Social Media Savvy Doctors
Doctor-patient relationships no longer stop at exam room walls. Medical communication is being transformed. Doctors are tweeting. Patients are posting to medical practices’ Facebook walls. Medicine has entered the world of social media. Dr. Jeff Livingston at Momentum Health OB-GYN in Irving, Texas, uses Facebook and Twitter to share the latest health news with his patients. When Livingston comes across an interesting health-related article, he shares it on the social sites. Post topics range from breastfeeding and weight loss to medication updates. The reason: Informed patients engage in higher-level discussions during exams, he says. And that means time is well spent. Read more »
Take Two Apps and Call Me in the Morning
Will doctors recommend health apps to patients? There has been an explosion in health apps. Patients are using them for weight loss, calorie counting, exercise monitoring, ovulation calculation and for many other health needs. But to truly integrate the concept of health apps in the health care system healthcare providers will need to get involved. There is discussion in the health IT world lately regarding physician adoption of technology specifically mobile health apps, electronic record systems and patient portals. Doctors have now been plugged into the equation for technological innovation. This represents a paradigm shift for doctors. Life was much simpler when all we had was a pager and a stethoscope. On the other hand, incorporating new innovation is nothing new for doctors. Physicians are constantly exposed to innovation. We are approached with new medications, new surgical devices, new equipment and new lab tests. Frequently, doctors are pitched a new product and have to decide whether to integrate it into practice or to pass for now. With medications, medical devices and lab tests the decision to accept and adopt is complex. It involves analyzing safety, efficacy, cost and other factors. Some physicians have the early adopter mentality. At home, we are the first to buy the latest iPhone (even though our current one works fine). We also rush out and buy a 3D television (much to the annoyance of our spouses). Early adopters are the first to try a new surgical technique. Other physicians are more likely to wait and view the success or failures of the early adopters before deciding to jump in. In many ways physicians are already leading the way in mobile health. The majority of doctors are using smart phone and physicians are early adopters of the iPad. Physicians are using apps clinically within the daily workflow. I use AirStrip OB daily to monitor my patients in labor and Epocrates to check medications. Using medical apps has gone mainstream and Health apps are flooding the market. This trend will continue as the Internet itself moves from the laptop to mobile. We know physicians will use health apps but will they prescribe apps to their patients as a direct part of patient care? It is very important that app developers understand the physician mindset if you expect us to use apps and to recommend your product to patients. We will not utilize or recommend a health app just because it is cool or just because we can. Adoption is unlikely to be based on cost, efficacy and safety. Your app needs to meet two simple criteria. First, the app needs to make physicians’ lives easier. Second, it needs to make the care we provide our patients better. Currently I prescribe a few in clinical practice. I suggest TweetWhatYouEat.com for weight loss. I like the iPregnancyApp.com for my pregnant patients. I suggest the HealthTap.com app for access to physician driven health information. Our practice is about to release our own app for our practice in 2013. So will physicians recommend apps to patients? Absolutely! Give us something worthwhile and we will be all over it. We ask very little in return – make our lives easier and make the care we provide better.
