An Attitude of Gratitude

We in America are good at wanting things. We are a consumer culture. Advertisements on TV show us things to buy. Everyone is concerned with having the latest, greatest, and newest. From the time we are kids, until we are adults, we seem to want, want, want.

Today, however, is a day for giving thanks for what we have. When I was young, I saw a motivational speaker. That speaker's topic was the importance of having an attitude of gratitude. At first blush, I did not really agree with what he said. Why was it important to have gratitude for the things I already had. I always thought my focus should be on my goals, and what I wanted. How on earth are you supposed to reach your goals by focusing on what you already possess.

I have grown and changed much in the intervening years since I saw this motivational speaker. As those of you who follow my blog know, I have had many trials and life experiences which have taught me the importance of being thankful. As it turns out, being thankful is critically important to any goal you might want to achieve in the future, for several reasons:

1. It reminds you of how blessed you already are- No matter how difficult your life is, there are some important things you possess. You possess life, the most precious gift imaginable. In addition, you likely have at least one or two people who love you. When you realize how important the things you have are, the things you want aren't quite so pressing.

2. It relieves stress- Part of the stress that we experience comes from the American rat race. The rat race is an endless pursuit. You run in circles pursuing a career, a higher rung on the corporate ladder, a bigger house, a nicer car, and more money. Ceaselessly pursuing the next big thing creates a feeling of pressure. This pressure turns to anxiety, which leads to stress. People who are under significant negative stress are at higher risk for obesity, heart attack, stroke, and sudden death. Gratitude is like a flood gate which releases the stress when opened. Someone who is grateful on a daily basis is far less likely to hold on to stress.

3. It makes you more likely to get what you want- I don't have a good explanation for this based upon science and nature, but it works. I attribute it to God. If you don't believe in God, you can call it the universe, karma, or whatever you want. Reason would suggest that there is no connection between being grateful for what you have, and getting what you want, but I can tell you from my own life that it works! If you spend time daily focusing on being grateful, many of the things you want will come to you, and you will be less concerned about the things that don't.

As you sit down with your family members to your (hopefully healthy) dinner, spend a minute being thankful for all the blessings in your life. In the end, you will have much more to be grateful for!

M. Jacob Ott, M.D.

Eat the Whole Food

Better living through chemistry. DuPont used this slogan back in the 80's. The intent of the phrase is obvious: DuPont (and by extension, mankind) can top nature by producing artificial products to meet all of our needs. Better materials, better drugs, better foods, all of these things are implied by the slogan. Back in the 80's, most people really believed in it. Not DuPont, necessarily, but the idea that we could create products out of virtually nothing which could supplant similar (inferior) versions made by nature.

These days, much of the public and virtually all of the healthcare industry believe the same thing. We have synthetic medications, clothing fibers, building materials, and synthetic foods.

Synthetic foods, you ask. OK, so you might be thinking "I don't see any polyester apples out there," and you are right. We don't have completely synthetic foods, but we have something very close to it. Food companies are able to chemically separate parts of foods, and combine those parts into various other types of "food." I put food in quotes, because these products have little or no value as food. Mostly they are clever combinations of corn and soy molecules. Not the good parts, mostly the fat and sugar.

Yet these convenience foods flood our grocery stores and vending machines, and many people eat a diet which consists of almost all processed convenience foods. Often times, these foods are even marketed as being good for you. The manufacturer will note one or two of the nutrients contained in the product, and tout it as being good for you. For example, I am currently looking at a cereal box that touts "heart healthy grains," and "14 vitamins and minerals." Of course, they fail to mention that the "heart healthy grains" are combined with high fructose corn syrup, and that the "14 vitamins and minerals" were added in artificially, and do not actually belong in the food in question.

What is the problem with synthetic foods, you might ask? If we get all of the nutrients we need from them, why is that not an OK way to eat? They are easy and taste good. Well, there are really two major problems, and a host of minor problems. I will discuss the major problems here:


1. The foods are too energy dense. Processed foods concentrate the parts of food that we humans find appealing based upon our sense of taste, namely the fat, salt, and sugar. They leave out the fiber, starch, and all the "filler" which is in whole foods. This amps up the calorie density, and makes the foods far richer than they should be. Thus, you eat far more calories before your brain knows that you are full.

