Prebiotic drinks; healthy foods; sharing feelings: Upstate Medical University's HealthLink on Air for Sunday, March 30, 2025

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a colon and rectal surgeon discusses prebiotic beverages and whether they are good for our digestive systems.

Kristina Go, MD: ... So once they reach the colon, they provide the benefit of promoting the good bacteria or the good microorganisms to keep doing what they need to do in your colon. ...

Host Amber Smith: A family medicine doctor explains new definitions for which foods are healthy.

Kaushal Nanavati, MD: ... They emphasize whole foods, trying to reduce unhealthy components, trying to improve and increase the beneficial ones in terms of our overall health, because what we recognize is that nutrition and diet, along with physical activity or inactivity, can contribute to up to 40% of chronic disease. ...

Host Amber Smith: And a chaplain tells about a program that helps health care workers share their feelings. All that, and The Healing Muse. But first, the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll hear about new FDA definitions for foods that can be called healthy. Then, a chaplain shares a program for health care workers that helps them share their feelings. But first, are prebiotic "gut pop" beverages safe to drink, and do they help digestion?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Sodas that claim to be good for your gut are growing in popularity, but what do these prebiotic beverages actually do, and will our digestive systems benefit? For answers about this new trend, I'm turning to Dr. Kristina Go. She's an assistant professor of surgery at Upstate, specializing in colon and rectal surgery.

Welcome back to "HealthLink on Air," Dr. Go.

Kristina Go, MD: Oh, thank you. Happy to be here.

Host Amber Smith: Both Coke and Pepsi are launching or planning to launch sodas that promote digestive health, which will join new brands that are already on the market called Olipop and Poppi. They're prebiotic as opposed to probiotic. Can you explain the differences between prebiotics and probiotics?

Kristina Go, MD: Yeah. So by definition, probiotics are live microorganisms. Generally what you see on the market are bacterias and yeast. Those are the main examples that in high enough quantities should provide a health benefit to the individual.

So that sounds maybe a little bit straightforward. But if you go to your grocery store, you can see many yogurts, say sauerkraut, kefir, a lot of fermented foods that promote a probiotic health benefit. What the challenge is, is if you look into really specific sources of experts, they don't consider those probiotics. They actually consider if it's a bacteria, the probiotic itself. So there's a lot of confusion in what that is then.

But, so going back to what prebiotics are, what we're really looking at are not necessarily microorganisms. We're looking at, specifically, carbohydrates that don't get digested by your GI (gastrointestinal, or digestive) tract. So once they reach the colon, they provide the benefit of promoting the good bacteria or the good microorganisms to keep doing what they need to do in your colon.

Host Amber Smith: So the prebiotics feed the good, or the healthy, bacteria that are in the colon?

Kristina Go, MD: Yeah. They can stimulate the colon bacteria's activity or promote growth of the good bacteria. So it's not bacteria itself or yeast. It's just something as an example, inulin, which you'll see in the Poppis and the Olipops of the world, that is an undigested fiber.

Host Amber Smith: So are probiotics and prebiotics meant to be used together?

Kristina Go, MD: They can be. Again, going to the studies where we look at patients who have specific health problems, sometimes using them together can promote better bacteria. So you can see that being studied and patients with bad allergies, irritable bowel syndrome, even diabetes.

Host Amber Smith: Are these gut sodas -- the Olipops and Poppis -- are they healthier than regular sodas or diet sodas?

Kristina Go, MD: In a way, I would say yes. If you look at your nutritional labels in comparison to non-diet, regular sodas, these types of sodas, these gut pops, tend to use sweeteners that are like fruit juices, agave syrup or stevia. So they end up giving you less calories than a regular soda would. I think there is some benefit to having fiber in a drink, and we can go into why fiber is good for your health overall a little bit later.

When you're looking at these, it's really important to read the nutrition label and think about any kind of either allergies that you might have or any kind of specific ingredients that you might have a bad reaction to that you already know of.

Host Amber Smith: Are they caffeinated?

Kristina Go, MD: Some of them can be, in my short perusal of what's on the market. As an example, some of the cola-flavored or the flavorings that taste very similar to Dr Pepper might have some caffeine in them.

Host Amber Smith: So people take these to keep their gut healthy, but how do you know they're working?

Kristina Go, MD: That's a really great question with not a very straightforward answer, right? So, a lot of the health benefits that are being promoted in our scientific literature are kind of vague. So when we talk about prebiotics or probiotics, really those models that people are studying in it tend to be animal models or even cell lines.

I'm a colorectal surgeon by training, so when I look at that, I'm really looking at one's colon health and maybe looking at colon cells as a way to see whether we can actually transfer that information to something as complex as the human body, and that's really difficult to do.

Host Amber Smith: Are these sodas safe for the general population?

