Shireen: Tinka Barnes is a Board Certified family medicine physician who relishes working in the underserved community. She is passionate about educating her patients on how to live a healthier life through nutrition and movement as medicine. Dr. Barnes, welcome.  

Dr. Barnes: Thank you for having me. I really do appreciate it.

Shireen: An absolute pleasure having you on. So Dr. Barnes, I want to dive right in and understand what led you to become a family medicine physician and how did this focus on food and then also food as an add movement as medicine actually come about? 

Dr. Barnes: Well, I am originally from Los Angeles, California, born and raised, and I grew up in a family of seven. So there was five kids and my mom and dad, and my mom and dad are from Mississippi, Louisiana, and they grew up on farms. So the whole thought process around food was definitely focused on how they saw they did not see fast food places as the main source of our dinners or lunches. So we usually had home cooked meals, my mom was mostly a stay at home mom until she was like 35. So I got the benefit of having home cooked meals. And I really enjoyed that my dad was like I call him the first black Jacquelane because he was juicing well before became popular now to juice. And we would choose carrots and greens and apples and parsley. So I got a strong introduction to healthy eating from my family. And my introduction to medicine came because I had some issues with my hip and I had to have some surgery. So I had to come in contact with doctors and it just really interests me how much they knew about the human body. And so with that introduction to medicine, at the age of nine, I decided I wanted to be a physician in a family medicine component kind of came when I got to medical school and I saw how much a family medicine doctor can do as it relates to interacting with patients of different ages as well as different medical conditions that they're they're dealing with. And so I love variety and family medicine is right up my alley when it comes to taking care of a variety of ailments with patients and then doing also some hands-on things like procedures and those kind of things. So I really do appreciate the, the interaction I had as a child that really led me to my love and passion for medicine.

Shireen: Now we hear about food as medicine, but you have coined a term called movement as medicine. What does this mean?

Dr. Barnes: Yeah, so I think I saw somewhere on the internet where it said movement is medicine or movement as medicine. And so I kind of picked up on that because I have always loved dancing and exercise and as a child I just was very active. And so when I got into my adult life and got into medical school, I was still very active. So when I was thinking about what we do to help lose weight, my focus was on let's exercise twice a day. That's what you got to do to lose weight. That was my thought process. Even up until maybe 10 years ago, that was my main focus was more on exercise, and it was on eating healthy. Although I was uh, I think, I think at that time was pretty healthy vegetarian, for the most part. But the exercise component is something that I think we, we know that, that is part of a healthy lifestyle is exercise. But I think we don't also see that it's not just part of our cardiovascular fitness and improving our cardiovascular health. It's also part of our mental health. So when you look at exercise and the recommendations from the American cardiology society, and from Mayo Clinic and Duke and all these different entities, they definitely focus on helping patients see what number of minutes you're supposed to be doing as far as your activities to try and be physically active. So 150 minutes to 300 minutes a week is what's recommended for physical activity. I don't think that we as a population focus so much on our physical activity can really help us from a mental health standpoint. And so movement as medicine is really a phrase to say you can use these activities that you're doing to improve your cardiovascular fitness, but you can also use these activities to improve your mental health. So if you have depression and anxiety there are multiple studies that show how physical activity helps to improve depression and anxiety, even yoga, stretching those kind of things really helped to improve and depression anxiety and looking at the definition so we look at what is the definition of physical activity, what's the definition exercise, so physical activity is doing any kind of movement that helps to the contraction of the skeletal muscles in question. energy expenditure above your base level. So your basal level of energy expenditure is, for example, you wake up in the morning, brush your teeth, you sit down on the couch, eat some popcorn, and you watch movies all day. So your body is actually burning some calories while you're doing that, and it's based off of your age, it's based off of your sex. And so when you factor those things in, you're going to have a certain number of calories that you're burning during that time period. So physical activity would be like taking the trash out, or going to the garden and doing some gardening that is physical activity. But what exercises that makes it different is a planned physical activity. It's a structured, repetitive and purposeful use of an activity that the main objective is for the improvement and maintenance of your overall health, physical fitness. So that's what exercises

Shireen: Interesting, how does this concept of movement as medicine really translate into your work and the patients that you see?

