Fueling Your Body and Mastering Sleep with Dr. Anita Lwanga

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Dr. Anita Lwanga to discuss Fueling Your Body and Mastering Sleep.

Dr. Anita Lwanga is an Exercise Physiologist, General Internist, Geriatrician and assistant professor in the Saskatchewan Health Region. Dr. Lwanga’s mission is to provide compassionate and holistic care. She helps people with chronic medical problems optimize their diet, exercise, sleep, and medications so that that can stay healthy and out of the hospital.

0:00 Welcome back to the Get Healthy, Tampa Bay Podcast!
0:43 Meet Dr. Anita Lwanga
5:32 Her biggest WHY
6:53 Specific things we should focus on
11:53 Sleeping habits
15:49 Recommendations for night shifters
18:52 Move
25:14 When to seek physician?
26:38 Where to find Dr. Lwanga?

Connect with Dr. Anita Lwanga
LinkedIn: https://www.linkedin.com/in/anitalwanga/
Instagram: https://www.instagram.com/lwangamd/
Twitter: @lwangaMD
Tiktok: https://www.tiktok.com/@drlwanga?is_from_webapp=1&sender_device=pc
Youtube: https://www.youtube.com/@drlwanga

Connect with Dr. Kerry Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
My linktree: linktr.ee/kerryrellermd
Follow on Facebook: https://www.facebook.com/ClearwaterFa...
Follow on Instagram: https://www.instagram.com/clearwaterf...
Clearwater Family Medicine and Allergy website: https://sites.google.com/view/clearwa...
Podcast: https://gethealthytbpodcast.buzzsprou... 

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Transcript

Kerry: 0:28

Hey everybody, it's Dr. Kerry Reller. Welcome back to the Get Healthy Tampa Bay podcast. Today we have a very special guest, Dr. Anita Lwanga. Dr. Anita, why don't you introduce yourself and tell us about who you are and what you do.

Anita: 0:42

Hi, Dr. Kerry. Thank you for having me on your show. My name is Anita Lwanga. I'm a general internist. I also did additional training in geriatric medicine. I also have a special Interest in sports medicine primarily because of my background as a child and I guess teenager. I was a competitive athlete and I learned a lot about the relationship in between diet and exercise through personal experience and partially through what our coaches taught us. I went on to do an undergrad in exercise and health physiology where I learned a lot more about nutrition, a lot about, the relationship in between how we exercise, how it impacts our body, how diet impacts our body, and even a little bit more about how sleep impacts our body. So in terms of my practice, I take care primarily of, adults. I've had patients from 17 years of age up to 109 years of age. The 109 year old was impressive, but that's another story.

Kerry: 1:37

Yeah, that's definitely impressive. I have not had anybody that old, but I did have a great grandmother who lived till 107, so that was impressive in her own regard. And hopefully we all get her longevity jeans right.

Anita: 1:50

Absolutely. Absolutely. That's a blessing.

Kerry: 1:53

Yeah, so exercise physiology. That's definitely an awesome, unique undergrad experience. Something I would've, probably been pretty passionate about as well. And so can you tell us a little bit about how you got into everything that you are doing now?

