complex regulation of energy balance."

Many people who live with overweight or obesity will need a tool such as a medication, an endoscopic bariatric procedure or bariatric surgery to help them achieve sustained weight loss, Dr. Hurtado says. In addition to nutritional and behavioral support, they also may benefit from physical therapy or occupational therapy to help them find ways to become physically active, she adds.

In the early 40s, and perhaps even earlier, it is important for women and their healthcare team to start discussing aging-related weight changes that are happening and will happen, Dr. Hurtado says.

"Every visit with a doctor is an opportunity, especially in these times when overweight and obesity are so highly prevalent," she says. "We want to prevent rather than treat something that may be more difficult to treat for several reasons. Lifestyle interventions are the core of all weight management interventions. While we need to understand that there is no magic pill, there are tools that can facilitate adhering to lifestyle changes."

Dr. Hurtado emphasizes that obesity is a disease.

"Starting the conversation about weight management with that message may help people have a different perspective: 'OK, so they are talking about something that is not my fault, but actually has a biological basis,'" Dr. Hurtado says. "Realizing that weight problems are a disease and not a character flaw can help them think about it differently and could be very impactful on the outcomes of weight loss interventions."

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.   

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post Aging-related weight gain in women: It may start earlier in life than you think appeared first on Mayo Clinic News Network.

With support from a Mayo Clinic Community Contributions grant, the Peer Recovery Program at Mayo Clinic's Emergency Department in Rochester, Minnesota, helps patients struggling with substance use find hope and healing.  

Seven years ago, Cedric Weathersbee spent many nights on a family friend's front porch. Although he couldn't go inside for breakfast, he was grateful for a spot to sleep. 

At age 37, after years of alcoholism, Cedric was homeless, out of work and estranged from his family. Without a clear path forward, he began contemplating suicide. "I couldn't see my life without drinking," he says, "and I knew I didn't want a life with drinking in it."  

Then he arrived at the Saint Marys Emergency Department (ED) at Mayo Clinic in Rochester.  

Cedric doesn't know how he got there, but he does remember meeting Cheryl Laugen, a peer support specialist from Recovery is Happening. With funding from a Mayo Clinic Community Contributions grant, the Rochester nonprofit provides on-call support for ED patients facing substance-related crises.  

It's by design that every peer support specialist has their own story of substance use.  

"They bring the compassion and empathy of lived experience to the bedside," says Dr. Robert Hyde, an emergency medicine physician at Mayo Clinic.  

Right away, Cheryl could see Cedric had hit rock bottom. She knew how critical it was to meet him there.  

"For individuals like us, these moments of desperation are when our brain says, 'I have to make changes,'" she says. "But that window of opportunity is often very small."  

As Cedric shared, Cheryl smiled. That little human kindness, long absent from his life, gave him courage.  

"There was no judgment. There was no telling me what to do," says Cedric. "Cheryl instilled hope in me that things could be better. She motivated me to try to move forward." 

A community of support 

Substance use is a key community health priority for Olmsted County. Often intersecting with needs related to housing, employment and mental health, it requires a coordinated network of support. 

"ED visits manage acute problems, but substance use disorder needs long-term management," says Dr. Hyde. "Peer supporters are a bridge to recovery. Often, they're the most impactful part of the patient's visit." 

After addressing immediate needs, peer support specialists can help patients create a recovery plan, connect them to local resources, or even accompany them to treatment facilities.  

It was Cheryl who told Cedric about Doc's Recovery House, a sober living community, where he moved after detoxing at a rehabilitation facility. Eleven months later, he was ready to begin rebuilding his life.  

But Cedric's journey to healing — and helping others — wasn't finished yet. 

Discovering a new purpose 

Some months later, Cedric began drifting away from his support system. When a bad day at work became a bad week, he checked into an extended stay hotel and started drinking. Even after relocating to his brother's house, he didn't stop — and soon he was facing an ultimatum: sober up or leave.  

Cedric decided to detox one more time.  

As his body recovered, his mind wandered to all the times he could have died or gone to jail but hadn't. He'd tried to quit drinking 30 or 40 times, and despite so many relapses, he was still here.  

Could there be a purpose behind it all?  