Kristina Go, MD: Generally, I can't see any harmful portions in the ingredients themselves. There is sugar in all of them, less than a regular non-diet soda. And I wouldn't promote trying to drink too many sugary drinks. I think that having fiber and keeping yourself hydrated, which these products tend to promote, do help.

Keep in mind that fiber can be a little bit bloating for people with sensitive tummies. So you might not feel like it's working for you because you're just having that adverse effect. But overall I don't think they're detrimental. I'm not sure if they promote all of the health benefits that they're marketing, though.

Host Amber Smith: Now what if you're a person who is already taking fiber supplements? Would this be too much?

Kristina Go, MD: I don't think so. So generally, when I talk to a patient in my clinic, I really endorse that they try to take at least 30 grams of fiber daily. That's a lot of fiber to try to take. So a supplement or a drink that has about 4 to 6 grams of fiber are going to help you get to that goal daily.

What I tell patients who are starting their fiber supplement journey is to go slowly to ramp up to that 30 grams. Again, even if you don't have something like irritable bowel syndrome that can cause a lot of bloating and make you feel full before you actually are, it might be better to go slowly instead of going all at once.

Host Amber Smith: What about people with colitis or Crohn's disease? These are inflammatory diseases, right?

Kristina Go, MD: When you look at guidelines from experts such as the Society of Gastroenterologists, or if you look at studies, they don't necessarily say everybody needs to be on a probiotic or a prebiotic, in terms of whether that helps regulate the colon health, but they also don't say that it's detrimental to the patient.

So at best, the way that when you're looking at these type of papers that have those suggestions, it's a conditional suggestion, as in it kind of depends on where a patient's overall state of health is. I would go by starting by talking to your doctor about whether this is a benefit to you.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with Upstate colon and rectal surgeon Dr. Kristina Go about gut pop.

What can you tell us about bacteria that live naturally in our gastrointestinal tracts?

Kristina Go, MD: I think this is a really exciting field of study, learning about one's microbiome. Sometimes we refer to it as just another part of your organ system. So there are at least thousands of species of bacteria living in one's large intestine or colon. And a lot of the times you hear us talk about good bacteria or bad bacteria. What this bacteria does is, it's colonized, but it doesn't usually cause you any harm. What it's really doing is trying to help you digest things in your diet that the rest of your body was unable to digest.

That can also help you get a little bit more nutrients, and sometimes it can even help make the vitamins that you need to to have a healthy life.

Host Amber Smith: So these bacteria are on the other side of the stomach, after the food's gone through the stomach? They're not in the esophagus?

Kristina Go, MD: Correct. So anytime that you're thinking about bacteria in a healthy patient in the esophagus or stomach, or even in parts of the small intestine, really that's coming from whatever you're digesting. And just to reassure people, this is just absolutely normal. It's not causing any detriments of what you're eating. You don't need to sterilize what you're eating in order to enjoy it.

Host Amber Smith: Are there diseases or conditions that develop if we have too few of these good bacteria or too many?

Kristina Go, MD: So there are many diseases that are implicated in having what we call dysbiosis, as in a poor mixture of good and bad bacteria.

One that is very well proven is having a type of diarrhea infection called Clostridium difficile, or C. diff. Generally, patients that suffer from this usually have a story of having to take antibiotics for a different infection that unfortunately kills the good bacteria in your colon and allows the bad bacteria, in this case C. diff, from proliferating and causing problems.

However, dysbiosis has been attributed to insulin resistance in diabetes, inflammatory states such as diverticulitis or even colon cancer, and even some types of autoimmune diseases, like having bad allergies. So there's a lot that we're still trying to understand when you're getting through thousands of species of what is a good or bad bacteria.

Do the healthy bacteria get enough nutrients from the foods that we eat, or is there a thought that they need these prebiotics? The short answer is that it's probably a mixture of many things to promote a healthy gut flora or microbiome. So maybe prebiotics or probiotic supplements can contribute to that. But a lot of other things, like a really healthy diet -- that means fiber is one of the examples we already talked about, a lot of fruits and vegetables, trying to avoid all of the good-tasting things like a high-fat diet, a very high-in-meat diet, things that sort of decrease inflammation, and your lifestyle, such as avoidance of tobacco or alcohol products and regular exercise. All of those are contributing to your body's interaction with your microbiome.

Host Amber Smith: I'd like to ask you about what people should do to maintain colon health over their lifetime and whether there's things that we should do starting as early as childhood.

Kristina Go, MD: Yeah. We're only starting to understand this as the increase in young-onset colorectal cancer becomes more and more prevalent in our society and in my clinic. So we do think that there is an association between eating processed foods and high-fat or foods high in meat products whenever you're young, and how that might change your microbiome and make you more susceptible to colorectal cancer at an earlier age, such as in your 20s or 30s.

