The LILI Letter - June 2025

Summer’s here! June rouses us from our regular routines with vacations, warmer weather, gardening, backyard barbecues and outdoor activities and concerts. We switch from the furnace to the AC. The possibilities seem endless when the weather warms up. Wishing you a fun and relaxed June. We observe Father’s Day, Juneteenth, Flag Day and the summer solstice.

In good health,

Jennifer James

Success story

We will all feel uncomfortable at times. For me, it is anything with the house or car that needs to be fixed. It is not my happy place. I have travelled all over the world, most of it on my own, and I do just fine. Ask me to replace a window screen by myself and I freak out. It seems silly, right? The “growth edge” is when we feel anxiety or agitation about something. It is a wonderful opportunity for us to resolve this agitation, often by trying something new, or looking at things differently. It may also be about detaching from a situation where we have no control. It gives us a chance to set our emotions aside and look at it more logically. Is this really something to be afraid of? Setting a long-overdue boundary with someone can be a “growth edge”. Ending a toxic relationship, visiting Paris, not coloring our hair anymore, volunteering for something we have never done before…all growth edges. I remember one older woman who took the weight loss class here, and set a goal to paint her bathroom, since she had never painted anything before. She was so proud of herself she moved on to paint the master bedroom. Her confidence and enthusiasm were contagious.

I am not writing this to cause more anxiety among y’all. I am writing this to get us moving through our fears, to grow and transform ourselves. Let’s think about the areas of our lives that agitate us. This part of our lives needs resolution in some form or another. Is it realistic to be afraid of these things? Have we been putting something off because it makes us uncomfortable? Growth edge! I will be replacing a window screen by myself this weekend. Am I nervous? Yes. But I am going to give it a shot. If we look back over our lives, what things did we accomplish in spite of being afraid? I am sure we all have some. Are our lives better because of those things we accomplished? You bet. For the month of June, I challenge all of us to push through one of our growth edges and try something new. Myself included. 😊 (Update: I replaced the window screen, easier than expected!)

Have you tried…Kefir?

Kefir is a fermented, acidic, “fizzy” milk. It is made from a kefir starter, or “grains”, which are added to milk. The grains are a symbiotic complex of yeast, bacteria, protein and fats that resemble cauliflower bits. Kefir is similar to buttermilk, but with bubbles and lower in sodium. Kefir has been a staple food in the Caucasus/Eastern European area for thousands of years. Herdsmen would ferment the milk in goat skin bags. Its recipe was a closely guarded secret, and kefir grains were highly prized. Kefir is packed with healthy microorganisms and is a good choice for a food high in probiotics. For an easy breakfast, check out the recipe below.

Ozempic teeth

There is a side effect rearing its ugly head with the use of GLP-1 agonist medications, such as Ozempic and Mounjaro. This class of medications slows gut activity, mimicking a full state. It also affects the brain, tongue, pancreas, mouth, muscles, and other organs. It has far-reaching effects. Our stomach makes a hormone, GLP-1 (glucagon-like peptide 1) after we eat, signaling the brain it is time to stop eating. The hormone stays in our blood for six minutes or so. The synthetic version of this hormone, the GLP-1 receptor agonist, stay in our blood for seven DAYS. This is why people inject the medication once a week and don’t feel hungry very much. Many people have lost weight with these medications when other approaches have failed. It has been a godsend for some people. However, it is not without its side effects.

The dental community is seeing people on these medications who are having more issues with their teeth. The mouth produces less saliva on these medications, since our “eating machinery” is told to stand down, faking a full state. Acid reflux may be an issue as well. The dental professionals are seeing more patients with dry mouths, bad breath, cavities, gum disease, tooth sensitivity, enamel erosion and cracked teeth.

Why is saliva so important to our oral health? It contains bicarbonate, which neutralizes acids created by harmful bacteria in our mouth or from stomach acid due to reflux. Saliva contains calcium and phosphorus, (which replenish the minerals in our teeth), lubricates the mouth, making it easier to speak, chew and swallow, it contains antibodies that prevent infections and helps rinse the teeth after we eat. Who knew? I certainly didn’t.