"There were just too many coincidences," Cedric says. "I concluded that something greater than myself was looking out for me." After a lifetime of atheism, "that cracked the door to spirituality," which led to long-term sobriety. He'll celebrate his sixth "sober birthday" in February.  

His spiritual revelation also led to a realization — he wanted to devote his life to serving others.  

Shortly after detoxing, Cedric took a class that taught him to support others as Cheryl had supported him. After joining Doc's Recovery House as a peer support specialist, he also became a licensed alcohol and drug counselor. Now the men's program manager, Cedric has guided hundreds of residents toward healing.  

"It brings me great joy to see that man I met in the Emergency Department giving back in a meaningful way — to see how far he's come and talk to people he's helped," says Cheryl. "He's come full circle."  

Although he doesn't work in the hospital setting, Cedric emulates Cheryl in every interaction.    

"I try to support and empower others to do what they want to do," he says. "It's about walking alongside them."  

Every time he sees Cheryl at a recovery event, Cedric thinks about their first encounter at Saint Marys.   

"That was the first step toward where I am today," he says. "I'm really grateful to be in Rochester. I'm grateful I'm sober. What I have now is happiness and actual purpose."  

Learn more 

• Visit Rochester Recovers, a Mayo-supported website, to find recovery resources in the Rochester, Minnesota area.  

The post Rochester Emergency Department offers peer support as a step toward sobriety   appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Resolutions to improve health typically include measures such as more exercise, a healthier diet and stopping smoking. But what about your gut microbiome? Taking steps to protect and improve it can benefit digestive health and more, says Purna Kashyap, M.B.B.S., a gastroenterologist at Mayo Clinic who specializes in the gut microbiome and gastrointestinal disorders.

"The microbiome is essentially a community of bacteria, fungi, viruses and all of their genes," Dr. Kashyap explains. "The skin, lungs and reproductive system each have their own microbiomes. The gut microbiome is probably the most diverse in our body. Its microbes perform several functions. The body's other microbiomes tend to be more specialized."

Your gut microbiome is as unique as your fingerprint. These bacteria perform important jobs, including breaking down fiber and starches; synthesizing vitamins and amino acids, such as vitamins B and K; and producing short-chain fatty acids (SCFA) that help prevent disease. They also maintain the intestinal barrier, a protective gut lining.

"For example, when you eat an apple, your stomach and small intestine break down some of it. The rest of the apple goes to your colon, where bacteria do the rest of the work for you," says Dr. Kashyap, the Bernard and Edith Waterman Director of the Microbiomics Program at the Mayo Clinic Center for Individualized Medicine.

"As the bacteria break down the apple's fiber, they produce substances that are good for the cells of the colon and the body."

If you lose these healthy bacteria, it creates an opportunity for some of the bacteria that cause disease to thrive. One example is Clostridioides difficile, or C. diff, a bacterium that can infect the colon, the longest part of the large intestine. Symptoms can range from diarrhea to life-threatening damage to the colon. Risk factors for C. diff infection include antibiotic use, hospitalization and certain medications that affect the immune system.

"If you take antibiotics, your microbiome might change for a short time, but it usually goes back to its original state," Dr. Kashyap says. "The same thing can happen with other changes or behaviors, such as traveling or eating a lot of fast food. Think of your microbiome like a rubber band. You can stretch it a bit, and it bounces back. But if you stretch it too much, it might get disrupted."

In addition to gut infections like C. diff, microbial imbalances are thought to play a role in other diseases and symptoms, including colon cancer; diabetes; depression and other mood disorders; Alzheimer's disease; Parkinson's disease; and cardiovascular disease. More research is needed to understand ties between the gut microbiome and these diseases, Dr. Kashyap says.

How far you can stretch your microbiome depends on several factors. Those include how long the disruption lasts. This is one reason it's important to avoid overusing antibiotics, Dr. Kashyap says.

Some underlying diseases, such as inflammatory intestinal diseases can affect which communities of bacteria can thrive in your gut and which can't. These include inflammatory bowel diseases such as Crohn's disease and ulcerative colitis.

Dr. Kashyap is studying the interactions between gut bacteria and dietary carbohydrates and how they influence the gastrointestinal system. His long-term goal is to develop new biomarkers and microbiota-targeted therapies for treatment of functional gastrointestinal disorders, including irritable bowel syndrome and chronic bloating, also known as functional bloating.

