The TOFI Tribe

Everybody has them... The friends that just seems to magically be thin. While you and I have to watch every single thing we eat, and spend hours at the gym, these people can eat whatever they want. They can gorge on double cheeseburgers and french fries, down milkshakes without a care, and trade their gym time for a double feature at the movie theater. Even though they apparently neglect all of the eating and nutrition rules, they never seem to gain weight. In fact many of them are downright skinny. You probably secretly hate this person, but you also envy them.

Don't.

I spend a lot of time counseling people on how to live like cavemen. There is one tribe out there that I very much worry about. It is the TOFI (Thin Outside Fat Inside) Tribe. From everything I wrote in the last paragraph, they seem to have it made. They eat whatever they want, don't exercise, and never really gain weight.  Unfortunately, reality is far more complex than that. TOFI's have several problems:

1. Their risk profile is more like that of an obese person than a thin person. TOFI's may look thin, but they have a fair degree of intra-abdominal fat around their visceral organs. This is the fat that really increases the risk of heart disease, type II diabetes, metabolic syndrome, high blood pressure, and early death. According to recent studies, TOFI's have 2-3 times the heart disease risk of fitter people, similar to an obese person.

2. They are largely unaware of their risk. We as a society put some social stigma on being overweight. It is hard to ignore the stigma, as well as the obvious health risks of being an overweight person. Trust me. Since TOFI's are thin in appearance, they do not suffer the social stigma that obese people do. In addition, they probably don't know that they are at an increased risk of diseases until they actually happen. I have seen this many times in my capacity as a physician, and they are always shocked to find out that they have diabetes or heart disease. Don't assume that being thin is all that matters.

3. They don't have to work for their thin body. If you have ever lost weight and tried to maintain an exercise regimen, you know what a struggle it is. Personally, I work out for at least 60-90 minutes a day. Exercise is not an easy thing to do, even if you find it fun like I do. The upside to all of this difficulty is that you truly value the product. The amount that we value something goes up in direct proportion to how difficult it was to obtain it. Since TOFI's are thin with little or no effort, they usually do not value what they have. Also, when they get older, and their ability to remain thin without effort goes away (as it usually does with age), they lack the abilities to exercise hard and eat right that formerly overweight people would have had.

So the next time you look at John or Jenny, the person who never has to work at it and is always thin, remember the burden of being part of the TOFI tribe. Value the hard work that you put in, and the harvest of fitness that you will reap at the end. Also mention this post to your TOFI friend*. You may just save their life.

*DevolveHealth and the Devolve Your Health blog assume no responsibility for ruin of friendship or bodily injury that may occur from telling your friends, colleagues, or enemies that they are fat on the inside, or on the outside for that matter.

Thag Eat Like Baby

So I was feeding my 7 month old the other day, with commercial baby food. Spinach and rice was the dish of the afternoon. He is just learning how to eat solids, and the process is far from efficient yet. Fully two thirds of what goes into his mouth comes back out, but with diligent chin scraping, eventually he can consume the whole jar.

Since I spend so much time thinking about nutrition and what food goes into my body, I decided to have a look at the ingredient list of the baby food in between bites. Keep in mind this is spinach and rice. The ingredient list was as follows:

Spinach
Rice
Water

That's it! Three ingredients, and exactly the ones advertized on the front label. I was shocked to discover that there were no preservatives, chemicals, or other nasty items. For a "processed" food, this was pretty awesome. It seemed that the only processing that went into the food was putting it through a blender, and putting it into a jar.

Why is it that we know what good nutrition is when giving it to a baby, but not when we give it to ourselves? Obviously the makers of this baby food (I will not say the name, but it is a mainstream brand) know that salt, preservatives, sugar, and artificial flavors are not good for us. If they truly thought that these things were OK, they would have no qualms with putting them into baby food. Yet they don't, because we all know that these food additives are no good. This same company makes food for adults as well, and those foods are full of added sodium, sugar, coloring, flavoring, and other miscellaneous chemicals.

I am not singling out this one company. Virtually all of the food companies offer processed foods that are very poor nutritionally. Yet we seem to be able to get it right when it comes to babies. I know that we adults have more complex tastes than babies, but if you have read my earlier posts, then you know as well as I that our tastes only serve to mislead us when it comes to food choices here in the 21st century. In short, we should all eat like babies.

Now don't get me wrong. I am not suggesting that you go and buy hundreds of jars of baby food. Economically that would not be very feasible. Also, think what your next dinner party would be like. Actually, that might be kind of funny. Instead, the very same ingredients in that baby food are offered for purchase at your local supermarket. Seriously. You don't even need to be a VIP or celebrity to get them.