Dr. Barnes: I have a benefit of working in a population that's more at risk. And so we take care of patients and I have been doing this since pretty much since I finished medical school and residency in 2006-2007. And working in federally qualified health centers and institutions and clinics where we focus on treating patients who may not have as much access, we get exposed to all the different socio economic things that may factor in and affect an individual's ability to eat healthy individuals ability to move and feel safe in their environments with activity. So when I see a patient, I always try and keep in mind that each patient is different that no matter what's going on in their life, we have to be mindful and respectful of their different cultures, and the different things that may allow them to have more barriers to movement. And we have more barriers to seeing food as medicine as well and try to understand where they're coming from. And so when it comes to movement, I just tell them, even if you can't get out the house, if you don't feel safe getting out the house or right now we're in a pandemic, so a lot of people are not trying to go to the gym, they're not trying to do activities where they're around other people, and they're exposing themselves to maybe so increased risk of contracting the virus So, so you can stay at home, you can use things at home as tools for exercising, for instance, you can use a one gallon jug of water, you can use your cans of beans or anything you got in your your cabinet. If you haven't donated those for Thanksgiving dinner, you can use whatever you have at home as a good source of tools to use to exercise. So I talked to them about using what they have on hand and not thinking that they have to have a lot of money to buy expensive equipments and things of that nature in order to be physically fit and work on their cardiovascular fitness. And then also just walking around your neighborhood getting some fresh air. Vitamin D is important as we're thinking about the pandemic and making sure that we're staying healthy, you get a lot of your conversion with vitamin D from the sun. So go outside, get some good sunlight. Those are important things that most of us can do. And it doesn't cost you anything. But we do talk a lot about that. And we talk about whatever ailments they may have. So some individuals may already have cardiovascular events, they may have had heart attacks, strokes. And so some of them may benefit more from a regimen or program that's already set up in place using a hospital based system that can monitor them. So definitely if someone is a individual who has multiple medical problems, talk with your primary care provider about what's best for you when it comes to starting a physical fitness regimen because you may need to be screened first, some people need EKGs or Eccles and those things before they can actually start a physical fitness regimen.

Shireen: Now one of the things in, you know, when you're seeing all of this, I'm thinking about other doctors, right? So when you talk about talking to your patients about being active and moving around and providing them this very detailed guidance, I don't see very many physicians doing that, nor are they trained to provide that kind of guidance, right. So we sort of hear the blanket statement that you know, eat healthy and exercise and come back again and you know, three months, six months, whatever, how do you go about sort of navigating that formation patient, providing them this type of guidance and also seeing impact from the guidance that you provide?

Dr. Barnes: So I can definitely agree that as far as the focus on nutrition and physical fitness as it relates to our prescriptions that we give patients, as physicians in medical school, the focus was not on definitely the dietary component, our writing a prescription for physical fitness, that was not the main thing that we were focusing on during our didactic years in medicine, things are changing now. So there are definitely more hours that they are implementing in the education of doctors, they can help us, you know, figure out how do we want to get a patient on a prescription for physical fitness. What I'm doing right now is a program in functional medicine that is focused around plant based nutrition that's focused around looking at the root cause of disease. So the neck particular aspect is definitely helpful as far as the physical fitness aspect, but I look at what the patient is, I look at their ability to move at all. So some patients are paraplegic, or if patients have problems with a stroke and they can't move one side of their body or the other. I look at each individual as a entity that needs a particular prescription for physical fitness and honestly when you look at the studies and the research there's not a one size fits all for patients because Everyone's different. And what they're able to do is going to dictate what it is you're going to ask them to do. So I really just have patients look at their individual situations, we start off with some goals, some basic goals that they can set for themselves. If it's just 15 minutes a day, two to three days a week, I say that's a good goal. And when you look at the goal, Now, the next week, we may need to change that a little bit, maybe we make it 20 minutes a day, three to four days a week. And so what we find when you look at this research on happiness, and, and how patients get into their flow flow is where you have an intersection between challenges and the ability to feel like you have the tools to be able to reach those challenges. So if you feel that you're strongly equipped, and you're also being challenged, then you hit a flow. And when it comes to being able to exercise and stay in sync with your goals that you set for yourself, you will have to challenge yourself a little bit. So from week to week, you have to set those goals and you may have to increase them with each week that you're doing them as that's what I talk to patients about if you give them a set goals that we communicate basic come up with this together, it's not just me saying here, this is what you need to do, sit down and look at this and then go complete that for the weekend. Give me a call in a month or so and let me know how you're doing that doesn't really work for patients, you really have to have them committed. And so they have to be part of the decision making process. In order for them to understand that this is their life, this is their body, this is their overall health. And if they're part of the discussion, they're also part of the solution. 