Why This Doctor Decided To Follow His Own Advice
There is an old saying in Medicine, “Medice, cura te ipsum”, which in English means, “Physician, heal thyself.” This doesn’t mean that as a physician I can’t go to the doctor or that I have to perform surgery on myself. What it does mean to me is that as a physician I should set a good example for my patients, and practice what I preach. I can’t say that I have always done that. My father, who is very fit and active in his 70’s, has said to me that there are people who eat to live and people who live to eat. I fall into the second category. Food for me has been something to celebrate with, console myself with, stave off boredom or fatigue with, and occasionally, nourish my body with. When I was in college playing basketball 2 hours a day and sporting a 20-year-old’s metabolism, I could get away with eating whatever, whenever. But as happens to most of us, our activity levels decline with age, our stress levels may increase, and our metabolism decreases. And we gain weight. Dr. Elisabeth Kubler-Ross in 1969 described the five stages of grief as denial, anger, bargaining, depression, and acceptance. While she was relating this to people faced with a terminal illness, I think that her model can be applied to those people dealing with a chronic disease, such as diabetes, hypertension, or in my case, obesity. I’m sure that over the years, as I grew more sedentary, and larger, I went through all of these stages. The last stage is acceptance. When talking about a chronic illness, such as obesity, I think acceptance is the realization that you have a chronic condition, you’re not going to wish it away, and you have to learn to manage it. I had that realization early this year when I got the courage to step on the bathroom scale, and the digital readout read, “OL”. In case you’re wondering, OL means over the limit. The limit on that scale is 350lbs. Now I’m very tall, 6’7”, but even so, I would have to be about 8 feet tall to justify more than 350lbs. I remember thinking, “Kevin, you are so fat that the scale won’t even tell you how fat you are.” In that moment, the first four stages of grief ran through my head at once, followed by a moment of clarity. I realized, and accepted, the fact that I suffer from obesity. At that moment, like many other people who realize they have a chronic condition, I had to decide what was I going to do. The first thing was, to be honest with myself about why I wanted to lose weight. Having a scale that doesn’t go up high enough is a wake-up call, but not a reason. The scale in my office goes up to 450lbs, and I’ve seen 5x and 6x scrubs for sale. Also, I have a fantastic family who I know loves me no matter how much I weigh. So why go through all the diet, exercise, frustration, and self-denial it takes to get back on track. I was able to come up with quite a few reasons. A lot of them had to do with my family. I also feel like I was blessed with a healthy body, and in some way, I feel that it is a sin not to take care of it. Another reason goes back to the proverb, “Physician, heal thyself.” Every day, I see patients who are overweight, or obese, and I see the consequences of this. Obese patients often have high blood pressure, diabetes, infertility, irregular periods, or are pregnant and have pregnancy complications. As you might expect, I would try to talk to my patients about healthy eating, exercise, and the benefits of weight loss. But as the words came out of my mouth, there was always the feeling that I was in a “do as I say, not as I do,” moment. Sometimes I would try to rationalize my way out of it by saying to the patient, “I know that exercising and losing weight is hard,” with my out of shape, obese self as living proof. I’ve always felt very comfortable talking to my patients about other healthy lifestyle choices such as quitting smoking, alcohol in moderation, don’t use drugs and practice safe sex. But when it came time to talk about weight loss, I felt like a hypocrite. Having made up my mind to do something, I sat down with my family and told them where I was and where I wanted to go, and I asked for their help. They helped me get all the junk food out of the house, and together we’ve come up with better meals to cook at home and less eating out. We switched to using smaller plates to avoid the “have to finish your plate” syndrome and help with portion control. And then I started exercising again. When you’re out of shape and trying to get back, the number of excuses you can come up with not to exercise are almost infinite. You have to, as the Nike commercials say, “Just Do It.” I don’t recommend expensive exercise equipment or gym memberships unless you are truly committed to using them. I am however, a fan of watches or phone apps that track your steps. If you’re walking, then you’re moving, and if you’re moving, you are burning calories. I’ve worked my way up from walking, to using an elliptical machine, to cycling and jogging. I also mix in some weightlifting to try to tone up my muscles (this helps keep up your metabolism because muscle burns more calories at rest than fat). I have gotten to the point where I try to exercise at 30-60 minutes 5 or 6 days a week, and I try not to take more than two days in a row off. It probably took me 3 or 4 months to get to this point,
The Quarantine 15: Who Else Is Fighting It and How Can We Fix It?
COVID-19’s unexpected effect on expanding waistlines. Why is my belt so tight? I can’t buckle my skinny jeans. I call out “Honey, I think my pants shrunk in the dryer,” as I loosen my belt a notch to accommodate my new #dadbod. I don’t think I am alone. My patients are complaining of weight gain too. As a result of the stay-at-home instructions, many of us altered our activity levels, diets, and routines. The result — The Quarantine 15. Obesity may be an unexpected outcome of this infectious disease pandemic. Why are we gaining weight? Various theories attempt to explain the mysterious Quarantine 15. Some blame stress. Stress increases our body’s cortisol production. Cortisol is the “stress hormone” known to increase the appetite. When under stress, we alter our food intake. Some people undereat. The medical term for undereating stressed-out individuals is “weirdos.” “Normal” people tend to grab a bag of Doritos and dip them in hot fudge covered ice-cream. Author’s image Ice-cream and other sugary carbohydrates trigger a dopamine surge. Dopamine hormone dopamine is produced in the pleasure center of the brain, an area of the brain called the nucleus accumbens. Dopamine is our mind’s reward system. When times are tough, rewards and treats provide relief. Some believe we naturally gravitate towards carb-laden foods when stressed out to get a quick energy boost. The sugar rush makes us feel better, temporarily. But what follows is the crash and crave phase. The crash makes us feel hungry again as our brains seek out more dopamine. Dopamine and cortisol. Is the Quarantine 15 a result of a complex combination of physiological hormonal changes? Perhaps. But I suspect we are just bored. Boredom leaves us feeling tired and sluggish. We tell ourselves we were “forced” to stop working out when gym and fitness centers closed during the lockdown. But many did not substitute an evening jog, daily walk, or even get up off the couch. Not only did we decrease our physical activity, but alcohol sales also skyrocketed up 27% during the pandemic. People are doing less and drinking more, and increased alcohol consumption means more calories What goes better with a craft beer than some fresh local takeout! Since restaurants were closed to dine-in, many of us began ordering take-out. Food delivery services increased sales during the lockdown. Many of us ordered food to “to support the local restaurants.” Hey, we are #inthistogether, and everyone has to do their part.