Kidding aside, the fact of the matter is that fruits, vegetables, grains, and nuts are what we were designed to eat in the first place. I don't know about you, but I've never seen aspartame growing in nature. I have seen spinach and rice, however. We should all take cues from the types of food we choose to introduce to our youngest children once they begin to eat solids, and like our younger versions, we would probably be less plagued by heart disease, diabetes, high blood pressure, and obesity.

M. Jacob Ott, M.D.

Thag Hurts

So I was running the other day. Nothing unusual for me, an easy five miles on the treadmill because I had to work later that night. I wasn't running particularly hard, but all of a sudden I got a severe pain in my right knee. It lasted only a minute or two, then went away. I finished my run and went to work.

The next morning, I was a little sore, but not too bad. I decided to give it a rest day, and see how things went. I took a day off, then ran the next. The knee got sore again when I was running, but felt better when I stopped. OK, I thought, not too bad.


The trouble really started the day after that, when I decided to put in a fast three mile tempo workout, to "really test my knee." All hell broke loose, and afterward, I was unable to walk without limping. It was clear that my injury was not as minor as I was pretending it was.

The fact of the matter was that I was being stupid. That tends to happen to me from time to time, especially when injuries are concerned. If you are going to choose physical activity as a way of life, then injuries will be part of it. Even if you don't, you will still be susceptible to injury, perhaps even more than those who exercise, as your body will be weaker. I will assume since you are reading this blog that you either exercise, or want to do so.

If and when you get injured, here is what you do:

1. Don't be like me- do not stupidly try to ignore your injury. It may be minor or it may not, but at least pay attention to it.
2. Seek professional assistance- If you have an injury that seems like more than just muscle soreness, particularly if it involves a joint, go to a sports medicine specialist for an exam, and possibly some testing. Athletes can be prone to stress fractures and other odd injuries that generalists are not well versed in diagnosing, and which don't show up on regular X-Rays, like the one above.
3. Rest- This is the part that I have the most trouble with. You need to stop activity and let your body heal. The good news is that the body is fantastic at rebuilding itself, and can heal the vast majority of injuries, provided that you give it time. If you're like me, you just need to get your obsessive compulsive nature out of the way and let it heal
3.5 Find Other Activities- This is what I failed to do that is so important. Even though I could not run on my bum knee, I could bike, swim, weight train, or any of dozens of other exercises that will let me get in my cardio and strength training and calorie burn. Just because you can't do what you want to do, doesn't mean you can't do anything.
4. Remember, Injuries are a Part of Athletics- If you are going to pursue athletics, you will get injured from time to time. It's that simple. There is really no way around it. None of us is impervious to injury. Remember that you are not alone, and everyone else gets injured from time to time as well. If you stick to your recovery plan and listen to the doctor that you saw in step 2, then you will be back to your chosen sport sooner than you think.

In summation, don't be stupid, like your local blog author. Realize that you are injured, trust your instincts, and follow these steps to recovery!

Plates and Pyramids, oh my

The pyramids are gone. No, not the ones in Egypt. I mean the food pyramid. For decades now, the USDA has offered a food pyramid like the one above as a guide to how to eat. It has been taught to nutritionists, and in public schools across the country (with the funding of dairy and food corporations, although they don't tell the students that).

After much political maneuvering, the USDA has changed the food pyramid to a plate. Instead of groups and groups of food with various numbers of servings, they have greatly simplified things. Now you have a plate divided into four quadrants. Half of the plate is fruits and vegetables. Half is grains and protein, with what is apparently a cup of dairy. Along with this comes some recommendations such as "enjoy your food, but eat less of it." or "make half of your grains whole grains." All in all, it was a brilliant marketing plan to make the USDA seem relevant. Unfortunately it will probably do nothing to solve our obesity crisis.

As I have discussed in earlier posts, we are hard wired to like salty, sugary, and fatty foods. The food industry has figured out over decades of practice how to best capitalize on this. Foods in stores today are formulated to maximize the flavor at the expense of nutrients. As such, their salt and processed sugar content is high. As if that isn't enough, the companies spend billions of dollars on lobbyists who try to influence groups such as congress and the USDA to allow them to purvey their crap. Thanks to these lobbyists, your new "Myplate" has a dairy group just like the old pyramid did, even though dairy is not even close to essential for a healthy diet, and may instead be harmful in some cases.