Anita: 2:09

For sure, for sure. In terms of my personal story, the reason I'm interested in sharing information about, diet and exercise with people is because of my personal story, I struggled a lot and it didn't actually have to be that difficult. I had a lot of the knowledge in theory, which we do have as physicians, but sometimes you don't have the knowledge in a practical sense in terms of being able to apply it. We have the knowledge about medicine, medical conditions. You do your residency internship and you learn how to apply what you learned in the books in real life. But in terms of using diet and exercise to optimize help, I didn't necessarily know how to apply that practically. So I'm sure you can relate, before medical school, you know, during your undergrad you have time to exercise, you have more time to eat properly, not necessarily the financial resource to do so, but there's a little bit more leeway. So for me, I ate pretty well during my undergraduate. I was exercising every day. Of course I was in kinesiology, so you know, we all go to the gym before our class. You walk by the gym after your class, you see your friends going to the gym. So it's just the culture. Once I got into med school, I was like, I need to study. I don't have time for all of this. So I was more focused on my books and I still ate generally healthy, and I managed to maintain a reasonable weight. But then when it came to residency, and I'm sure you can relate, the first year especially, all of us are under a lot of stress. So I think if you looked at pictures of my residency class by January, February of the first year, we all lost 20 pounds. So in my head I was like, oh, I'm skinny. I can eat whatever I want to eat. So I'll have like a latte for breakfast, have like two chocolate bars in my pocket, eat through- I know that's bad throughout the day. Maybe have a couple granola bars. And then perhaps eat a decent dinner and go to bed if I had energy to eat dinner. So I managed to kind of maintain my weight, if not stay quite slim throughout residency. And then when I started working as an attending, I'm like, okay, I'm being such a hypocrite. I'm like, I eat whatever I want to eat. I eat rubbish Most of the time not eating regular meals. So I decided to make some changes. Paradoxically, I actually gained a lot of weight, which I found very frustrating. I was doing these high intensity interval training workouts, probably too many, which was part of the problem. I was doing them like five or six days per week before a 12 hour night shift. I was doing night shifts, primarily working 14 nights on 14 nights off. And we'll talk a little bit about how sleep can affect your weight. And then on top of that I was eating more, wholesome foods, but probably eating the wrong foods at the wrong time. So we'll talk a little bit more about that. And another thing I was doing was stress eating, which is something that a lot of us do. You have a bad day, and I think for us as physicians, Bad days can vary from, a patient passing away, to something happening at work, some political thing happening at work. So I was managing my stress through eating. And finally last year I got a nutrition coach and the things he taught me were so simple, shockingly simple, that he's like, okay, yeah, you lose about 25 pounds in, three, four months. And I think, yeah, I ended up losing about more than that, 30 some pounds. And it was shockingly, Easy, and I'm using all the information or some bits and pieces of the information with my patients, and I think that this information, it's simple and it'll be useful to the general public so people don't have to struggle as much as they do.

Kerry: 5:26

So how did you get the courage to even think about hiring a coach for yourself for nutrition? When you have all this knowledge, right, that you learned and that Oh yeah, you know, I should probably know what to do. How did you get the courage to do that?

Anita: 5:39

That is a great question. I laugh because my why. You know, people always ask you, what is your big why for doing something? My why was so superficial. I bought all these scrubs during the pandemic. My clothes don't fit me. I want my clothes to fit me. So that was very superficial. Why? And I was just frustrated. I was like, you know, let's try something. And I watched some of his clients and I'm like, they got results. So it's worth a try. Like, I've been doing this for three years, it's not working. So it wasn't courage. It was maybe a little bit of vanity and definitely frustration.

Kerry: 6:10

Yeah, well I can definitely relate to your story, obviously in med school residency and beyond. And I mean, I think the big thing is a lot of the stress eating and the disorganized eating and eating on the go and not having time to eat or sit down and have a real meal. So that really does happen, in our training, and I'm sure a lot of our listeners could relate as well, depending upon what walk of life they're going through, right? Whether it's, some sort of intense school or a job. And the biggest thing that you mentioned was the night shift. I mean, people who work at night. It's really difficult to help them get proper nutrition and rest to sustain a normal healthy weight is difficult. So there were some specific things that you kind of wanted to focus on, and why don't we pick the first one.