I wish I had a magic bullet to tell somebody, but it's really the boring stuff that people might not want to do, myself included: lots of fruits, vegetables, regular exercise, avoid the red meats and the processed foods, and avoid tobacco and alcohol products.

Host Amber Smith: What does regular exercise do for our colon? Because I always think about that as, like, keeping your body healthy, but I've never thought about it, like, specifically helping my colon.

Kristina Go, MD: Overall it can help with your bowel motility. A lot of patients who are experiencing constipation, part of that, in addition to consuming 64 ounces of fluid and 30 grams of fiber, is just getting out and about and moving on a regular basis. I think it also just promotes this anti-inflammatory state that can help with colon cancer and all types of other cancers.

Host Amber Smith: Are cleanses or detoxes good for your colon?

Kristina Go, MD: To be honest, I haven't really found any cleanses or detoxes that are helpful. It sounds like a good idea, right? Just cleansing all of the bacteria at once and starting from scratch. But in, in reality, it could possibly make it dehydrated for one thing, and I don't really see a good health benefit from it.

Host Amber Smith: Well, can you go over the colon cancer screening guidelines? When should people begin having colonoscopies?

Kristina Go, MD: If you're a person who has a low risk -- as nobody who has a first-degree relative who has colon cancer, you don't have many relatives with polyps, you don't have an inflammatory bowel disease diagnosis such as ulcerative colitis or Crohn's disease as examples -- we recommend that you start your colon cancer screening at the age of 45.

Host Amber Smith: Age 45, and then have them every 10 years?

Kristina Go, MD: So it really depends on what's found on the colonoscopy. If your doctor sees certain types of polyps, and that depends on, say, the size and what it looks like under the microscope and the number of polyps, you might need to have a colonoscopy sooner than 10 years.

Host Amber Smith: Now, how would someone know their colon is not healthy? Are there signs and symptoms to watch out for?

Kristina Go, MD: So a lot of them start off vaguely, and that can be very anxiety ridden for a patient. Sometimes just having persistent, nondescript abdominal pain might be from your colon. What I get nervous about, in the context of somebody who might have a colon cancer, is if they're having persistent blood in the stool, if they've had sudden but persistent changes in their bowel habits. As an example, all of a sudden you're having many days of constipation and then sudden diarrhea. Or the caliber of your stool, instead of being about the diameter of a quarter or larger is consistently thin like spaghetti or a pencil. Those make me nervous that there might be something else going on.

Host Amber Smith: Well, this has been very enlightening, and I thank you so much for making time for this interview, Dr. Go.

Kristina Go, MD: Oh, you're very welcome.

Host Amber Smith: My guest has been Dr. Kristina Go, an assistant professor of surgery at Upstate who specializes in colon and rectal surgery. I'm Amber Smith for Upstate's "HealthLink on Air."

Which foods can call themselves healthy -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

The Food and Drug Administration recently updated its definition of what packaged foods have to do in order to call themselves "healthy." Here to help explain what that means is Dr. Kaushal Nanavati. He's a doctor of family medicine and director of integrative medicine and assistant dean of wellness at Upstate.

Welcome back to "HealthLink on Air," Dr. Nanavati.

Kaushal Nanavati, MD: Thank you.

Host Amber Smith: This is an update to a definition that was put in place 30 years ago that says in order to make the claim of being healthy, foods have to contain a certain amount of one or more fruits, vegetables, grains, dairy or protein. So what do the new rules do?

Kaushal Nanavati, MD: So the new rules actually relabel healthy in a little more of a stricter nutritional criteria, focusing on things like nutrient density in the food versus isolated benefits. And they emphasize whole foods, trying to reduce unhealthy components, trying to improve and increase the beneficial ones in terms of our overall health, because what we recognize is that nutrition and diet, along with physical activity or inactivity, can contribute to up to 40% of chronic disease, right? And so it's important for us to recognize that when it comes to chronic disease and kind of the leading causes of morbidity, which is sickness and mortality, death, cardiovascular disease, cancer, and then obesity as an underlying factor, diabetes, chronic lung disease, all have inflammation as a component, and also the gut microbiome, when you think about gut disorders.

So, I think they're trying to recognize that in the last 30 years we've gotten better information, which means updating the criteria and the guidelines only makes sense.

Host Amber Smith: So we have a better understanding that what we eat influences these chronic diseases now.

Kaushal Nanavati, MD: That's absolutely right. And that's been, even in food policy, but even in our Healthy People 2020, Healthy People 2030 criteria and objectives that come out. And even the WHO's guidelines, the World Health Organization's guidelines, they're recognizing the importance of nutrition, fundamental in health promotion that goes even beyond disease prevention.