For those of us on a GLP-1 agonist who want to take good care of our dental hygiene, what should we do? According to the Blende Dental Group, who wrote a very informative article about this, they recommend the following:

• Stay hydrated! Drink plenty of water throughout the day, at least 2 quarts.
• Avoid sodas, acidic beverages, caffeine and alcohol, which worsen a dry mouth.
• Rinse our mouth with water after meals.
• Stimulate saliva flow by chewing sugar-free gum.
• Use saliva substitutes.
• Use a humidifier in the bedroom.
• Use toothpaste designed for dry mouth.
• Brush our teeth twice a day, floss once a day.
• Visit our dentist regularly.
• Rinse the mouth after vomiting or reflux, wait 30-60 minutes before brushing (acid softens the enamel).
• If reflux is a problem, visit our PCP to address this.
• Leave 3 hours between dinner and bedtime.
• Sleep on a wedge or extra pillows, sleeping on an incline.
• Avoid acidic, spicy or fatty foods, mint and chocolate.

Blende Dental Group. (2025, May 26- June 1). Ozempic teeth: protecting your oral health while on GLP-1 agonists.  Blendedentalgroup.com.

Academy of Nutrition and Dietetics. (2018). Gastroesophageal reflux disease nutrition therapy. Nutrition Care Manual, GI section, Client Education and Handouts. 

Clinthorne, J and Kirkpatrick, K. (2024). Anti-Obesity Medications: A interdisciplinary panel discusses cases. Webinar. Academy of Nutrition and Dietetics.

The backslide

Have we sworn off drinking or eating something, like regular sodas? We do a really good job of avoiding them, only to revert to drinking them again? How does this happen?? Or we decide to go to the gym twice a week for yoga classes, and we start off great, then stop going? Of course, we have done these things! We need to realize that relapse, “falling off the wagon”, backsliding, whatever you want to call it, will happen. We are not robots. We absolutely cannot be perfect, but we can keep trying and not be too critical of ourselves in the process.

Let’s take an investigative approach over a judgmental approach. I like to think about the difference between the days we are successful and the days we’re not. What was it about those days that helped or hurt us? Rather than looking at what went wrong, let’s look at what went right. When we avoided soda, it was because we had infused water in the fridge all the time, and we asked the spouse to drink their sodas at work. When we made it to yoga, we ate a healthy snack an hour before yoga class to avoid hunger pangs and we had our yoga clothes ready to go. Voila! This is not that difficult folks. Investigate, don’t judge. Pat ourselves on the back for trying to make a healthy change.

In summary, realize the backslide will happen. Healthy habits are ongoing, not a “one and done”. Stay logical, investigate why it happened without being critical. Set up our environment to be successful, and try again. Monitoring our actions can be helpful, or keeping a food log to get back on track. If we backslide again, so be it. Tomorrow is another day and we can keep striving until hopefully, it becomes a solid habit.

Push the protein?

Protein is our current macronutrient “darling”. We are on protein overload, if you ask me. We don’t eat granola bars so much anymore, we eat protein bars. Is there an amount that is healthy? How much is too much? The RDA for protein is based on 0.8 gram/kilogram (gm/kg) as a MINIMUM amount to consume every day. This does not account for very active people, those who are fighting a chronic illness, recovering from surgery, or those trying to build muscle mass.

The building blocks of protein are amino acids, which are obtained from food or made by our bodies. Protein is quite similar chemically to carbohydrates and fat, with the exception of nitrogen. When our bodies process protein, the liver removes the nitrogen from the rest of the protein molecule. The nitrogen is converted into ammonia, then ultimately urea, which is excreted by our kidneys into the urine. If we consume whopping amounts of protein, our kidneys have more work to do. Anyone with kidney issues that I see as an outpatient needs to restrict their protein intake (and sodium).