Avoid This Mistake or Your New Year’s Resolution Will Fail
Create an action plan, not meaningless words. I want to lose weight. I want to make more money. I want to eat healthier. These are common New Year’s resolutions all destined to fail. These nonspecific statements are just words. Setting a goal is one step, but creating a plan is what leads to success. Resolutions fail. Plans work. What do you want to change? Before you create a New Year’s resolution, stop and reflect on what you want to change in your life. What is the most important issue to you? Scratch everything off the list of what you should change keeping only what you want to change. We all have things we should change, but these may or may not be the issue about which we are most passionate. What does success look like to you? Once you have decided what you want to change, imagine yourself at the end of the road. The goal has been achieved. The race has been won. What is the result or outcome? If your goal is a 20-pound weight loss then imagine how you would feel, how you would look and how life would be different. Make sure that the outcome is acceptable, appealing and motivating. If visualization of your future self is not motivating then you may have chosen the wrong goal. How did you achieve this goal? View your self from the future and determine how you got there. What were the steps you took to get to your imagined outcome? Write down the steps. Working backward allows you to evaluate what changes in your life are necessary. Create your plan based on these discoveries. Decide to change Deciding to change may sound silly but it is crucial. Your mind will constantly work against you making excuses and rationalizations. Once the decision is made then there is no more debate. It is done. We must internalize the decision. Measure your progress Find a way to track your steps. If your goal is weight loss then use Myfitness pal. If your goal is to exercise, then use a Fitbit or an Apple watch. If your goal is freedom from debt, then track your credit cards. Some hire a personal trainer, a financial counselor or an executive coach. Choose a system that works for you to monitor your journey and to hold yourself accountable. Analyze the results and make the necessary changes. Be open to change, adapt and adjust. Remember why you are making the change Maintain a laser-like focus on the underlying reasons you are seeking change in your life. Why are you making this change? Find ways to remind yourself each day of your WHY. Making a resolution will not trigger change. Create a plan and have the grit to stick to it. Thank you to Live Your Life On Purpose for publishing this a article on Medium.
