wellness – Tarrant County Physician Online

Lifestyle Modifications

By Hujefa Vora, MD, Publications Committee Chair

This article was originally published in the September/October 2025 issue of Tarrant County Physician.

With your annual physical last week, we drew annual labs. We’ve got to discuss these results today. Your cholesterols need better control. Your total cholesterol is greater than 200 mg/dL, but to really understand these results, we’ve got to look at the breakdown. Your HDL, your “good” cholesterol, should be higher than 40 mg/dL. It looks like we have some work to do on this.

No, you don’t need to increase your cholesterol intake. To raise your HDL level, you need to increase your aerobic exercise. You need to make some lifestyle modifications. Your LDL, your “bad” cholesterol, is markedly elevated, and this is not a good thing. This combination of low HDL and high LDL can dramatically increase your risk for cardiovascular disease. I want to finish reviewing these lab reports, and then we will take a few minutes to circle back to this issue. Let’s see here. Your kidney and liver function tests are normal. Your fasting blood sugar is a little higher than expected. Your blood counts, red blood cells, white blood cells, platelets—all look good, which means your inner factory is working. The implication here is that your nutritional status is good. Your body has all of the raw materials it needs to produce all of these cell lines. Your thyroid appears to be functioning at normal levels. Finally, and most importantly, there is the matter of your glycosylated hemoglobin level. This has nothing to do with the blood counts and hemoglobin we reviewed earlier. It is actually also called hemoglobin A1c. This is a measure of your average blood sugar level over the past three months. And your A1c is just a tad on the higher side here. The World Health Organization defines diabetes as an A1c of 6.5 percent or greater. Your numbers landed in the prediabetes range. So now we’ve really got some more issues to talk about.

Alright, no time to panic. I want us to relax and really understand what it is we are talking about here. Prediabetes is like a warning shot. Your body is telling us that if we don’t take action in the here and now, then you are at significant risk of developing diabetes.

No, you are not diabetic. I understand that you feel fine, that you don’t feel diabetic. The thought I want to stress to you is that this is a preventative visit. Our goal is to prevent the complications of low HDL, high LDL, and borderline hemoglobin A1c. Those complications include heart attacks, strokes, kidney disease, vision disturbances, all ultimately negatively affecting your quality of life, possibly even your quantity of life.

No, these levels are not fatal, but if we let these things go long enough without addressing their root cause, the complications can be detrimental to your overall health. The most effective ways to lower your risk of developing diabetes when you are prediabetic are by losing weight, increasing physical activity, and eating a healthy, well-balanced diet. I don’t expect you to go out and run a marathon (although that would be amazing!) but rather just make some modest lifestyle modifications. If you are able to effectively make lifestyle modifications, then we may be able to avoid full-blown diabetes. We may not necessarily need to prescribe medications right off. Lifestyle modifications most certainly can help to decrease your risk of heart attacks and strokes.

Lifestyle modifications. That’s a buzzword that we talk about in our offices all the time. I’m going to give you some food for thought at this point. Lose excess weight. For people who are overweight, losing just 5 percent to 7 percent of your body weight can reduce your risk of developing type 2 diabetes by over 50 percent.¹ Increase physical activity. The CDC recommends getting at least 150 minutes of moderate-intensity aerobic exercise per week.² This can include activities like brisk walking, cycling, or water aerobics. Regular exercise helps your body use insulin more effectively. Combine cardio with strength training. Incorporating strength training for all major muscle groups at least two days a week further improves insulin sensitivity and glycemic control.² Quit smoking. Smoking can increase insulin resistance, making it harder for your body to manage blood sugar. Get enough sleep. Poor sleep is linked to insulin resistance and weight gain. Aim for seven to nine hours of quality sleep per night. Manage stress. Chronic stress can increase blood sugar levels. Find healthy ways to cope, such as meditation, yoga, or deep breathing exercises.

Lifestyle modifications also include making dietary changes. Focus on whole foods. Emphasize a balanced diet rich in vegetables, fruits, whole grains, and lean proteins and low in saturated and trans fats. Choose high-fiber foods. Fiber-rich foods, such as vegetables, fruits, and whole grains, slow down digestion and prevent rapid blood sugar spikes. Limit refined carbohydrates, processed foods, and added sugars. Avoid or limit sugary drinks, processed foods, and refined carbohydrates like white bread and pasta, which can cause blood sugar levels to spike. Drink more water. Water is the best choice for hydration and helps to maintain healthy blood glucose levels.

In the American medical system, we don’t emphasize preventative medicine as much as we emphasize reactionary medicine. We are taught to take care of the problems, treat the complications of underlying symptom-free subclinical metabolic issues. As primary care physicians, our role is to work to prevent disease, keeping you healthy so as to avoid illness. Most of what I discuss with my patients in clinic was not given to me through books in medical school but rather acquired through years of experiential learning, caring for the healthy, and teaching them to avoid disease. Lifestyle modifications don’t always get into our medicine textbooks but they should. The point of my diatribe today? Make sure that all of you are going to see your primary care physicians. Make sure that you are taking care of your health, so that all of us can better understand and serve our patients. My name is Hujefa Vora, MD, and this is my Last Word.

References:

“Diabetes Prevention: 5 Tips for Taking Control,” Mayo Clinic, March 12, 2025, https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639.
U.S. Afsheen Syeda et al., “The Importance of Exercise for Glycemic Control in Type 2 Diabetes,” American Journal of Medicine Open 9 (June 2023): 100031, https://doi.org/10.1016/j.ajmo.2023.100031.