Lifestyle can also play an important role in the health of your gut microbiome, Dr. Kashyap adds: "Gut bacteria eat what you eat. If you eat a lot of sugary, salty, fatty foods such as snacks, sweets and highly processed foods or consume a lot of alcohol, you'll starve bacteria. As a result, they will try to get nutrients from your gut lining and will damage it in the process."

On the other hand, if your diet is loaded with a diverse array of fruits, vegetables and fiber, you'll nourish a diverse microbial community in your gut.

"The more diverse your gut microbes, the farther you can stretch things before you experience disruption," Dr. Kashyap says. "Happy bugs, happy life."

Other lifestyle habits will help to protect gut health:

• Drink plenty of healthy fluids such as water and limit or avoid alcohol.
• Exercise for at least 30 minutes most days.
• Don't smoke.
• Manage stress.

For more information about the microbiome and microbiome research at Mayo Clinic, visit Mayo Clinic Press and the Mayo Clinic Center for Individualized Medicine.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu
  

The post Get to know your microbiome: It can improve gut health and more, Mayo Clinic expert explains appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: In the past few years, my mom passed away, and I lost a dear friend. The holidays were always a special time for us. Since their deaths, the holidays are really hard. Do you have any suggestions for managing this grief?

ANSWER: The holiday season can be especially challenging if you're mourning the death of someone close to you. Whether it was a recent loss or one that occurred some time ago, feelings of grief can be heightened and may seem overwhelming during the holiday season.

This is the time of year known for traditions and togetherness with family and friends, yet you may face challenges in how you celebrate and gather. Understanding how grief affects you, having conversations about plans with those close to you, and finding ways to remember your loved ones can help restore a sense of balance. These choices also can help you navigate through rough spots and find warmth in special, unexpected places.

Experiencing grief emotionally, physically

Grief and bereavement are universal human responses to loss. How each person processes their symptoms and reactions varies greatly. Because all people are different, how and when those feelings surface are also different. There's no predictable timetable or pattern.

While you may feel it on an emotional level or in your everyday activities or relationships, grief also can have physical effects. These can include:

• Tiring more easily or low energy.
• Having trouble eating or sleeping.
• Seeming more susceptible to headaches and other illnesses.
• Having trouble concentrating or focusing.
• Having low tolerance.

You're not imagining these reactions. They're real.

Some of what you're experiencing may include responses that don't feel socially acceptable. 

You might find that tears come easily in unexpected places or you can't cry — the tears just won't come. You might feel so down or exhausted that you have trouble just getting out of bed or off the sofa. You might realize that the coping responses you've developed might not be the healthiest.

The important thing is to honor your process and acknowledge that this is how you respond and how you're coping. There is no right or wrong way to grieve. Go at your own pace.

Seeking help to navigate the holidays

Pay close attention to your health and take good care of yourself while grieving. It's important to be gentle with yourself. Try to eat healthy foods and get enough rest. 

If you're experiencing these symptoms, it's a good idea to consult with your healthcare team to ensure that all is well physically and to receive additional emotional guidance during this difficult time.

It may be beneficial to seek grief counseling or join a grief support group. Knowing that you're not alone can make a world of difference. Connecting with those who understand or are going through a similar situation can provide new perspectives and affirm that what you're going through is normal.

Sharing stories among family and friends, making favorite foods, looking at photographs of happy times, or other activities may help you find connection. But pay attention to whether this helps or becomes too much to handle. Let your feelings be your guide. Finding the path to navigate through all the season's activities may provide a sense of empowerment.

You're grieving because you've loved, have been loved and continue to love. An important part of your healing this holiday season may be to embrace the love and memories you've shared with your loved ones.

Wishing you peace through the holiday season.

Jessie Wolf, Psychiatry and Psychology, Mayo Clinic Health System, New Prague, Minnesota 

Related post:

• Loneliness and social isolation through the holidays

The post Mayo Clinic Q&A: Managing grief during the holiday season appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — A new year offers new beginnings and an opportunity to reset your eating habits after the holidays. Andrea Delgado, a Mayo Clinic dietitian, says it's best to eliminate what you don't need, including party food leftovers. 