Your Morning Routine Can Change Your Life Tomorrow
Thank you, Hal Elrod, for waking me up to a new perspective Snooze button. Snooze button again. Tired, sluggish, and dreading the day, I drag myself out of bed like a zombie from The Walking Dead. Like many hard-working entrepreneurs, this was my daily morning routine. Two years ago, I stumbled upon a podcast interview with author Hal Elrod in which he shared his incredible story and explained his book The Miracle Morning. His message hit me like a ton of bricks. We are all work so hard to create an amazing life for ourselves, but we never stop and take the time to enjoy the life we have created. For entrepreneurs, our days are a nonstop sprint of texts, emails, phone calls, and office work. We rarely stop and take time each day to reap the benefits of our hard work. Hal points out that the only safe time is in the morning before we start our day. He emphasizes that we owe it to ourselves to block out this time to experience life without interruptions or distractions. He suggests a morning routine called SAVERS (silence, affirmation, visualization, exercise, reading, and scribing). The two-week rule I have a process for the implementation of new self-improvement ideas I call the two-week rule. When I try something new, I commit 100% for two weeks. I go ALL IN. I do not judge results or deviate from the plan. This allows me to do a fair assessment of the new endeavor. No excuses are allowed. I just decide “this is what I am going to do.” Once the decision is made, then there is no more thinking or debate. After hearing about the Miracle Morning, I started my two-week evaluation. Two years later, I am still doing it every day. Why it matters Friends have asked me “what is the point of waking up early?” My answer is that it changed how I view my life. It kick-started a new diet, a 30-pound weight loss, integration of mindfulness into my life, and I conquered physician burnout. I have read more books in the past two years than in the previous twenty. I also created and started living my personal mission statement “to become the best version of myself to have the maximum impact on others.” Every day I work to make this a reality. Create your own Miracle Morning Individualize the plan and make it your own. I started off doing SAVERS precisely as described in the book. For those struggling to start, you can do it 6 min; 1 min for each step. I quickly realized that I needed to make some adjustments to fit my personality. I prefer practicing mindfulness in the evening before I go to bed. Meditation in the morning made me sleepy. Switching the practice to the night time has become a vital tool for me to beat insomnia. For those new to meditation, I recommend Headspace, 10% Happier, or Insight Timer. I prefer to exercise after work. I run in the evenings. It calms my mind, and I can shed the stress from the day. For those “Type A” people like me needing a plan, try the app Couch to 5K. My Miracle Morning I set my alarm for 5:15. When the alarm goes off, I immediately get up. No snooze button. Step 1: I step on the scale and type the number into Myfitness Pal. Weight management is a top priority for me, and stepping on the scale first thing in the morning helps me start the day with intentionality; today I am going to eat right and focus on my health. Step 2: I move to the kitchen. While my coffee brews, I drink a large glass of water. This simple step is critical because our bodies get dehydrated through the night. I read an article or two on Medium. I do not check email, Facebook, or Twitter. No work allowed. Step 3: Once the coffee is ready, I sit a comfortable chair, and I read an affirmation paragraph. The affirmation keeps me focused on my mission and values. Reading the paragraph out loud is an important step as it forces my mind to think through the words instead of just going through the motions. Step 4: I open a book and read. I avoid reading anything in my industry and allow this quiet time to be truly mine. I choose books on personal growth, leadership, business, and fiction. Step 5: When it is time to get ready for work, I do a quick downward dog yoga stretch followed by ten pushups. It is not enough exercise to sweat but enough to get the blood flowing. Waking up early is not as hard as you think Many people say they can never wake up early. From my experience, what was at first, an obstacle quickly evolved into motivation. I felt the benefits of an established routine so quickly that my mornings became the most important and enjoyable part of my day. I have become a better husband, father, physician, and entrepreneur by taking a few minutes each day to learn, grow and be present in the moment.
The Quarantine 15: Who Else Is Fighting It and How Can We Fix It?
COVID-19’s unexpected effect on expanding waistlines. Why is my belt so tight? I can’t buckle my skinny jeans. I call out “Honey, I think my pants shrunk in the dryer,” as I loosen my belt a notch to accommodate my new #dadbod. I don’t think I am alone. My patients are complaining of weight gain too. As a result of the stay-at-home instructions, many of us altered our activity levels, diets, and routines. The result — The Quarantine 15. Obesity may be an unexpected outcome of this infectious disease pandemic. Why are we gaining weight? Various theories attempt to explain the mysterious Quarantine 15. Some blame stress. Stress increases our body’s cortisol production. Cortisol is the “stress hormone” known to increase the appetite. When under stress, we alter our food intake. Some people undereat. The medical term for undereating stressed-out individuals is “weirdos.” “Normal” people tend to grab a bag of Doritos and dip them in hot fudge covered ice-cream. Author’s image Ice-cream and other sugary carbohydrates trigger a dopamine surge. Dopamine hormone dopamine is produced in the pleasure center of the brain, an area of the brain called the nucleus accumbens. Dopamine is our mind’s reward system. When times are tough, rewards and treats provide relief. Some believe we naturally gravitate towards carb-laden foods when stressed out to get a quick energy boost. The sugar rush makes us feel better, temporarily. But what follows is the crash and crave phase. The crash makes us feel hungry again as our brains seek out more dopamine. Dopamine and cortisol. Is the Quarantine 15 a result of a complex combination of physiological hormonal changes? Perhaps. But I suspect we are just bored. Boredom leaves us feeling tired and sluggish. We tell ourselves we were “forced” to stop working out when gym and fitness centers closed during the lockdown. But many did not substitute an evening jog, daily walk, or even get up off the couch. Not only did we decrease our physical activity, but alcohol sales also skyrocketed up 27% during the pandemic. People are doing less and drinking more, and increased alcohol consumption means more calories What goes better with a craft beer than some fresh local takeout! Since restaurants were closed to dine-in, many of us began ordering take-out. Food delivery services increased sales during the lockdown. Many of us ordered food to “to support the local restaurants.” Hey, we are #inthistogether, and everyone has to do their part.