Shireen: I love that approach. I wish more physicians did that. You talked about functional medicine and looking at food so I want to switch gears real quick and touch upon food and the nutrition side of things. Do you prescribe a particular diet? You know, how about you know specifically for your diabetes patients? What do you do there?

Dr. Barnes: With the diabetic patients, with their new patients, new onset diabetics, I love to get them in with diabetic educator. This is someone who is trained for hours and hours. So usually nurses and they go on to, to get further certification to become diabetic educator. And they have the abilities and the tools to sit down with them to go over their medication requirements to go over what it is they're eating and how to set up their meal plan how to look at food from you know the carbohydrates and macronutrient components and be able to come up with a meal plan individually for them that works. So with the diabetics, I definitely set them up diabetic educator and for all of my other patients who may not be diabetic, maybe they're pre diabetic, maybe they have hypertension, or maybe they are obese or something of that nature, I look at where they are right now I really like them to give me a five day food diary. So that's one of their holdings that I like them to have. I like to sit down with them and kind of go over that five day food diary and see what things are showing up that could be inflammatory types of foods, because inflammation is really the key to how we see disease presenting itself in our bodies. So it's something that a lot of researches we've gone into as it relates to your gut health and your ability to fight off infections, your ability to decrease the risk of cancer and decrease the risk of cardiovascular events is really linked to a lot of inflammation in our body. So looking at their five day food diary, seeing what's already there, then seeing what changes they're willing to make. Because it is a partnership that we're doing when it comes to making these changes with their diet. It's something that they as the patient I feel they express a greater ability to stick with the plan if they're helping to make that plan for themselves. So I, I love talking with them about things like the elimination diet, which I'm learning more about through the functional medicine course I'm taking, there's a cardio metabolic diet, detox diet. So there's different things that we can talk about when it comes to what it is needs to be eliminated from their diet, what needs to be added to it, a lot of times people will understand and know that, okay, I can't eat fast food, but what is it that you need to eat instead of the fast food in order to you know, decrease your risk of infection to decrease your problems with loading, those are things that I like to talk to patients about.

Shireen: And so this is coming more from the functional medicine side of things.

Dr. Barnes: Yes, it actually, what I love about functional medicine is that I just started it, but the whole thought process around the root cause of disease. I've been doing that for years. And I really just appreciate that I'm linking up with a program that really helps to get that evidence based medicine behind the focus on nutrition and how nutrition is something that we can use to help heal our bodies from the inside. Because the body is such a smart, intelligent and wonderful tool that we can use that we've been given. And when you have problems in the body, we have diabetes, and we have you know, problems with polycystic ovarian syndrome. All those things that are going on, those are not things that just happened to our bodies. Those are things that our bodies is saying, hey, there's something going on and here and we need to make some changes. So it's really important to listen to your body and pay attention to what it's telling you because it's, it's showing you that there's something going on at the level of the cellular level that needs to be addressed. And a lot of times it will be improved by changing things in our diet.