Host Amber Smith: What types of foods are going to no longer count as healthy?

Kaushal Nanavati, MD: The foods that have added sugars. So when you think about processed snacks, right? Sugary cereals, some flavored yogurts that are high in sugar, high-sodium canned soups, white bread, for example, right?

Foods high in added sugar, sodium and saturated fats but low in essential nutrients will no longer qualify.

Host Amber Smith: Let me ask you about, limiting added sugars. Sugars are full of calories. Is this going to help us lose weight?

Kaushal Nanavati, MD: (Laughs) So that's a very specific question, Amber. So what I'll say with sugar is that when we consume sugar, there's natural sugar that's in fruits that our body naturally processes better and then added sugars. And what happens with added sugars is we know that we've been able to look at data and say that when people get sugar in, first of all, the body needs to release insulin to get the sugar out of the blood.

Because if sugar stays in the blood, think about an analogy where basically if you keep adding more sugar to water and keep it going, ultimately that's going to get thicker, like a syrup. And because blood is our transport medium, our taxi of oxygen to the rest of the body's tissues, if you've got thick syrup going through those arteries, it's not going to get through the smallest channels. You can't get oxygen to the tissues, and then that becomes a problem. The second thing is when the insulin's released and the body brings the sugar in, it tells the brain, "Hey, I'm bringing sugar in. I've got to store it somewhere."

Well, what store it? Those are fat cells, right? We think that by reducing added sugars, we can reduce the risk of Type 2 diabetes, lower the likelihood of heart disease, inflammation and even metabolic imbalances in the body that can lead to other chronic conditions as well.

Host Amber Smith: Why are there new limits on sodium, or salt?

Kaushal Nanavati, MD: Well, sodium, in salt, specifically, has been directly correlated with elevated blood pressure, right, which leads to cardiovascular disease, heart attack, strokes. And so limiting especially added salts, right, is what we're talking about. So natural salts in certain foods are one thing, but when you start to add salt, then that becomes a bigger issue, in terms of elevating blood pressure and then the risks that go with it. Every two points of blood pressure elevation are thought to increase the risk of heart attack or stroke by 1%. And so that can be significant over time for people.

Host Amber Smith: How will limiting saturated fats help us?

Kaushal Nanavati, MD: So saturated fats are primarily, when you think about it, found in animal-based foods, right? And they're linked to higher cholesterol levels, increased plaque in the arteries as well. And that can lead to increased risk of heart disease. One of the primary reasons to cut back on saturated fats is because that can have an impact on the No. 1 cause of deaths in the world, in terms of chronic disease, which is cardiovascular disease.

Host Amber Smith: These new rules are meant to improve public health, so let's talk about what a healthy diet actually looks like. The dietary guidelines say that most adults should get their calories mostly from carbohydrates, but we also need protein and fats. Let's start with carbohydrates. What counts as a carbohydrate?

Kaushal Nanavati, MD: So carbohydrates, you think about sugars, starches and fiber, right? And so when you think about carbohydrates, you think about vegetables, all kinds of vegetables. And I'll put an asterisk by cruciferous vegetables (such as broccoli, kale and cabbage). They're even better. And if we have time, we can talk a little bit about that, in terms of their value for most people; certain health conditions, you have to be careful.

But you've got vegetables and fruit as fiber, even legumes as fiber. And then you've got starches like potatoes and that type of thing. And the sugars, again, we have to be very careful, but whole grains are a great source of carbohydrate as well, like brown rice, quinoa, whole wheat, for people that can tolerate them.

It's the processed carbs like white bread, sugary cereals, pastries, that we talk about that don't have the best health benefit, right? And so you think about carbs in terms of, people say, "Well, I want to go 'carb-low.' " Well, ideally, having a good amount of fiber is important and healthy in preventing chronic disease, so the vegetables and plant-based eating as a foundation is important.

And then you think about proteins, and there's vegetarian proteins and animal-based proteins, right? So the No. 1 food, according to some of the information from the "blue zones" (places with long-lived people), et cetera, are legumes, and beans, right? Great source of protein. And all kinds of beans: green beans, black beans, kidney beans, chickpeas, fava beans, cannellini, whatever you like, are great in terms of a lot of value. They do have some starch. The bigger the bean, the more the starch, and so people can weigh, literally, what they want to have in terms of the type of bean, but they're very healthy.

Animal proteins: Again, you think about fish, you think about turkey, you think about chicken, you think about red meat. And different cultures have different meats, if meat is a part of their cultural foods, and so we respect cultural norms. What we know as a big picture is that plant-based eating, meaning that the protein and the fats can become the condiment more so than the main portion of the plate, that becomes important as well, right?