If your refrigerator is holding onto less-than-healthy holiday leftovers into the new year, it is OK to let them go. Dispose of leftovers or eat them gradually and in smaller portions, Delgado advises.

"You want to slowly regress back to your old healthier habits or establish new ones. Start introducing vegetables and fruits with most meals," Delgado says.

And pay attention to portion sizes. 

"You don't necessarily have to go on a diet. You don't necessarily have to eliminate treats. Instead, look at the portion sizes and how often you have those foods," she says.

Opt for lean protein, whole grains and fresh produce in your diet, still allowing for an occasional treat.

"With nutrition, there is no all or nothing. We can still enjoy those nice treats, those good desserts, those savory beverages. It's all in how much and how often we are having them,"  Delgado says.

Reset your eating habits with portion control

Simplify your portion control by dividing your plate into three sections. This can assist you in making healthier food choices and managing your portions more effectively.

• One-half: fruit and nonstarchy vegetables
• One-quarter: whole grains
• One-quarter: protein-rich foods, such as legumes, fish or lean meats

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post When holiday leftovers linger, reset your eating habits for a new year appeared first on Mayo Clinic News Network.

In Lusaka, Zambia, where clinical improvisation is often essential, Mayo Clinic anesthesiologist Kashmira Chawla, M.D., led a group of senior residents from Mayo Clinic School of Graduate Medical Education (MCSGME) on a collaborative expedition to improve airway management and perioperative care. 

Supported by a scholarship from the Mayo Clinic Global Health Program, Dr. Chawla and her trainees spent a month working with Zambian clinicians so they could both teach and perform a life-saving procedure called awake fiberoptic intubation. This procedure helps doctors safely place a breathing tube in patients with difficult airways. But in Zambia, the team had only one donated scope and limited medications. To make the procedure work, they had to get creative. 

Instead of using standard equipment like nebulizers to numb the throat, they used a syringe and a small catheter to deliver lidocaine, a numbing agent, to the area. Only one concentration of lidocaine was available, so they adjusted their technique to make it effective. Once the breathing tube was in place, they used ketamine to induce anesthesia.

Collaboration and cultural exchange

Without electronic medical records or a formal scheduling system, the team used WhatsApp to coordinate with surgeons and identify patients who needed special airway care. They often met patients for the first time in the preoperative holding area on the day of surgery, relying on paper charts and patient interviews to prepare. And because of limited staffing, residents proactively tracked and gathered supplies to prevent delays from happening during surgical procedures.

"We weren't just applying what we knew," Dr. Chawla says. "We were learning from our Zambian colleagues, who navigate these challenges every day with incredible skill and creativity."

One moment stood out during a busy surgical day. A patient arrived with a large mass obstructing the nose and throat, and the team had limited monitoring tools. A Zambian resident explained a plan using calm coaching and culturally sensitive care, recalls Dr. Chawla, and the Mayo team asked questions to better understand the local approach. This led to a successful procedure and a meaningful exchange of ideas, with both teams sharing strategies and learning from each other.

Building partnerships with lasting global impact

The rotation was designed to be a two-way exchange: Mayo residents taught bedside techniques and led simulation training sessions using high-fidelity mannequin simulators. Zambian clinicians shared their expertise in adapting care to local conditions. The team also used a problem-solving model called SEIPS (Systems Engineering Initiative for Patient Safety) to study how the hospital's systems worked and find ways to improve them.

The project was supported by the Office of Health Equity and Inclusion (OHEI), which helps ensure that Mayo's global health efforts are respectful, inclusive and sustainable. "OHEI's support is vital to sustaining and expanding this work," Dr. Chawla says.

The team's work was recently published in the British Journal of Anaesthesia, first-authored by former MCSGME resident Jennifer Eller, M.D., giving international visibility to the collaboration. 

"It's a moment of reflection," Dr. Chawla says. "It reminds us that meaningful research can come from shared learning, humility and a commitment to improving care in different settings."

Plans are underway to continue the program and possibly expand it to other hospitals in low-resource areas. The team hopes to build on what they learned in Zambia and create training models that are tailored to each location's needs.

For Dr. Chawla, the experience was more than a professional milestone. It was a chance to live out the Mayo Model of Care in a new environment. 

"Global health is not just about outreach," she says. "It's about building something together that lasts."