Navigating Nausea While on GLP-1 Medications: Tips for a Smoother Journey
As an ObGyn dedicated to helping patients achieve their weight loss goals, I often hear concerns about the side effects of GLP-1 medications, particularly nausea. If you’re experiencing this side effect, know that you’re not alone—nausea is one of the most common challenges patients face, especially in the early stages of treatment. But don’t let nausea get you down! We have effective ways to manage nausea, and you can take advantage of them. Why Nausea Happens and What It Means When you first start on GLP-1 medications like Semaglutide, your gastrointestinal (GI) system needs time to adjust. These medications work by slowing gastric emptying and increasing feelings of fullness, which can lead to nausea as your body adapts to the new signals. Some patients breeze through this phase with minimal discomfort, while others find it more challenging. Understanding that mild nausea is a normal side effect is essential. In fact, it can be useful in helping to suppress appetite and control eating behaviors. But there’s a fine line—while mild nausea can be tolerated and even beneficial, we don’t want it to become debilitating. Using Mild Nausea to Your Advantage Mild nausea can actually support your weight loss journey by helping to reduce cravings and curbing the desire to overeat. It’s a signal that your body is responding to the medication as intended. Rather than rushing to treat every twinge of discomfort, try to see it as part of the process. For many patients, this initial phase of adjustment is temporary and manageable with a few simple strategies: Picture by Towfiqu Barbhuiya When Nausea Becomes Too Much While mild is ok, we don’t want it to interfere with your daily life. If you find yourself missing work, school, or other activities because of nausea, it’s time to take action. Here are some options: Understanding Gastroparesis: A Rare but Serious Concern In very rare cases, GLP-1 medications can cause a condition called gastroparesis. This occurs when the stomach’s ability to empty itself is slowed significantly, leading to severe nausea, vomiting, and even malnutrition in extreme cases. Symptoms of gastroparesis include: If you experience these symptoms, contacting your healthcare provider immediately is crucial. We can evaluate your symptoms and determine the best course of action. While gastroparesis is rare, it’s important to be aware of this potential risk and seek help if you notice severe or persistent symptoms. Final Thoughts: Listening to Your Body Every patient’s journey with GLP-1 medications is unique, and there’s no one-size-fits-all approach. The key is to listen to your body and communicate openly with your healthcare team. If mild nausea is helping you control your appetite, that’s great. If it’s disrupting your life, let’s find a solution together. Remember, you’re not in this alone. Whether you’re adjusting your dose, considering anti-nausea medications, or just needing reassurance, we’re here to support you every step. Your health and comfort are our top priorities, and with the right strategies, you can achieve your weight loss goals without unnecessary discomfort. Stay patient, stay mindful, and most importantly, stay connected. We’ll navigate this journey together, one pound at a time.