And then the fats. Think about saturated fat. Think about monounsaturated and polyunsaturated fats. Saturated fat is the stuff that's solid at room temperature, right? And so that's also the stuff that can lead to more triggered cell damage in the body, more inflammation in the body, whereas monounsaturated fats tend to be optimal. And then polyunsaturated fats are also better than saturated fats.

Host Amber Smith: I want to ask you more about proteins and fats, but before we get to that, in the category of carbohydrates, if we're eating, like, fresh vegetables, we don't have to worry about added sugars and sodium, but there are some carbs that we would have to be concerned about that. Is that right?

Kaushal Nanavati, MD: Well, so you think about, like, if you're eating potatoes all day, right? That's a lot of starch. It's a carbohydrate, it's a lot of calories as well, right? Whereas if you're eating spinach, zucchini, broccoli, asparagus, right, mixed greens, those types of things, you're getting starch. It's fibrous starch, which actually has a health benefit for us as well.

And if you think about vegetables, the optimal recommendation based on (medical) literature would be to have seven-plus servings, which is even higher than the guidelines might suggest. But the value of that is that that's actually shown to reduce risk of cardiovascular disease, cancer, all causes of mortality or death.

And within the veggies, how do you get seven servings? Well, between raw, cooked and pickled, there are different ways to get vegetables onto your plate. In fact, when people have higher proteins and fats, to have some pickled vegetable actually helps to digest those foods even better, so it's easier when you think about mixing and matching.

I tell my patients, if you think about your lunch and dinner plate as basically a salad, and you can put your healthy fats and proteins on top of it, versus having a salad on the side and then filling the plate with a bunch of other stuff. Now, suddenly, you're eating two plates' worth of food, right?

So the idea is to keep that one plate, but make the base plant-based, and then have your other portions be more like condiment-sized portions for healthy fats and healthy proteins.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Kaushal Nanavati. He's the assistant dean of wellness at Upstate, and we're talking about healthy eating.

So let me ask you about protein. Are Americans in general getting enough protein, and are we eating the right kinds of protein?

Kaushal Nanavati, MD: So, that is a great question. In general, Americans get an adequate amount of protein, although what happens often is a lot of people rely on processed meats, which tend to be higher in sodium and saturated fats. Think about bacon and sausage, that type of stuff, instead of lean or plant-based sources. So, if you think about how much the recommendations are for protein for the sedentary person, 0.8 grams per kilogram of body weight is what's recommended.

So for the average weight, it would be about 46 grams of protein for women, 56 grams for men. However, when people are more active, they actually need more protein. So, like, endurance athletes might get 1.2 to 1.4 grams per kilogram. Strength athletes may get 1.6 to 2.2 grams, and actually older adults need to get a little bit more, so people over 65, the recommendation would be around one to 1.2 grams per kilogram.

Just because we know protein has an impact on not only muscle, that's what we usually associate protein with, but it's also immune function, metabolic function, right? So it's a matter of keeping your body healthy, but it's a great, great source of energy and nutrient base.

Host Amber Smith: Let me ask you about the type of protein. Food sources is one thing, but the additive protein powders, those have become pretty popular.

Are they as good as food?

Kaushal Nanavati, MD: So, I would say that in terms of protein, optimally, if you were thinking about it, vegetarian-based sources of protein, such as beans, lentils, tofu, quinoa, nuts, seeds, that kind of stuff, even tempeh, some people use, are actually good. And when you take plant proteins and combine them with rice or quinoa, you actually get the full amino acid or what we call essential amino acid profile.

So, there are certain components, that we don't make in our own body, we get from food sources. And with plant-based proteins, in many cases, those amino acids are kind of in a locked form. And when you add rice or quinoa, that actually activates, or unlocks, it so that it's more user-friendly in the body.

So you look at all cultures around the world, like, rice and beans have been a staple, right, along with vegetables. So that's actually like a complete meal in and of itself. Then you think about animal proteins and lean meats, and that's where fish, especially with omega-3, which is a healthy fat, becomes a good source. With fish, we think about cold-water, freshwater, wild-caught fish versus shellfish. Shellfish doesn't necessarily have the greatest profile in terms of cholesterol and for heart health, whereas cold-water, freshwater, wild-caught fish like salmon, tuna, mackerel, those fish tend to have better value if you're going to have animal-based proteins.

And then protein powders: For athletes it can be good as an add-on. But I always think about protein powders as a "complement to," right, not a "replacement for." And that's very important to realize because a lot of people like to drink their calories. And the problem with that is that that actually has an impact on how we absorb nutrients because the stomach has a role to play in breaking foods down. The intestines have a role to play. And when you have liquid calories, that kind of actually bypasses some of the processing that the body does that actually allows for us to be able to absorb nutrients better. So I always say, if you're going to use protein powders, use them as a complement to rather than a substitute for.