2. All that "filler" is pretty important. We are pretty arrogant as a species. Because we now believe in the omniscience of science, we study foods, and try and isolate the parts of food that are "good for us." We hone in on these nutrients, and study them. When we find one that shows some benefit in our studies, we start adding it to all kinds of processed goodies. We feel good about ourselves, because we think that this makes the otherwise unhealthy food healthy. Unfortunately, this is very far from the truth. In our arrogance, we forget that there might be other chemicals in the whole foods that we can't detect which contribute to the benefit we see. A classic example of this phenomenon is fiber. I'm sure you have heard that fiber prevents colon cancer. Shortly after this was discovered, synthetic fiber products appeared in large numbers on grocery shelves. Fiber was added to cereal, doughnuts, bread, and scores of other foods. People feel better, because they are able to get their 35 grams of fiber without changing their habitual diet at all. Wonderful, right?

Not so much. The colon cancer rates did not fall with this influx of fiber. In fact, they got higher! When the scientists did research as to why, they got quite a shock. Where the fiber in whole foods did lower the risk of colon cancer, the "fake fiber" in the other products did not. The same is true of most of the nutrients the USDA recommends. While vitamins are crucially important, and deficiencies of vitamins cause diseases, taking vitamins in pill form does not improve lifespan or mortality. In fact, some recent studies have shown that taking a vitamin may actually INCREASE your risk of death!

The bottom line is that we were meant to consume the whole foods, not their chemically rearranged counterparts. There are probably thousands of nutrients in the whole foods that we are unable to detect that work together to produce health benefits. That is why the Devolve eating rule #1 is:

Eat foods like they grow in nature

Wherever possible, eat the whole, unprocessed food. The closer you get to plucking it off the tree or pulling it out of the earth, the more nutritional value you will get out of it. In general, if your food was created in a lab, you will probably need to take a lot of lab created medicines to treat the diseases your created foods caused.

M. Jacob Ott, M.D.

The not so Incredible Edible (but Don't Eat it) Egg

The egg. Throughout my life, I have watched the egg swing like a pendulum in the court of public opinion. There is no food that goes from good guy to bad guy quite like these little guys.

In the 50's and 60's, athletes used to drink raw eggs to build strength. In the 70's, there was a backlash against the egg, and people were told to stop eating eggs, or cut back due to the spike in heart disease. Cholesterol in the eggs was blamed for this spike. In the 80's, eggs got a reprieve (I pulled the little slogan that I modified for this post's title from the 80's, although it has recurred in egg advertising throughout the years).

And so it goes. Every decade it seems, the egg switches from one extreme to the other. Eat it, don't eat it... Right now, it happens to be enjoying another good period. I recall Dr. Oz telling millions of unsuspecting people to eat an egg a day. I shudder to think of the devastation his advice on this point will cause.

As the court of public opinion with regards to nutrition is generally based upon expert opinion, let me explain why experts can't figure out where exactly to place the egg.

To the left is the nutrition label for the egg. One egg contains a relatively modest number of calories (around 70), and no carbohydrates. The numbers that the experts go back and forth on are the cholesterol and protein. As you can see, the egg has a lot of cholesterol (70% of what the USDA says that you need), and 6 g of protein (a pretty large amount for the small number of calories in the egg). So what is the problem?

The problem is, that in the opinion of most experts, protein is good, but is the amount of protein in the egg worth the amount of cholesterol that it contains? So experts with differing views argue back and forth.

Now for the problem with the problem: the experts are completely ignoring some very important facts. Many of them are aware of these facts, but because of various interests (financial is one, trying to appear mainstream is another), they choose not to tell the public. This puts you at some risk.

I am going to tell you the truth as I see it based upon research that has been done. I believe in this so much that I choose to follow my own advice in my diet, to tremendous result. You can choose to believe what I write, or not, but at least please read it and give it a chance. I just want to improve your health. I have no financial interest in this situation, and I don't care what the mainstream thinks about what I have to say.

Let's start with cholesterol. The USDA sets a limit of 300 milligrams of dietary cholesterol as what you should consume daily. As I already said, the egg has about 70% of that. What is this number based upon? Nothing at all. It is the consensus of a group of experts. Since all animal fat contains cholesterol, they had to pick a number that allowed for what they considered adequate amounts of animal foods in the diet. As you can imagine, this was heavily influenced by the egg, dairy, and meat industries.