Cosmetic changes aside, the USDA really hasn't altered their recommendations at all. This is not too surprising, since they are using a flawed paradigm of nutrition that is not compatible with our bodies. Only in the modern era have we been able to eat large quantities of meat and grains. Only in the modern era have humans consumed dairy past infancy. Yet as a society, we base our meals on these two foods.

Until we get away from eating like modern people, and return our diet to that of our caveman ancestors, we will continue to suffer from the diseases of modern society, such as obesity, diabetes, and cancer. No fancy graphic will save you from that.

My dietary recommendations are unchanged. I still suggest that you follow these guidelines:

1. Eat foods like they grow in nature
2. Eat a wide variety of fruits and vegetables, and very little if any meat, dairy, or eggs
3. Choose foods for nutrition first, flavor second

Until the government gets it, and expels the lobbyists and food corporations from the recommendation process, you are better off not following their advice. None of them are looking out for your best interest, and they have demonstrated their willingness to alter the recommendations to maximize profits and re-election chances at the expense of the public. That is rather shameful.

I personally and publicly challenge our so called "representatives" to be brave and speak for us, rather than for big food corporations. After all, they are supposed to be OUR lobbyists.

Support Systems

I've been working night shifts the past week or so, as I do once every month. This is tough on your body, as it has to adapt to a different sleep/wake schedule. As you can probably guess, my appetite and exercise schedule go a little haywire while this happens.

I came home from a night shift on Saturday morning, and my wife was up, having just awakened. She was eating breakfast. After talking with her for a minute or two, I made ready to go up to bed, as I normally do after a night shift. I was hungry, because that is normally breakfast time for me, and for whatever reason I decided to make a s'more, even though I would normally never eat that.

My wife, who has to frequently suffer through my rambling about healthy lifestyle since she has been with me for ten years, through my high weight phase and all of my weight loss, went ballistic. "What are you DOING?" She asked me. I mumbled some sort of halfhearted excuse, and she said just the right thing:

Why are you eating?
Why are you eating THAT?

If you have read my blog before, you may recognize these questions. They are the very same ones I encourage the people I advise to ask before a meal. Asking the questions focuses your attention on what you are about to eat, so that you are thinking with your brain, rather than your emotions. Your brain makes far better food choices than your feelings.

Once I had engaged my tired brain, I of course realized that eating sugar laden s'mores was bad. Eating them right before going to sleep was even worse. This was a very poor food choice, and Christy had just saved me from making it. The correct thing to do was to ignore my hunger (it wasn't that bad, anyway), and go right to bed.

This episode reminded me of the importance of support systems. Whether you subscribe to religion's view ("And God said: "It is not good that the Man should be alone." - Genesis 2:18) or the evolutionary view (primates as a rule are extremely social creatures), we were almost certainly meant to interact with our fellow humans. A great many activities are easier when done with others. This is definitely true for weight loss. I don't know about you, but there are many days that I just don't have what it takes. There are days when I just don't want to do what is necessary to be healthy, either because I am feeling lazy, or just emotional. On those days it is nice to have someone to help carry the load, and remind me what I am doing all of this for.

Now many of you may not be married or have children, but there are plenty of support groups out there, and most people have at least one friend they can share with. If all else fails, email me, and I will be your virtual diet and workout buddy. Just remember, even the strongest of us needs help now and again. Admitting this is not a sign of weakness, but of strength and self-awareness.

Motivation

Everyone knows someone like this: They are that annoying friend who always seems to be motivated. You wake up feeling crappy and decide to take the day off. They cheerfully go to the gym at 5 AM every day, no matter if they were up until 1 AM the night before. You break down and eat an entire box of Krispy Kreme doughnuts. They seem to subsist on a lettuce leaf and a sliver of carrot, and enjoy it. Bottom line, despite the fact that they are your friend, you hate them. You also want to be like them and wonder what their secret is.

I have been both of those people throughout my life. I was the obese, donut eating couch potato. I am now a standard-bearer for diet and exercise. The difference between the two is motivation. When I was 350 lbs, I spent much of the day wondering what it was like to be thin, and wishing that I could make the changes necessary to lose weight. I felt stupid and embarrassed because I lacked the "willpower" to make changes. I also felt ashamed because I am a doctor, and should have known better then to get myself into such a mess.

I was committing a classic mistake. I was confusing desire with motivation. Most of us have desire. We want to be richer, better looking, happier, thinner, or healthier. We want these things, and assume that since we want them, the desire should be sufficient. It is not. Desire without motivation is not strong enough to force a change. Take alcoholics and people addicted to drugs. I see many people in these situations on a daily basis in the Emergency Department. Whenever I ask them if they want to stop, they say yes. In fact, many of them present to the ED with the chief complaint of "I want to detox from alcohol/ drugs." Sadly, 80-90% of these people will fail in their quest. Most people who successfully stop alcohol or drug abuse first have to hit rock bottom.