Host Amber Smith: Are there saturated fats that we need to look out for in the animal proteins?

Kaushal Nanavati, MD: Yeah, so specifically in red meats, processed meats, and even some dairy, you can have high saturated fat, high sodium and even some sugars. Sometimes you look at yogurts, and sometimes the lower-fat yogurts might actually have more sugar content, right?

And so you have to be careful about that as well. Generally, you think about lean meat. So like with chicken, chicken breasts tend to be less fatty than chicken thighs or bone-in or chicken wings. And I do joke with some people about this, that if you want to have chicken wings Super Bowl Sunday or for Syracuse, when SU makes the Final Four, then you can have some.

And the point is 90/10, right? Majority of the time, if you get the leaner meats, it's better for you. The saturated fats and red meats, processed meats, and even some dairy, can, be detrimental over time with overconsumption.

Host Amber Smith: The FDA says that three-quarters of Americans don't get enough dairy.

Why do you think it's hard for us to get enough dairy? Is dairy just being demonized?

Kaushal Nanavati, MD: So I'm smiling as you say that, and I'll get a few phone calls either way I answer this question. But the point is with dairy, again, what is the value of dairy?

Well, there's healthy fats. There's good calories. Generally it's vitamin D fortified. It's a good source of protein as well. And so from that perspective, we think, "Well, great, it's good for us," right? At the same time, for many people, as we grow older, lactose intolerance is a real thing. So if you consume dairy and you either get gassy or bloated or your bowel movements, you can either get constipated or looser stools, then you have to think, right?

And so you can easily try to eliminate (dairy) for anywhere from one to four weeks and then reintroduce it and see how differently you feel, right? So when we think about the benefits of dairy for protein, vitamin D, healthy fats, there are also alternative sources for that, including calories.

So it's become a discussion piece. We have a big dairy industry in New York state, and a lot of friends and local community members who, that's their livelihood. And for many people that tolerate it, it's a great source of protein and calories and vitamin D and even calcium, right?

But if you have any kind of health issues related to it, then that's something. In the United States, that's part of the issue. Some avoid dairy because of concerns of fat content or digestive issues or based on the information that they've seen.

Host Amber Smith: Now, as for fats, can you help us understand which fats are healthy compared with the saturated fats that are not?

Kaushal Nanavati, MD: Yeah, so healthy fats, I would say would be like the unsaturated, so mono- or polyunsaturated fats. Think about, olive oil, right? And again, know, we use, olive oil for cooking and we use extra virgin olive oil, like on salads and stuff. Depending on how much heat, you can use that for cooking as well.

Avocados, nuts, seeds. And then the cold-water, freshwater, wild-caught fish. Great sources of omega-3, and between omega-3, omega-6 and omega-9, which are all healthy fats, omega-3 and -9, actually help reduce inflammation, whereas omega-6 is pro-inflammatory, but that can be protective if you have an injury.

So there's value to fats, especially because they help to stabilize the cell wall in our body for our cells. So it's not that fats are bad, but the right kinds of fats are healthier. Unhealthy fats like saturated fats from red meat, even butter, full-fat dairy and processed foods, those we have to limit because they can put us at a higher risk.

And then there are trans fats, right? They're found in fried foods, hydrogenated oils, and those really trigger inflammation, cell damage, trauma to the body at the cellular level. And those are the things that we should try to avoid. And I think, over the last decade in society, in many places, people have been much more conscious of trans fats and trying to avoid that, even in things that are sold, there's less and less of trans fats that we're getting.

Host Amber Smith: Why are these unsaturated fats necessary in our diets? What do they do for our body?

Kaushal Nanavati, MD: So fats, actually, are a great source of energy, and so they support cell function. They actually, in our hormone cycle and our hormone cascade (a series of reactions), they're very essential for hormone production. And it can also help us with nutrient absorption. So like, there are fat-soluble vitamins, so vitamins A, D, E and K, which actually help with energy, with mood, with metabolism, skin, hair, nails, our circulation, and even with mentation (thinking) and brain health. They're fat soluble, which means they actually require fat to be absorbed, right?

Fats also provide longer-lasting energy. and so that's important as well. and things like, nuts, walnuts, almonds, they actually help with the good cholesterol, what we call the HDL or healthy cholesterol, to do better and are a great source of protein as well.

Host Amber Smith: Well, Dr. Nanavati, I appreciate you making time to talk to us about healthy eating. Thank you.

Kaushal Nanavati, MD: I sincerely appreciate this conversation. Thank you.

Host Amber Smith: My guest has been Dr. Kaushal Nanavati, an assistant professor of family medicine, the director of integrative medicine, and the assistant dean of wellness at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," health care workers gather to de-stress.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." The Schwartz Rounds is a program that allows health caregivers to gather regularly to share their thoughts and feelings about their work lives. Today I'm talking about this program with Zeynab Mancini, a chaplain who coordinates the Schwartz Rounds at Upstate. Welcome to "HealthLink on Air," chaplain Mancini.