The Mayo Clinic School of Graduate Medical Education (MCSGME) is one of the oldest and largest graduate medical education schools in the U.S. With more than 2,000 trainees, MCSGME is transforming the future of healthcare by preparing physicians and specialists to deliver high-quality, patient-centered care and lead in clinical innovation, education and research. The school offers 380 residency and fellowship programs across Mayo Clinic’s Minnesota, Florida and Arizona campuses and the Mayo Clinic Health System.

The post Mayo Clinic residents bring innovation and compassion to Zambia through global health rotation appeared first on Mayo Clinic News Network.

November is Diabetes Awareness Month

JACKSONVILLE, Fla. — Diabetes affects how the body uses glucose, also known as blood sugar. It can mean that there is too much sugar in the blood. This can harm people in several ways. One serious complication is chronic kidney disease. Ivan Porter II, M.D., a nephrologist at Mayo Clinic in Florida, explains the connection between diabetes and chronic kidney disease.

Up to 40% of people with diabetes develop chronic kidney disease, also called chronic kidney failure, global statistics show. Their kidneys cannot effectively do their most important job, which is regulating the composition of the blood by filtering out waste and maintaining the balance and amount of salt and water in the body.

Chronic kidney disease may be advanced before symptoms appear and a person is diagnosed. It can progress to end-stage kidney failure, which can be fatal without dialysis or a kidney transplant.

Both type 1 and type 2 diabetes can lead to chronic kidney disease. Type 2 diabetes is a far more common cause. With either type, the body can't produce enough insulin. Insulin is a hormone produced in the pancreas that helps the body convert sugar into energy. Because one of the kidneys' most important jobs is cleaning the blood, they help regulate blood glucose levels, Dr. Porter explains.

"The high levels of circulating glucose in the blood are poisonous to nerves and blood vessels, and the kidneys are a big ball of blood vessels," Dr. Porter says. "The presence of high glucose leads to chemical changes that cause protein in urine, and the presence of protein in urine directly activates factors that cause scarring and fibrosis within the kidney, leading to worsening of kidney disease."

How diabetes and chronic kidney disease overlap and interact with each other is complex. Too much glucose in the blood can damage the kidneys and lead to chronic kidney disease. At the same time, declining kidney function related to chronic kidney disease can lead to insulin resistance, which can cause type 2 diabetes. In addition, declining kidney function can worsen preexisting diabetes.

The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications such as chronic kidney disease. 

There are five stages of kidney disease, based on the glomerular filtration rate (GFR). The GFR measures how well the kidneys filter waste from the blood. The stages are:

• Stage 1. At this stage, the GFR is 90 or higher, which is considered a healthy level. However, there is also another indicator of kidney disease present, such as blood or protein in the urine.

• Stage 2. At this stage, the GFR is 60 to 89.

• Stage 3. This stage is broken down into two subtypes — stage 3a and stage 3b. With 3a, the GFR is 45 to 59, and there is mild to moderate decline in kidney function. With 3b, the GFR is 30 to 44, and there is a more severe decline in kidney function.

• Stage 4. The GFR is 15 to 29, and kidney decline is severe.

• Stage 5. This stage is considered end-stage renal disease, also called kidney failure. The GFR is under 15. At this point, dialysis or a kidney transplant is needed.

Most often, chronic kidney disease is diagnosed in stage 3 or later.

"The presence of other comorbidities, such as uncontrolled blood pressure, uncontrolled diabetes or the presence of protein in the urine, can make what might seem like an earlier stage worse for someone," Dr. Porter says.

Not everyone living with diabetes will develop chronic kidney disease. Dr. Porter says it is critical to manage your diabetes, monitor your kidney function regularly and take steps to protect your kidney health to help lower risk.

Controlling diabetes includes managing medication, developing a healthy eating routine, exercising and planning for factors that can affect blood sugar levels, such as illness, stress, and changes in hormone levels due to menstrual cycles, perimenopause and menopause.

Type 2 diabetes has risk factors that people can try to avoid. These include preventing or treating overweight or obesity; being active; maintaining healthy levels of HDL cholesterol, also known as good cholesterol; and avoiding alcohol or limiting consumption to a moderate level. 

For more information, visit Mayo Clinic and Mayo Clinic Press.

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