Anita: 6:57

the first one is to change our mindset about food. The way that my coach told me to think about food is think of few food as fuel for your body. Food is not here to entertain you. Food is not your, comforter. It's not your counselor. Food is primarily to fuel you. So with that in mind, When you select foods, it's easier to stick to the foods that you plan to eat. When you think of it as fuel, it's easier to eat regular meals and remember, okay, it's time to fuel my body, because that was part of my problem. I'd wait for like 10 hours and then eat everything in sight. And it's easier to make your lifestyle changes sustainable. If you think of an expensive car like a Mercedes-Benz, you're not gonna put cheap gas in it, and you're not gonna wait for an oil change until the red light comes on. You're gonna put the best fuel you can afford in the car, and you're gonna do regular oil changes, regular checkups. That's the same thing with food, putting food in our body. We're gonna select high quality food, nutrient dense food, and I'll talk about what nutrient-dense foods are rather than foods that are not so nutrient dense. And we're gonna feed ourselves regularly. So in terms of selecting nutrient dense foods, I'm gonna give examples from my diet before and my diet after. For example, a typical breakfast for me before would be a nice venti latte from Starbucks with soy milk and all the syrups, whatever syrup or syrup combination I want to try today. And I'd say, oh, I'm gonna be healthy. I'm gonna get a reduced fat Turkey bacon sandwich. Turkey bacon is not natural. I don't know what kind of cheese they're putting in there. It's probably not real cheese and whatever bread they're putting in there, this stuff is frozen and then they microwave it and give it to you. So that's not very healthy. I thought that was healthy, but that's not a good breakfast. So what I'm eating now for breakfast are more natural foods. So I have like a large, omelet. It's maybe made out of seven egg whites and one whole egg. And I put a ton of vegetables in there. And then I have a say sweet potatoes. So that compared to what I used to eat before, I actually eat a lot more volume. It's a lot more satisfying. But these are all foods in their natural form. So if you're gonna make this modifications to your diet, I've heard a saying that makes it very simple when you're assessing foods, look at something and see does it fly? Does it walk, does it swim or did it grow that way? So my Turkey bacon sandwich didn't do any of those things. My omelet, the eggs were grown that way. The vegetables I put in them were grown that way. Same with the sweet potato. It was grown that way. My cafe latte was, it's very not natural at all. Maybe the coffee's the only natural thing in it, but I've switched that out for mostly black coffee. I put a little bit of almond milk in there, but if you can drink straight black coffee, that's a lot better for you.

Kerry: 9:43

I definitely like that whole, does it fly? Does it walk, does it swim? That's a great, way to think about it, right? To make sure that you're getting those natural foods. So you did switch up your coffee. Now I'm not a coffee drinker, I don't know what's in the venti latte, but if you mentioned the syrups, they're probably full of sugar and that's not something that anybody should be starting their day out with. So that's gonna cause, a lot of blood sugar roller coaster things that we are trying to avoid when you're trying to be healthy and even trying to maintain or lose weight. It's not good to be fluctuating like that. Because what you ate or drank before is not really keeping you probably full that long either. But you mentioned that you've increased the volume, but you also, talk about the amount of protein, and fiber in that breakfast that you're getting now, that is definitely gonna keep you fuller much longer. So that's an excellent breakfast and a really good, comparison of before and after. I really like what you're saying there about changing the mindset basically too, of thinking, fueling your body, and I tell my patients that a lot as well. Yeah, it's very important to think of it that way. Now you can enjoy food, right? Because I'm sure you like that omelet, right.

Anita: 10:56

Restaurants, I'm not full. So learn to enjoy healthy foods. It's really interesting how our desires and our palate changes, especially when we change mindset.

Kerry: 11:08

Yeah, I definitely have, well, I think I personally changed my palate too, but I think I have seen people who may not have been interested in some sort of food before, but as they, kind of get rid of the processed stuff, then they're starting to enjoy like real foods more. Especially I try to also encourage them to cook it in a different way. So sometimes maybe, growing up my mom made broccoli with lemon. That's not my favorite thing. But now you roast the broccoli with olive oil, salt pepper, things like that. And it's much more delicious. And it happens to be my son's like favorite thing, broccoli. So that's great. Yeah. What else do you um, recommend?