Protein is the building material for new tissue. Obviously if one is growing something, like another human, tissue for wound healing or more muscle, more is needed. For couch potatoes, the 0.8 gm/kg is likely adequate. The highest I will go for someone, when calculating protein needs, is 2.0 gm/kg. There may be conditions, such as cancer treatment or after major surgery when someone needs more, especially if they are malnourished, but that is the exception. We need to eat adequately, i.e. at least 1200-1500 calories per day, to spare the protein to be used as a building material, not burned for energy. According to experts and some professional organizations, 1.0 gm/kg seems adequate for active people, but others recommend 1.2-2.0 gm /kg. For athletes, 1.4-2.0 gm/kg, depending on the activity, with endurance athletes and those doing strength training at 1.6-2.0 gm/kg. For those pursuing weight loss, 1.2-1.6 gm/kg seems reasonable, as protein provides more satiation (fullness) after a meal. As for older people, they tend to use protein less efficiently, so the RDA is probably too low, even for the couch potatoes. Some experts recommend 1.0-1.2 gm/kg for these folks. If one is obese, use the desired weight to calculate protein needs. (To convert to grams of protein per pound, multiple the gram/kg by 0.45. So, 0.8 gm/kg multiplied by 0.45 would be 0.36 gm protein per POUND. A 175-pound person would eat 63 gm of protein (175 x 0.36 = 63)).

As for when and how much protein to eat, it is better to spread our protein intake throughout the day, with roughly equal amounts at meals. High protein foods include poultry, fish, meat, eggs, cheese, cottage cheese, Greek yogurt, cow’s milk, soy milk, legumes, nut butters, tofu and edamame. Combining high-quality carbohydrates (whole grains, legumes and whole fruit) with a high-protein food, healthy fats and some vegetables is a good approach for planning meals. If we want to track our protein intake, read the food labels, or better yet, enter our food intake into cronometer.com or use the Cronometer app. It will tally the protein, along with all other nutrients, and shows how nutritious our diet is overall.

We really don’t need to be eating 200+ grams of protein per day, unless we are a linebacker or professional power lifter. It means we are skimping on other nutrients and making life harder for our kidneys, with protein likely being used for energy. I like the whole foods approach unless someone can’t consume enough protein from the foods listed above. There are a myriad of protein shakes, powders and supplements out there for those who are struggling. The bottom line is to eat adequate calories, eat adequate protein from a variety of sources, and spread it throughout the day. Eat at least 1.0 gm/kg (or 0.45 gm/pound) if we are  a senior, are very active, are pregnant, recovering from surgery or a chronic illness, or do strength training, but not more than 2.0 gm/kg (0.9 gm/pound). There you have it.

Here is a sample day’s intake for a person who weighs 80 kg/176 pounds and needs 1.0 gm/kg, or 0.45 gm/pound, (80 gm protein).

Breakfast: 1 egg, 1 cup cow’s milk, 2 Tbsp. raisins, 1 cup oatmeal (21 gm)

Lunch: peanut butter sandwich, with 2 Tbsp. peanut butter, 2 slices whole wheat bread; 1 cup baby carrots, apple, 5.3 ounces Greek yogurt (27 gm)

Dinner:  3 ounces grilled chicken, 2/3 cup brown rice, 1 cup broccoli, handful of grapes (29 gm)

Snack: 6 Triscuit crackers with 2 Tbsp. hummus (6 gm)

Total: 83 grams of protein

Dennett, C. (2025). Great Debates. Protein recommendations. Today’s Dietitian. 27(5), 26-31.

Kefir berry breakfast

Kefir can be substituted for buttermilk in any recipe, but kefir is lower in sodium. This is an easy overnight breakfast for the next day. Use a pint mason jar or other container with a lid. This recipe serves one person, so double or quadruple the measurements for more people. A good “on-the-go” breakfast.

¼ cup rolled oats or Bob’s Red Mill muesli

¾ cup frozen berries

¾ cup plain kefir, 1%

1 tsp. coconut

1 Tbsp. raw sunflower seeds, optional

Large pinch of cinnamon

Add the ingredients in the following order to the container: cereal, coconut and cinnamon, frozen fruit, kefir. Refrigerate overnight. The mixture will have softened during the night. Stir to combine. If you want some crunch, add a tablespoon of sunflower seeds. Enjoy!

1 serving with seeds   ~335 calories, 14 grams of protein

June support groups

Mondays, 2-3 pm

Heart Center Conference Room

ORMC Medical Plaza

Free to graduates of ORMC weight loss classes

“Every experience in your life is being orchestrated to teach you something you need to know to move forward”.

---Brian Tracy