Shireen: Such a close relationship between illness and diet and also activity and if you're, if you're not focused on sort of that, how, how they play a role. You sort of miss a boat on what your body's really trying to say to you.

Dr. Barnes: Yeah, so we can't ignore those cues. So if you're having a lot of excuse my reference to it but gas and bloating, that means there's something going on in your gut, you know, there's some way that your body is not processing food appropriately that's causing that loading. If you're having problems with, like I was talking about polycystic ovarian syndrome, or problems with insulin insensitivity, you know, these things are linked to how we're eating, how much things we're eating. And it's important for us to stop if we're still having those issues, and kind of back up a little bit and look upstream, look at what could be the cause for those two good things are going on and stop just putting medications and prescriptions on top of prescription that we know do not work as well, because we look at medications. And studies show that when patients are taking these medications, they're only working for a small sector of the population that exactly the way we want them to work without any side effects. So medications, if definitely, if your doctor has recommended that you take something talking about that, but it's something that we know does not work for everybody the same like just because it has not been tested on every single person and everybody's genetics a little bit different. So someone who takes Metformin may do perfectly fine. If this is you know, Paige patient Smith, but if we go over to patient Johnson, that Metformin may not be doing as well for them as far as lowering their blood sugars. So really understanding that it's not about just writing the prescription. It's understanding where the patient's coming from what they're doing in their day to day life and their lifestyle, that may be something that can contribute to that medication, not helping them. And then before we even start thinking about medications, what is their diet look like? What is their sleep look like? You know, what kind of stressors do they have in their life? Do they even have the money to purchase these medications? Did they have some kind of predisposed idea that Oh, my mom took that. And you know, a month after that, you know, she had her leg cut off. I've had patients tell me that like when it comes to insulin, they're like, I'm not taking insulin, because this is my mother started taking insulin, you know, she had to have an amputation. So we have to look at it from a behavioral health standpoint, definitely. Because there's certain things that patients are not going to want to do. And it may not have anything to do with the medication at all, but really to do with how they perceive that medication works.

Shireen: There's some powerful words in there. And again, as you're saying, all this in my mind and thinking and more physicians were to use that language and were to really meet patients where they are, boy, the difference we can make. So we're, we're rounding up toward the end of the episode. I before I let you go, though, Dr. Barnes, I do have to ask you any other creative exercise ideas that you have for us?

Dr. Barnes: Well, I definitely love dancing. That's one of the things that a lot of folks will see on my timeline. It said, I love dancing. I love all styles and genres of dancing. Anything that's cultural and ethnic, I love to do some bosasa, West African, we do sabar, I'm currently, I am doing Kizomba, which is a lovely dance from Angola. And the instructor that I'm using, she lives in Amsterdam, but we do it through zoom. And so I definitely would recommend if you feel like you can't move in to talk with your doctor. First, make sure that you're clear to do any exercise. If you feel like you can't do any kind of activity, because you can't get out of your house, look into those online programs that may be available for you. If it fits your pace more to do something like yoga, or Tai Chi, there's a ton of things that's online, I recommend just at least investigating what's on there. And if you don't have any chronic mental conditions that need to be cleared and evaluated first with your primary care doctor then trying to see if some of those things may work for you as far as moving your bodies around, even in the comfort of your home where you don't have to worry so much about touching those fomites that are out there. But all of that movement is important for your soul. It's important for your spirit, and it's also important for your cardiovascular fitness. 

Shireen: On that note, Dr. Brian, thank you so much for your time again today. How can folks connect with you after this episode?

Dr. Barnes: You can look me up on Instagram at the vegan MD that is my handle. I am also on Twitter as well take a Barnes and then I'm also on LinkedIn. So I tend to do a lot more posting on Instagram so you'll be able to see some of my creative exercising and resistance strength based activities that I do. But I'm also on Facebook and so I try to connect in those different ways.

Shireen: Well thank you again for your time Dr. Bronze it was an absolute pleasure talking to you and learning about movement as medicine. 

Dr. Barnes: Thank you so much.

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