Anita: 11:47

Okay. The sleeping habits. So we're a busy society. Everyone wants to go, go, go 24 hours a day. In general, it's recommended that adults sleep seven to eight hours per night. So some of the things that you can do to try and accomplish that are avoiding blue light closer to the end of the day. So one thing I've done with myself and even with my patients is change the settings on their phone so that the blue light is reduced at about four or 5:00 PM in your house. You can also take a look at where the lights are. It's better to have floor lamps or lamps that are a little bit lower down because they found that for some reason, if you have light, later on in the day from higher up, it tends to trigger our brain to think, oh, it's daytime, and we don't release that melatonin to help us go to sleep. So if you have lower lights, and lights that are more yellow or orange in tinge towards the end of the day, that will help you sleep. Also try, this also replies to me is try avoid scrolling on your phone, to relax before you go to bed. You can do something a little bit different, such as reading a book, that also limits your blue light exposure, and then set alarms. I have to set an alarm for myself an hour before bed to have a wind down routine that can help as well. So an interesting story about this whole business of sleeping more. So my brother saw how much weight I lost and I told him some of the things I did, and the only thing he decided he was gonna do is sleep more. He's one of these guys who can function on four hours of sleep and he's fine, but he is like, okay, I'll just sleep. So I don't know exactly how many hours he increased from four hours to maybe six or seven in one month, he lost 11 pounds and he's like, what voodoo is this? How can I lose weight by sleeping more? But it works. It works. And there's more scientific information about what happens, but some of the challenges, with not sleeping much or not sleeping at the right time. When we wake up, we have cortisol, which is a hormone that spikes and gives us energy and gets us going. If you do not sleep enough, your cortisol levels remain elevated even at night, and then the next day they're still elevated. And cortisol is one of these hormones that makes us retain salt and water. It's basically a stress hormone, and you'll see people who have high cortisol levels. There's a syndrome called Cushing Syndrome and other medical conditions they'll hold onto water around their stomach. Some people also have high blood pressure related to not having their cortisol levels reset. There are also other hormones involved in, our sleep wake cycle, but they have found essentially that if you're not sleeping enough, it's more difficult for you to make good choices in terms of selecting healthy foods. And you tend to feel more hungry, so you're going to eat more calories at a very subconscious level without, understanding or knowing you're eating more. And that, of course, makes it harder to lose weight in the long run.

Kerry: 14:36

So were you still on night shift when you were making all these changes? Yes. Okay.

Anita: 14:40

Oh, so my story going back to the whole night shift thing. So, I was working primarily an nocturnists job. So I was working 14 days on, 14 days off, and I was working 12 hour night shifts. So for me, just having that flipping back and forth. I found that I was not recovering very well, and I think on the days that I was off, I was still very groggy and tired and probably eating more than I should. And then the days that I was actually working night shifts, I was very hungry at night. Partially because my body was, understood. You know, this is really not at night you're sleeping during the day and at night you're trying to remain awake. So I was eating a lot of high sugar foods to give me energy to make it throughout the whole day. So I did switch to another job where I work less night shifts. I still work some night shifts, but the interesting thing is during my journey of weight loss, the weeks that I was working night shift, my weight wouldn't go down. And I'm like, I'm eating all the right foods. I'm doing everything I was doing last week. I'm still, doing my cardio, my fasted cardio. We'll talk about that later and my weight wouldn't budge. And then the next week I was off night shift and I'd lose two pounds and I'm like, this is incredible. You can sleep and lose weight?

Kerry: 15:49

So do you have any recommendations through those that may be working at night on how to kind of make it better?

Anita: 15:56

That's a great question. I think the biggest, tip my coach gave me, it's something that I really struggled with. I thought to myself, okay, I'm working at night, so I need more energy so I have the right to eat more at night. And he's like, no, no, you don't. Know what you're supposed to be eating, whether it's day shift or night shift, whether you're on or off, preplan your meals, and if you happen to be awake most of the day because you have kids to take care of. Don't allow yourself to eat more at night to make up for the energy you don't have. Something you can use is, say a protein supplement. So I use collagen powder as my source of protein and I mix it with water and crystal light. That's maybe not the healthiest, but at least having a source of protein, maybe like a chicken breast, something like that as a snack to carry you through and maybe allow yourself just one extra snack at night. And if you tell yourself, mentally, I've eaten my food, I'm not allowed to eat anymore. That should help control your week.