Zeynab Mancini: Thank you.

The Schwartz Rounds comes from the Schwartz Center for Compassionate health care, which is a national nonprofit that formed 30 years ago in 1995. Can you tell us about its mission or why it was created?

I would like to start this with quote from Ken Schwartz, who started the Schwartz Rounds at Schwartz Center. He said, "this act of kindness, the simple human touch from my caregivers have made the unbearable, bearable."

Zeynab Mancini: The Schwartz Rounds is dedicated to human connection in the heart of health care. And today's health care environment, crowded with competing priorities, and the human connection is too easily overlooked. And caregivers, burned out. Patients and families are fearful and suffering. Through innovative programs, education, advocacy, and compassion rounds that we are having through Schwartz Center is working to support caregivers, health care leaders, and others to bring compassion to every health care experience.

So Schwartz Center, as you said, created by Ken Schwartz, and his story is very touching. And he started it after his own experience with health care in 1995. And there is lots of hospitals involved with Schwartz Center. In United States, more than 400 hospitals are members of the Schwartz Center. And UK and Ireland have more than 280. And Australia, Canada and New Zealand also has Schwartz Rounds, are members of the Schwartz centers and doing the Schwartz rounds at their hospitals.

Host Amber Smith: So it's gone international.

Zeynab Mancini: Yes.

Host Amber Smith: So all from this man who was a patient who had his own health care crisis and saw how important it was to have health care workers who were compassionate.

Zeynab Mancini: Yes.

Host Amber Smith: Well, can you tell us how Schwartz Rounds works at Upstate? Who participates?

Zeynab Mancini: We started Schwartz Rounds 11 years ago. Every health care worker, regardless they are bedside caregiver or not, they are able to participate. They have accessibility to Schwartz Rounds. And we are from administrative to the bedside caregiver, environmental services, supply chain, physical plant, human resources even. We are having participants from them too. Like everyone who are health care worker have access to the Schwartz Rounds at Upstate.

Host Amber Smith: And we have a planning committee. We have palliative care doctor, we have ED (emergency department) doctor, we have wellness chief, we have psychiatrist, we have case manager, nursing directors, we have social workers, we have physical plant, environmental services and hospitalist and supply chain in my planning committee. We are meeting every few months, planning for Schwartz Rounds and bringing up topics and defining who will be good panelists for the topics, and then we are setting the dates. What did you do during the COVID pandemic? Did Schwartz Rounds still take place?

Zeynab Mancini: Yes, Schwartz Rounds did not stop providing compassionate support and care to the health care givers, especially during the pandemic. There was a lot of need. But we did it online and we, again, had topics. And also it is not only topics. Sometimes it is difficult cases that involves many interdisciplinary teams and that impact them emotionally and their experience and their practice. Sometimes we are bringing up the cases. Sometimes we are bringing up just topics relating to health care workers experience.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with chaplain Zeynab Manini about a program called Schwartz Rounds that gives health care workers a safe place to share their feelings about their work lives.

What is the goal of Schwartz Rounds? When you gather all of these health care workers from a variety of roles in the hospital, what are you hoping to achieve when they all come together?

Zeynab Mancini: For us at Upstate, our goal to create the safe space for staff to share their feelings and safe spa space for them to be vulnerable, to feel connected and to gain strengths, knowing that there are others who went through similar difficulties and experiences and challenges, and that there are similar stories that empower them and make them connected and make them to feel more motivated what they are doing humanly in their caregiving.

We are not seeking for problem solving or fixing what is going wrong. We are mostly focusing on, and we are bringing people to focus on, to process their feelings, to be vulnerable, to just discuss how humanly they can approach to these difficult cases together and empower each other.

Host Amber Smith: Are people allowed to come and just listen?

Zeynab Mancini: Yes. As long as they are staff of Upstate, they are allowed to come and listen. We are also opening it -- after panelists share their stories -- we are opening to audience to kind of, to resonate with their feelings, with their stories, with the stories of the panelists too, and share something from themselves. And it is also safe space for audience that they can share, process their feelings, and be vulnerable.

Host Amber Smith: Can you give us some examples of the themes or the topics that you've addressed?

Zeynab Mancini: I just picked a few topics from the past year that I have been coordinating and there is topics that we did: "When Helpers Need Help, the View of Other Side of the Bed," then "Taking Off the Cape, From Hero to Human," or "Baptized by Fire, When There is No Playbook," and "Healing the Healer, Balancing and Navigating Self Care Needs of the Patient Care. And, we had also "The Balancing Act: Carrying Joy and Grief in our Care," specially coordinated for the holiday season last year.