BY SETU SHIROYA, MS-II TCU , WITH NEHA SOOGOOR, MS-II TCU; EDITED BY JAYESH SHARMA, MS-II TCU

Breathe in. Breathe out.

It is my first day in the clinic. My heart is racing in my white coat that I have little confidence wearing. My anxiety skyrockets, as do my feelings of not belonging.

What if my attending doesn’t like me? What if I make a mistake? What if my patient starts crying? How do I do a lung auscultation again? What does losartan do?

I can’t remember. I can’t think.

Breathe in. Breathe out.

I have been studying the whole day, my career-defining board exam is in one week, my head is throbbing, my eyelids are drooping. I am clicking through flashcards but nothing sticks. The days are merging into one; someone asked me for the day of the week, and I came up blank.

Breathe in. Breathe out. Breathe in. Breathe out.

Only one year into medical school, and everything feels like a dream. I’ve made it so far, yet the future seems so daunting. I love my life but also fear it at the same time. I want to keep going. I’m excited, but I’m nervous. Where am I in my life? Do I even belong here? Am I the only one thinking this?

Breathe in. Breathe out.

I say it to myself over and over again—my thoughts have been spiraling for days. I need to breathe. I need to calm down.

Breathe in. Breathe out.

I do belong here. I’ve made it so far in this journey; the hard work, the endless hours were not in vain. There is so much more to go and I remind myself that I am excited. I just need to take it one step at a time.

Breathe in. Breathe out.

I am going to be present for patients. I will be a doctor. One step at a time.

Breathe in. Breathe out.

The rampaging thoughts settle, my mind clears, and I open my eyes.

It’s going to be okay.

The morning alarm rings, and my first thought is always the same: “Can I sleep for five more minutes and not think about the long day ahead?” I have stressful exams to take and sometimes dread the workload awaiting me. It feels like the only quiet time I get is in the morning, when I am drinking coffee, working out, or just embracing the quietness. I try to find time to relax, but burnout feels like it is always looming over my shoulder. However, mindfulness and meditation have helped me reorient myself and develop a healthy way to process these feelings.

What does it truly mean to be mindful? To me, mindfulness is staying grounded to what is in the present moment. It can be easy to think of the past or try to anticipate the future. However, the only inevitability we hold is this present moment. Not a second before, not a second after.

How can we practice this? Mindfulness comes in many forms; some find relief in running or weightlifting, making it a point to have a constant regimen at the gym. Others find it through meditation, focusing on breathing and relaxing the mind. These share one commonality: a mental space we create where we stop thinking about the past or trying to anticipate the future, focusing instead on what is present within and around us. There isn’t one answer to seeking mindfulness; the greatest difficulty lies in knowing where to begin.

As medical students and future doctors we are expected to quickly calm ourselves after these stressful moments and proceed. Sadhguru, a guru who is the founder of the Isha Foundation, states: “Fear, anger, resentment, and stress are poisons you create in your mind. If you take charge of your mind, you can create a chemistry of blissfulness”.1 It is especially easy in a hectic and high-paced environment or period of life to get lost in our thoughts about the stressors we experience. Our thoughts are like clouds. We can either let them pass, or we can dive into them. Taking control of our mind to let the clouds pass, helping our mind become still and focus on the present, is difficult.

This is where meditation techniques can help train our mind. Meditation techniques often involve bringing awareness to a single action or sound. For example, they can be used to bring awareness to your breathing or the repetition of a few words. One method I use is called “4-7- 8 breathing.” Close your eyes. Breathe in for four seconds through your nose. Hold your breath for seven seconds. Breathe out for eight seconds through your mouth. As you inhale, stay aware of how the air flows through your body, from the tip of your nose to your navel. As you exhale, follow the air out from your navel to your mouth. Repeat this about two to three times.

At TCU Burnett School of Medicine, our Meditation and Mindfulness Student Interest Group aims to educate medical students about techniques such as 4-7-8 breathing and help them stay engaged in healthy mindful practices to avoid burnout. Our goal is to cultivate a supportive student community dedicated to mindfulness, fostering connection through monthly meditation sessions, inspiring physician guest speakers, and meaningful community volunteering.

It is going to be okay.

My mother always told me, “Take it one step at a time, one day at a time.” As medical students, we’re often exposed to patients and situations that can take an emotional toll on our mental well-being; times such as witnessing a patient’s death or delivering a life-shattering diagnosis. Before we can process what we’ve witnessed, we’re often thrown back into a fast-paced environment without a moment to rest. In such a high intensity life, grounding ourselves with activities that bring comfort and ease becomes crucial to our mental well-being. My hope is that we future physicians can practice mindfulness early, so that we can be present for our patients. In turn, we can help our patients be mindful as we work together throughout our most difficult moments to maintain healthy behaviors.

References:

1. Sadhguru Quotes – Fear, anger, resentment, and stress are poisons you create. If you take charge, you can create a chemistry of blissfulness within yourself. Accessed February 13, 2025. https://isha.sadhguru.org/en/wisdom/quotes/date/december-06-2021

Tag: wellness

The Last Word

Lifestyle Modifications

The Poison, the Clouds, and the Clearing: Mindfulness in Medicine