The Calorie Creep

But Doctor I am not eating that much…

While there are always exceptions rarely does one become overweight by not eating.

The balancing act of  creating a calorie deficit is key for weight loss.  Please see my prior blog post regarding the fundamentals of weight loss:

Calories Consumed < Calories Expended= Weight Losswtmgt4

It can be one misstep in your day that will sabotage all your good efforts.  Stealing the term introduced to me by an inspiring patient, I would like to bring “the calorie creep” to life in the pictures below:

Keep in mind it does not have to be junk food that can be your calorie creep–avoid the creep in whatever form!

Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare


To Flu or Not to Flu

“I have the flu…”Flu3

Influenza strikes every year and leaves much to be discussed.  The flu statistics reveal that the highest risk groups are those 65+ years of age followed by those 0-4 years of age.  The other high risk groups include pregnant women and those with chronic respiratory illness or those with weakened immune systems.

Seasonal influenza is typically the following with rapid onset:

Symptoms of Influenza
  • fever
  • chills
  • profound fatigue
  • headaches
  • joint pain
  • runny nose
  • cough
  • sore throat


Seasonal influenza is not typically:

  • nausea
  • vomiting
  • diarrhea


The only absolute is a positive influenza swab.  Unfortunately the test can children doctorbe inaccurate.  Some studies suggest the influenza swab is only 30% accurate while others suggest 70% accuracy. The best case scenario it misses 3 out of 10 individuals with influenza.  This makes clinical suspicion and evaluation by your physician key in diagnosis.


Tamiflu or other antivirals are the only prescription form of treatment but have their Flu1limitations.  They need to be started within 48-72 hours of onset of symptoms. Antivirals when started early in the course of the illness can decrease the severity of symptoms and length of course but are not a cure. Large families or those with high risk individuals may opt to take antivirals as preventive or prophylactic care when a known influenza carrier has been diagnosed.

Supportive care is the true mainstay of care for anyone with influenza:

  • fluids
  • rest
  • acetaminophen

Flu Vaccine

There are always lots of opinions regarding vaccination.  While it is not a perfect vaccine as far as guaranteed coverage for influenza, it is safe.

Flu4The CDC recommends annual vaccination for everyone 6 months of age and older.

Vaccination is one way to protect yourself from influenza and can reduce the severity of illness if contracted and prevent hospitalizations in addition to doctor visits and time off work.

Common questions:

  • Does the flu shot cause the flu?

            No but can cause a flu-like response with mild headache, joint pains, and fever

  • How long until I am covered after receiving the vaccination?

           2 weeks

Common Sense Prevails

  • avoid contact with those with symptoms
  • wash your hands
  • eat healthy
  • exercise
  • rest

Stay well!


Ann Riggs, DO

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Patient-Driven Affordable Healthcare






Water Is Your Friend

When patients quote their doctor

I found myself laughing the other day when a patient quoted back to me, “Water is my friend.”

I say it several times a day with a bouncy little cadence, “Water is your friend.  Water is water–not pop, coffee, or tea. Water is water.”

water 9Whether a patient is sick, well, seeking diet advice, or general well-being, the phrase makes its way into my patient interactions multiple times a day.  A very simple concept but so often ignored.

Water is essential

The average person is made up of 55% water–60% in men and 50% in women.  While water is found in all tissue, the bulk of the water is found in your lungs, blood, skin, muscles, brain, and bones.

Water is key in:

  • brain functionwater3
  • lung function
  • muscle function
  • bone health
  • regulating body temperature
  • maintaining weight
  • transporting of blood containing oxygen and nutrients to all tissues
How Much should I drink?

We have probably all heard the eight cups of water a day rule.  While this is a good rule, you may fall short of your body’s daily needs.


A better estimate as depicted in the graphic to the left takes weight into account.  Keep in mind the fitter you are the more water you need as lean tissue contains more water than adipose tissue.

Your activity levels are also going to increase demands on water intake as well.  With every 20 minutes of exercise anticipate a minimum of 6 oz of additional water intake.

Thirst is not a good indicator.  If you are thirsty you are already behind on your water balance.

Your urine is another tip-off to your hydration status.  It should be clear to light yellow.

Why Doesn’t Pop, Coffee, or Tea Count?

water7Pop(or soda), coffee, and tea are traditionally consumed with caffeine.  It is the caffeine that takes them off the list as providing you any hydration.  In fact, the caffeine acts as a diuretic and robs your body of essential water.  Rule of thumb I tell patients is to consume an extra cup of water for every cup of caffeinated beverage or avoid them altogether.


Bottoms up!



Ann Riggs, DO

Patient-Driven Affordable Healthcare
Patient-Driven Affordable Healthcare



Direct Approach To Weight Loss


The New Year often brings renewed commitment to weight loss or healthier choices.

I spend a lot of my time as a physician counseling patients on how to approach weight loss.

wtmgt4What is the key to successful weight management?  It truly is simple.  You need to have a calorie deficit.   A calorie deficit is when your daily calories burned are greater than your calories consumed.

The difficulty is that the number of calories burned in a day is so variable from person to person.  We each have what is called our basal metabolic rate which is the amount of calories our body uses just sitting around.  A 200 pound muscular male may have a basal metabolic rate of 3000 calories per day while a 200 pound obese male may have a basal metabolic rate of 1200 calories per day.  Comparing diet plans to your neighbor should never be done.  Discovering the calorie deficit for you as an individual to successfully lose weight is the key.

I had a discussion with a registered dietician/personal trainer about a client who was gaining weight despite her great efforts in the gym.  She had her on an 1800 calorie a day diet.  I pointed out that her basal metabolic rate is probably too low to allow for 1800 calories.  If she wtmgt9is working out one hour in the gym and burning 600 calories during that time and her basal metabolic rate is 1000 calories, she will gain weight.  The proof was in her lack of weight loss, but she went ahead and pursued VO2 max testing.  This test evaluates oxygen consumption at rest and estimates your basal metabolic rate.  I was not surprised when her results came back at 800 calories per day.

There are always questions about tools to help with weight loss.  Yes, there are many things that can be used to help aid in weight loss, but they are only tools to help you do the fundamentals. We all know individuals that have had success with surgery or medicine only to regain the weight and more.  If you use the aids to help you eat good food in appropriate portions, you will have success.  When surgery or medicine is used as the solution rather than the aid, failure is likely.

I am a runner and have learned fundamentally that it takes time and energy, methodically wtmgt7putting one foot in front of the other.  I have tools to help make the process easier—good supportive running shoes, inspiring music, and an app on my phone to tell me good job as I go.  The truth is I still have to run.  Weight loss is the same.  You still have to do the fundamentals—remember calorie deficit.

So what should a good diet plan focus on other than the number of calories?    Real food and not processed food which includes fruits, veggies, lean meats, and dairy.   This should be the mainstay of your diet.

weightmgt6Poor diet choices cannot be compensated for by hours in the gym—the math just won’t add up for an appropriate calorie deficit. Exercise is good and necessary for a healthy lifestyle, but it is not the key to good weight management.


Ann Riggs, DO

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Patient-Driven Affordable Healthcare