Rethinking Exercise on GLP-1 Medications: Why Strength Training is Key
Exercise is vital to any weight loss journey and body transformation. However, when taking GLP-1 medications like Semaglutide, it’s crucial to approach exercise differently. Many of us remember when we could eat whatever we wanted and exercise our way to a fit figure. Unfortunately, as we age, that strategy doesn’t work. The game changes, and so must our approach. Cardio vs. Strength Training: Which is Better for Weight Loss? When most people think of exercise and weight loss, they immediately picture cardio—running, cycling, or hopping on the elliptical machine. While cardio has tremendous benefits for our heart and brain health, it’s not the most effective weight loss approach when taking GLP-1 medications. In fact, strength training is far more important for achieving weight loss and body transformation. Let’s break it down. The Cardio Conundrum Imagine you go to the gym and spend 45 minutes on the treadmill. You log your workout in an app like MyFitnessPal, and it tells you that you’ve burned around 500 calories. That sounds great, right? The problem is that cardio workouts have a sneaky way of stimulating your appetite. This is just human physiology—when you spend time jogging, walking, or engaging in other forms of cardio, your body naturally feels hungry afterward. This is where things get tricky. You’ve worked hard, you’re feeling great, and now you’re starving. It’s all too easy to justify a treat—maybe a couple of cookies or an extra serving at dinner. The problem is that those extra snacks can easily offset your burned calories. And just like that, the calorie deficit you worked so hard to achieve is gone. What is a Calorie Deficit, and Why Does It Matter? A calorie deficit occurs when you consume fewer calories than your body uses daily. When you’re in a deficit, your body turns to stored fat for energy, which leads to weight loss.However, our bodies are not designed to lose fat and keep muscle. Our bodies simply respond to the deficit by shedding weight, and that weight can come from both fat and muscle.This is where GLP-1 medications come into play. These medications help suppress appetite, making it easier to maintain a calorie deficit. But with the right kind of exercise, you could avoid losing valuable muscle along with the fat. We want to lose the belly and keep the biceps! The Strength Training Solution Here’s where strength training shines. Spending the same 45 minutes lifting weights or doing resistance exercises might not burn as many calories in the moment, but it has powerful long-term benefits. First and foremost, strength training does not stimulate your appetite like cardio. This means you’re less likely to feel ravenous after a workout, making it easier to stick to your calorie goals. But the benefits don’t stop there. Strength training helps you build muscle over time, and the more muscle you have, the more calories your body burns at rest. This means that even when you’re not working out, your body works harder, burning more calories throughout the day. Picture by Dr. Jeff Livingston Prioritize Protein and Strength Training When you’re in a calorie deficit, your body doesn’t inherently know how to target fat loss while preserving muscle. The only way to offset this is to prioritize protein intake and incorporate strength training into your routine. Final Thoughts Your journey with GLP-1 medications is unique, and so is your approach to exercise. While cardio has its place, strength training is the real game-changer for long-term weight loss and body transformation. By combining the appetite-suppressing benefits of GLP-1 medications with a focus on building muscle, you’re setting yourself up for success.Remember, the goal isn’t just to lose weight—it’s to build a healthier, more muscular body. So, the next time you hit the gym, consider skipping the treadmill and heading to the weights instead.Your body will thank you for it. Every weight loss journey is personal, and finding the right balance can be challenging. But with the right strategy, you can achieve your goals and transform your body. Keep moving forward and remember—we’re in this together.
Why I Weigh Myself Every Day—and How It Helps Me Stay Fit
I weigh myself every day. I do it for a few important reasons. Weighing daily is part of my morning routine. Each day, I start the day on a positive note with a simple habit that reinforces my commitment to healthy eating and fitness goals. The Importance of Consistent Monitoring I firmly believe in the adage: “What gets measured gets managed.” Regularly tracking my weight provides tangible data, allowing me to observe trends over time. Daily weigh-ins have been associated with more significant weight loss and the adoption of weight control behaviors. Photo by Adolfo Félix on Unsplash Ensuring Accurate Comparisons To maintain consistency, I weigh myself at the same time each morning. This practice ensures that I compare apples to apples, as weight can fluctuate throughout the day due to various factors. Understanding Daily Weight Fluctuations It’s essential to recognize that daily weight changes are normal and can be influenced by: Understanding these fluctuations helps me stay focused on long-term progress rather than getting discouraged by short-term changes. If the scale doesn’t show the results you were hoping for, remember that weight is just one aspect of your health. Focus on the positive changes in your diet and exercise routine, and remember that progress takes time. I use this scale at home. It is cheap and syncs to my Apple Health and MyfitnessPal. It measures weight and body fat. Photo by FITINDEX on Amazon. Focusing on Long-Term Progress Regular weigh-ins remind me of my health objectives, helping me stay accountable and motivated. By monitoring my weight daily, I can detect patterns and make necessary adjustments to my lifestyle. This proactive approach aids in maintaining focus, which I believe is half the battle in any health journey. Final Thoughts Incorporating daily weigh-ins into my routine has been instrumental in my health and fitness journey. It provides immediate feedback, fosters accountability, and enhances my understanding of my body’s responses. While this approach works well for me, it’s important to remember that the scale is just one tool among many on the path to better health. It’s there to support us, not to dictate our worth or progress.