Why does hitting bottom make success more likely? It adds motivation to their desire. Instead of some abstract concept of being drug free trying to compete with the very real pleasure offered by the drugs or alcohol, the person is faced with extremely negative emotions due to very bad consequences in their life. These negative emotions are strong enough in many cases to enable permanent change.

You don't have to be a drug addict, or hit bottom to use this idea in your own life. The key is the emotion. We spend a lot of time and energy trying to avoid our negative emotions, because they are uncomfortable. It is hard to look at ourselves and see the flaws. It is much easier to lie to ourselves and minimize our flaws. This is unfortunate, as our negative emotions can actually be our best friends. The key is to view them for what they are: tools. Emotions are tools used by our brains to make us do things. It is not a coincidence that the word "emotion" contains the word "motion." Practically everything we do starts with an emotion. Emotion produces thought, which produces action.

This means to motivate yourself to change, you just have to attach negative enough emotions to the way things are that changing is the more palatable alternative. For me, the negative emotions came from the fact that I might not get to see my children grow up due to my poor health. The shame and sadness that this scenario brought to me was enough to get me started on the path to weight loss. Now, that shame and fear of going back to the way I used to be keep me motivated. If you want to have such motivation in your life, then you need to find your reason. In order to say no to the pleasurable foods, pervasive advertisements, and easy sedentary lifestyles which are so common in our society, you must have a bigger yes inside of you. The negative emotions will clue in to what you want most, and provide the yes that you need to move from desire to motivation.

Gym? You Don't Need No Steenking Gym!!!

Perhaps the two biggest excuses I hear when it comes to exercise are these:

1. I don't have time to work out or go to the gym
2. I can't afford a gym membership

I know that we live in a busy world. Since regular physical activity is no longer part of our daily lives, and we no longer have to struggle to survive for the most part, if we don't specifically build exercise into our day, it won't happen. The cost of this is staggering, and I'm not just talking about dollars here. If you are obese, your life will be on average 7 years shorter than your normal weight next door neighbor.

Because of these costs, we can't afford to have excuses when it comes to our health. I will be your excuse remover. In this post, I will show you how to develop a simple and effective strength and cardio workout that can be done in your house or anywhere, with little or no equipment.

The Devolve Workout
This is one of many work outs that you can do. It consists of strength moves hitting the major muscle groups, then cardio. I have arranged it into an easy circuit, which you can mix and match as you see fit.

Abs:
Plank
Side plank
Twisting plank- Start in plank, then twist your body, kicking your leg toward the opposite arm.
Chaturanga- Like plank, but hold yourself with your chest 1-2 inches off the ground.

Back:
Pull up- either unassisted or with a chair under your legs if you are not strong enough to do a regular pull up.
Inverted row- hang from a barbell on a rack with your legs out in front of you and pull yourself up.
Table

Legs:
Squat
Squat with medicine ball- hold the ball out in front of you. Keep your back straight!
Prisoner squat- squat with arms folded behind head.
Lunges
Wall squat- lean against wall, legs at 90 degrees and hold. Try to ignore the horrid burning sensation.

Arms:
Push up
Moving push up- do a push up, move to the right while in plank, then do another. Repeat.
Fingertip pushup
*for pushups, if you can't do a flat pushup, do it at an incline. DO NOT do knee pushups.

Cardio:
Rope Work- Take a rope, twist it once around a pole, then use your whole body to move it up and down, side to side, or in circles to create a wave.
punching bag
Truck tires- push a truck tire, flipping it over (this obviously requires a truck tire)
No power treadmill- if you are near a treadmill, get on it, and push it with your feet, making the belt move.
Burpee
Floor run- get in plank and run with your legs
Sprint
Jumping Jacks
High knee run
Squat Jumps- Do a broad jump forward in jump position

This is by no means an all inclusive list of exercises. The point is that there are plenty that you can do without very much equipment.

How to set up the circuit:
Pick one exercise from each category. Do each exercise for 1 minute. Rest 30 seconds after the circuit. Pick different exercises and repeat. Do this until you have reached 20-40 minutes. Over time, increase the amount of time that you do each exercise for, and increase your total circuit time to 1 hour.

Remember to MIX IT UP! Your body adapts to the same old thing, so switch exercises regularly. Preferentially do the ones that are particularly hard for you, as those are the ones that will give you the most benefit!

M. Jacob Ott, M.D.