Kerry: 16:50

I think it's very difficult. I don't know like what other jobs night shift workers would have, but I know for doctors and training and residency and things like that's when people bring all those highly palatable baked goods and things like that into the atmosphere of where you're working. And that makes it even harder, especially I recall like being on a ob residency training and there's always something that people were bringing in, which is nice and social, but it really didn't help everybody reach their health goals. So it's difficult. So one, like I usually talk about, You know, not getting enough sleep is twofold, obviously. One is if you have more waking hours, you're probably gonna be eating more, right? Kind of like you were saying. So you don't really have that, I guess, like you said, the right to consume more, just'cause you're awake. And then the lack of sleep also causes impaired function to make not as good choices. So that's one thing, but then the elevated cortisol levels already are like underlying and defeating your ability to make, once again, good choices, but also to lose that weight, like it will cause, more insulin resistance, basically having that elevated cortisol more often than you should. So those are really, really good points that you're making about that. One thing I didn't know was the, well, at least I know for me, I can't stand when the lights are overhead and I'm ready to tune down for the night and to be drowsy, but I didn't know that just moving the light to the floor or anything like that would help, like I guess secrete melatonin and make you be ready for bed. So that's a really good, tip there. While I never really suggest to patients to set an alarm for routine, I happen to have that anyway. I think it's just'cause your phone asks you when you go to bed or something like that. So it reminds me, but I never thought of, bringing it up to the patient. So that's a really good idea as well. So there's a lot to learn and take home from here, so that's great. What's next in your excellent recommendations?

Anita: 18:51

Okay, the last tip I'm gonna give people is to move. So what I mean by moving is you don't really have to do crazy workouts. In my situation, I was doing these high intensity interval training workouts. It was during the time of the pandemic, there were no gyms, and I was like, okay, a workout is better than nothing. And this is something I actually learned in kinesiology, like if you're gonna do high intensity interval workouts, you only need to do maybe two max three per week. But I was doing about six. Or seven sometimes. And the problem with that is that your body doesn't recover. That's one problem. So you are more likely to have injuries. Another thing is that when you do high intensity workouts, you're hungrier, so you're more likely to eat more food. So for me, I was doing this at a very subconscious level. I was working at night. I'm tired, and I'm like, I worked out very hard. I can eat whatever I want to eat. The truth is you cannot outwork a bad diet. Like even that high interval intensity workout, if you're a big guy, you're gonna burn 700 calories, but 700 calories is not much. It's like one burger you're done. But if you think you can eat everything, it's gonna be very hard to actually lose weight and you end up gaining weight, something that's a little bit better and more sustainable. And this is what my coach recommended while I was focusing on the weight loss component of the program was just to walk and it seems very counterintuitive. But all you need to do is walk and specifically do fasted cardio. So I'm supposed to wake up in the morning and walk, for maybe 40 to 60 minutes, and you, if you don't have a lot of time, you can start at a minimum of three days per week and then ideally work up to maybe six days per week. But the interesting thing about walking and walking in the morning before you've eaten is that your body uses a different source of fuel. When you're doing high intensity workouts, your body uses carbohydrates that are stored in the liver and in the muscles, and it's very hard for your body to use fat breakdown fat fast enough to burn for fuel. If you're doing lower intensity workouts, especially once you hit the 40 minute mark, your body has burned through most of the carbohydrates it has in its stores, and then it's more likely to burn fat. You supercharge this by fasting overnight, so your body has burned through most of its glucose stores. And then if you happen to have a little bit of glucose during the first bit of your walk, your body's gonna burn that. But from 40 to 60 minutes, it has nothing. So it's gonna use the fat that you've already stored. So you're supercharging that by fasting and by going at a lower intensity.

Kerry: 21:27

So that definitely makes sense metabolically that, the fasted cardio concept where you're gonna be using those fat cells for fuel instead of, the carbohydrate glucose. I hear a lot of the opposite recommendations from people of where you shouldn't do any workouts fasted, and you should have energy drinks before you work out. So I think while I may operate more on the recommendations that you're suggesting as well, I do think, some people may be in a different role and really, I think that if they have their nutrition right, they can certainly operate on the fasted state, but if they're still including some other products that might, I guess insulin spiking and things like that, then it might be harder and it might feel not as good to do that. But like you said, if it's lower intensity walking, it's probably something very easily that they could switch over to. So I really like that idea as well. Was there something you were going to add about that?

Anita: 22:24

Oh yeah, absolutely. I kind of cheat. I actually have my coffee when I'm walking because I'm like, I can't do this. So I have like one cup while I'm getting dressed, a second cup while I'm walking. So it's a cheat. But if you can do straight black coffee, it'll give you that spike of energy. And you don't need to walk very fast. In terms of the specifics, there's a target heart rate. This might be a little bit too much for your audience, but if you have a little Fitbit or a heart rate monitor, you wanna target, 50 to 70% of your heart rate max. And that's not a lot.