Host Amber Smith: So the way the titles are, it makes me think, you're describing jobs that are potentially high stress. But like you said, with joy, but also with some grief. Are you trying to help people learn how to process a stressful job?

Zeynab Mancini: We are trying to help them to reduce the stress while they're sharing and they're processing their stressful work, their feelings and the impact that they are getting from difficult cases, difficult encounters, difficult illnesses.

Host Amber Smith: How do you think programs like the Schwartz Rounds improve health care for patients?

Zeynab Mancini: Schwartz Rounds improve health care for patients by fostering more compassionate understanding and emotionally resilient health care workers. And then, these rounds provide safe space for caregivers to share their experiences and reflect on the emotional impact of their work, and then gain insight of their colleagues.

And addressing these emotional strain helps health care workers, providers, and professionals feel supported and emotionally balanced. And then they can provide attentive, compassionate, and improving overall patient care. And also by encouraging reflection on the emotional and ethical challenges of the patient care through storytelling and shared experience.

Schwartz Rounds also helps clinicians and health care workers to connect with the human side of the medicine and leading to more empathetic and more patient-centered care. These rounds brings together staff from different disciplines and strengthening understanding among health care professionals.

Host Amber Smith: Well, chaplain Mancini, thank you for making time to tell us about Schwartz Rounds.

Zeynab Mancini: Thank you very much for having me.

Host Amber Smith: My guest has been Zeynab Mancini, a chaplain at Upstate who coordinates the Schwartz Rounds. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from surgical oncologist, Dr. Daniel Thomas, from Upstate Medical University: How is melanoma skin cancer diagnosed?

Daniel Thomas, MD: Most melanomas are diagnosed either by primary care doctors or dermatologists. And really what they are looking for are what we call the A-B-C-D-E rule. That's looking at a specific pigmented or dark mole and assessing the characteristics of how it works. And our A-B-C-D-E rule is that the mole is asymmetrical, or it's not a perfect circle or oval.

And the B is the border, if it has what we call irregular borders, and that's if the edges of it aren't kind of confined, it can jut out and have kind of fingerlike projections on it. The C is color. If a mole has more than one different color, often, if it's a melanoma, it will be a light brown or maybe a medium-brown mole that has an area or two within the mole itself that is much darker, darker brown, or even black.

And then the D is for diameter. Most moles are within the size of about the end of an eraser tip on a pencil, which is about 5 to 6 millimeters. And so when they get larger than that, even in the absence of some of the other characteristics, it's something that many primary care doctors or dermatologists will just keep a close eye on, if not biopsy.

And then the E is evolution, which means that you had this mole, you know it was there, it's been there for years or maybe just a few months, but then you start to notice it changes or evolves. And, really, any change over the course of months to a year or two is something that should probably be brought to attention, because most moles don't change over the course of that short time period. People can have moles their entire life that sure change over many years or decades, but when they change in a shorter interval, it's something to bring up.

And then the last one -- and this one is important for people who have many moles -- is what we call the ugly duckling sign. It's you have a lot of moles and this one that you just noticed doesn't look quite like the others, for one reason or another. People who have a lot of moles, they tend to all look similar and scattered throughout whichever part of their body. But if there's one that just doesn't look like the other, the ugly duckling sign, that's something you should probably bring up as well.

These are usually diagnosed by primary care doctors or dermatologists who are performing thorough skin exams and really keeping track of a patient's moles and skin lesions over the course of many visits so that we can get a good idea of what is changing and what's just staying the same.

Host Amber Smith: You've been listening to surgical oncologist Daniel Thomas from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Claudia M. Reder is the author of several books of poetry. She reminds us of the bittersweet aspects of aging, when our bodies and minds can't be relied upon in the ways they once could. Here's her poem "To a Friend Whose Memory Is as Long as an Elephant's."

It is okay to forget that meal

where we waited forever to get served,

or the meal that was supposed to honor your dead mother,

where no one spoke of her,

or the time we spoke of your long memory

and my shorter one,

and I said it's not always helpful to be an elephant.

All that emotion atop of scoop of garlic

mashed potatoes with butter, whole milk and cream,

served with a side of grilled asparagus.

We shuffle to the kitchen for tea and back

serving each other lemon, honey, and tiny stirring spoons,

while waiting to hear from doctors for test results,

or for your sister to say she is sorry

which she never does.

I do not know who we will be on Wednesday

when your doctor calls.

I brush the names of the dead into my hair,

tucking the curls under a hat

to go about the business of living.

I remember your long legs on the outdoor chaise,

your golden retriever leaning against your thigh. We were hot,

sipping passionflower iced tea and laughing.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

This is your host, Amber Smith, thanking you for listening.