As part of the 2023 Wellness Academy, Victor Baquero, MD, a UC Davis physician, shared insights on lifestyle and nutrition interventions for disease prevention.
During his Q&A session below, he tackles practical questions on how to implement whole-person health approaches in daily life, from managing cholesterol to fostering a healthy microbiome.
About the expert: Victor Baquero, MD
Victor Baquero, MD, serves as the Clinic Medical Director and an Associate Physician in the Department of Family Medicine. He chose family practice due to its broad scope, which allows him to address a variety of medical and social issues. Dr. Baquero enjoys working with families and providing care for all members from infancy to adulthood. As a patient advocate, he emphasizes preventive medicine, early intervention, and a healthy lifestyle to maintain good health. His philosophy of care is simple yet profound: “treat others as you would like to be treated.”
Q&A with Victor Baquero, MD
This transcript has been edited for clarity.
Q: How do we get out of the box of the disease response system into this more wellness discussion we all need to have with our doctors?
Dr. Baquero: That’s a great question. The focus is to start training doctors about nutrition and lifestyle, which is something we are not getting at all.
Even my colleagues, at lunch time, I see them eating chips and drinking a surgery drink. They are overweight and taking a lot of medicines themselves, so it’s not something that is really in the mindset of most physicians. Though lifestyle education is coming along, doctors are learning more and more the benefits as the public is, but it will still be a challenge.
Q: You spoke about kinds of lipids and dietary cholesterol. What’s the relationship between what we eat, dietary cholesterol and its impact on health?
Dr. Baquero: Right. There is a lot out there in the media that will contradict statements said by experts. The bottom line is, yes, LDL cholesterol, is the bad player. But that’s just part of the story. There’s more to that.
LDL comes in two forms, type A, which is the large, fluffy cholesterol, which is not so bad, and then type B, which is the small dense cholesterol, which tends to get into the arteries more. There are also sub-types, like lipo-protein-A, which are also small, dense forms of LDL that get into the arteries and cause heart disease.
So there is more to the picture. When we first started checking cholesterol, we would just check total cholesterol. And now we know that is not entirely the whole story because you can have a lot of the good or healthy cholesterol, HDL, and have a very high total cholesterol and not have any heart disease.
So, usually, when we are exploring a little further, I will talk to my patients about getting a more advanced screening test to look at these sub-types of cholesterol. And there, we decide, you know, if they have a lot of the bad types or if they’re unfortunate to have really high lipo-protein levels.
That goes on to the genetic disorders category. And those patients we need to look at a little closer since, you know, many of those will have heart disease in their 40s.
But they’re unaware because they are not looking at the whole picture.
Q: So, again, focusing on molecules, you know, you talked a lot about sugar and glucose, but what about people who are trying to avoid the, you know, inflammatory, toxic effects of too much sugar by consuming large amounts of sugar substitutes? What’s your perspective on that?
Dr. Baquero: At the end of the day, what I try to guide my patients is towards eating more of a whole food diets. Trying to find substitutes that are not entirely natural can complicate things. Sugar substitutes in themselves can cause problems to the microbiome as we talked about; some have been labeled carcinogenic.
A more whole foods diet that gives you sugars in a natural setting, which are usually bound to fiber, don’t get absorbed immediately, but rather little by little. In fact, there are interesting studies, such as a study on diabetes that explores this concept of comparing given a diabetic pure sugar vs the sugar in the form of a cup of berries.
You’d think that the ones who got the added sugar from the berries would have a larger effect on their blood sugars, and the opposite happened. Their agencies were lower there. There was an insulin spike that was reduced when you added berries to the diet. To the high sugar load. So, its again, eating more of a whole-food diet that will tend to normalize things.
When we try to add substitutes, things get a little more wonky.
Q: What’s the best way to support a healthy microbiome or what would be a pro healthy microbiome diet? What do you think of adding, pro or pre, or even post biotics? and what about antibiotics?
Dr. Baquero: Okay, so let’s talk about antibiotics first. Antibiotics obviously are meant to kill bacteria. In doing their job, they will kill the bacteria in our gut. These effects of antibiotics are varied. We as doctors are very aware of using very strong antibiotics and the consequence of developing colitis or C diff, which is an overgrowth of this bad bacteria.
There have be interesting studies. In fact, I was part of a study looking at antibiotic use for the daily treatment of acne in teenagers. Some of the antibiotics tested in the study had a big effect on the microbiome, and it can take a whole year to get the microbiome back to normal.
Other antibiotics, like penicillin, it may take only three weeks to get your gut flora back to normal. So depending on the severity of antibiotics, the microbiome can get affected more or less. So it takes a while in terms of keeping the microbiome healthy.
I really promote the use of prebiotics, which are fibers your gut bacteria feeds on. The bacteria turns fiber into short chain fatty acids, or spheres, which then keep your gut healthy. So the more diverse the fiber consumption, the more support the colonies of bacteria will have.
Instead of telling patients to consume more probiotics, I usually encourage them to get a diversity of fiber rich foods in their diet.
I encourage them to consume at least 30 fiber rich foods per week. So that’s, vegetables and fruits, legumes, nuts, seeds, grains, and cereals, that will help promote positive bacterial colonies. So therefore, you don’t have to consume probiotics, it will be in the food themselves. For example, sauerkraut is made with just cabbage and salt, and the probiotics form during the fermentation process. So most of the foods out there have their own probiotics.
Should everyone get a dose of sauerkraut at the end of antibiotic use? The studies are mixed here, but it doesn’t hurt to consume your probiotics, whether it’s kombucha or sauerkraut or kimchi or for any of those foods that will help give you healthy bacteria.
I also recommend get your good sources of fiber, because this will also promote a balanced microbiome.
Q: How can I improve my sleep without relying on medication?
Dr. Baquero: That’s a very common question. Our lives are very busy, we have so much going on, and then we have all the screen time and a million things that we do during the day that we try to pack it in before we go to bed.
There are a lot of different solutions, yes there are somethings we can take, but a big part of it it is the things we do the hour before we got to sleep.
I often recommend a book called, Energize! by Michael Bruce and Stacy Griffith. It’s more of an approach to getting your sleep back in order. It determines your chronotype or your sleep type and your body type, and then you go to the section that tells you how your body may function best.
We are genetically essentially programmed to have a certain chronotype or sleep type, and this book optimizes your daily workflows and patterns, to get your sleep back in order.
About the Author