Kerry: 22:52

Yeah, I think just even setting it as like a morning routine and getting up and getting out there and having that, mindset of I'm gonna move my body. And it's not to torture yourself. You don't have to do it that many times a week. I just had a physical therapist who also has extra strength training and she also agrees that you don't really need to hit, you know, h i i t, the high intensity interval training, more than, two, three times a week. But yeah, you should be giving your time body to rest and mixing up the activity. And then the other thing is just, continued movement as we have more and more life as sedentary. Moving around more in general is good. So we always advise, parking farther from the store, standing more at work than sitting, right? If you have a job or a standup desk, like even that can help. So they even say fidgeting is good. Not that I'm a fidgeter, but I don't, I don't, I don't really recommend that one. But I mean, any movement to increase your, lack of movement throughout the day is very, very good. There was one other thing you had said. Oh, the mindset. So you had said basically you had a mentality of, oh, you did these HIIT workouts. Yeah. You can eat whatever now. And that is one of the biggest flaws I think, of the way that unfortunately a lot of people approach, exercise and eating. And it, it can lead to, you disordered eating even. We cannot think of, you know, oh gosh, you have to go run off this meal, or I'm gonna do all this exercise so I can go eat this. And it's just a really not a good, healthy way of having a relationship with food. And it's unfortunate. I remember when I used to do Weight Watchers. And in college and my friend always joked, activity points, activity points, and I don't think we knew as much then. This was like 20 something years ago. But it was like, okay, I would save all of those to go well when I was in college, maybe have a beer or something. But you know what I mean? It's just not a good mindset to think of and I don't think it's usually a healthy relationship, but I do believe they've changed things in that. So I wouldn't be concerned now. But that's something that was, you know, it was always as calories and calories out. So when you have that mindset, it can be not healthy, really. So, like you said in the beginning, fueling your body with food is how you should think about it and fueling your body so you can do a workout, but not to burn off those calories.

Anita: 25:13

Absolutely. Yeah, and I think the last thing I'll say is, if you've tried all of these things and you're still having difficulties, the next step will be to talk to your doctor and see if there's a medical reason that you can't lose weight. As physicians, like as a general internist, I don't necessarily have training in obesity medicine. But there are some conditions that can cause individuals to gain weight no matter what they're doing, no matter what they even try. If we don't deal with those conditions. it'll be difficult to lose weight.

Kerry: 25:44

Yes, absolutely. I'm also board certified in obesity medicine and I do do a workup prior to seeing my patients and seeing what they may or may not have as a medical condition. I mean, obviously we're gonna be checking thyroid. And for insulin resistance and diabetes, but there are certain things that are more rare that we may not check, right up front, but if it leads to any problems down the line, we may be doing that as well. So yes, I definitely, agree reach out to, a board certified obesity medicine physician in your area if you need extra help. Definitely to rule out a medical problem. Yeah. Actually there's a A, the A B O M, American Board of Obesity Medicine, I think it's dot org if anybody needs to look up one closer to where they live.'cause I'm in Clearwater, in Palm Harbor, Florida. So is there anything else you'd like to share with us?

Anita: 26:35

That was it.

Kerry: 26:37

Okay. And how can people find you if they wanna reach you?

Anita: 26:40

So I'm on all the social media platforms. Anita Lwanga on Facebook at Lwanga MD on Instagram. I think Dr. Lwanga all lowercase on YouTube. TikTok, I haven't been there for a while. That's a little bit controversial, but I think if you Google or check Dr. Lwanga. On TikTok, you should find some of my old videos there. Facebook, Anita Lwanga. And if you guys have any questions or you know, you're in the Regina Saskatchewan area, you can ask your family doctor to refer you to see me. I take care of all medical conditions that adults face. So you can ask your family doctor for a referral.

Kerry: 27:17

Can you spell Lwanga for everybody? I mean, we'll put it in the show notes, but just in case.

Anita: 27:22

It's L W A N G A.

Kerry: 27:24

Thank you. Well, thank you so much for coming on today. This was a lot of fun. I definitely love hearing all your wisdom and expertise in, your area. And, hopefully we'll work together again. But, everybody, please, tune in next week. And if you need a doctor in Clearwater Palm Harbor, come find me.