Jake, you might ask, how much cholesterol does your body actually need? Great question. The answer is none. Zero. Zip. Cholesterol is a very important fat, and is found in virtually every cell of your body. Here's the rub: your body can easily make all the cholesterol you need, from other nutrients you intake. There is absolutely no need to take any in at all. On the other hand, cholesterol intake does have some other significant consequences. In multiple studies, a blood cholesterol level of greater than 200 was associated with double the heart attack risk of a level under 200. In medicine, we set the "normal" value for cholesterol at 200. This is incomplete data, however. In other studies, a cholesterol level of less than 150 was associated with a 5 times smaller risk of heart attack than a level of over 150. The cholesterol level of your average meat eater? 150-200. Your average vegetarian? 150-175. Your average vegan? 136.

Faced with these numbers, you might be wondering if all that protein is worth the risk that the cholesterol brings. Now we will deal with the protein issue.

Based upon multiple sources, including The China Study, animal protein intake has been linked to the following diseases:

Heart disease
Stroke
High Blood Pressure
Diabetes
Peripheral Vascular Disease
Colon Cancer
Prostate Cancer
Breast Cancer
Esophageal Cancer
Obesity
Osteoporosis

This list is not all inclusive, but is a good sampling. It should be enough to give you the gist. It is becoming more apparent that the protein is just as bad as the cholesterol, if not worse. To top it off, you don't really need the protein anyway. The USDA recommends that protein make up about 20% of your daily calories. That is double the 10% of daily calories recommended by the World Health Organization, and four times the 5% that multiple studies have shown are necessary for survival and muscle growth. The USDA's number is heavily influenced by experts who were taught the same fiction that you have been taught (and that I was taught in medical school), and by lobbyists for various groups who farm the animals that produce the protein.

The bottom line: the experts who tell you to eat or not eat eggs were trying to balance what they considered to be the good (protein) vs the bad (cholesterol). What they didn't tell you is that both nutrients go on the same side of the balance scale. They are both bad. Eggs are edible, but unless you happen to be a snake or a mongoose, you probably shouldn't eat them, unless you want the diseases on the list above.

M. Jacob Ott, M. D.

Another SIde Effect of the Standard American Diet

In this blog, I spend a lot of time talking about the major health problems that go along with the standard American diet. There is no doubt that a western diet leads to multiple chronic health problems, obesity, and early death. I have seen it with my own eyes, both in myself and in my patients, many of whom suffer from hypertension, diabetes, obesity, heart disease, and various forms of cancer.

Today I was thinking about some of the other side effects of the western diet, mostly due to my daughter. Yesterday, she went to a small carnival at her elementary school, with a friend of hers. Christy and I were not there with her. She was with the parent of her friend.

Although our children are not completely vegan, only a tiny percent of their daily calories come from animal products. In general, they eat a diet of whole, unprocessed fruits and vegetables. At the little carnival, as you might imagine, the foods available were not the kinds we would usually feed her. She ate a couple of hot dogs, as well as several dessert foods made with processed sugar and flour.

Later that night, my daughter complained of abdominal pain. She had crampy abdominal pain, as well as several episodes of diarrhea. This lasted most of the night, and went away after about 12 hours or so. By morning she was all better.

I know what you are thinking: little kid ate too much and got a tummy ache. I was thinking the same thing, until I remembered that I used to get the same symptoms. Before I switched to a vegan diet, when I was very overweight, I used to get abdominal cramps and diarrhea so frequently that I had diagnosed myself with Irritable Bowel Syndrome. Until today I had never thought about it, but those symptoms stopped immediately after I switched to a whole foods vegan diet.

Apparently Irritable Bowel Syndrome is yet another side dish served with the standard american diet. If you have IBS, and don't believe what I am writing, I challenge you to switch to a whole foods vegan diet, and prove me wrong.

M. Jacob Ott

Milk: It Does(n't Do) a Body Good

Milk. I can think of no food or beverage that is more aggressively marketed. There are milk commercials on TV, celebrities sporting milk moustaches in magazines, and everyone knows the old slogan: "milk: it does a body good."

Milk is almost universally admired, and holds almost sacred status as a health food. Kids are told by their health teachers and parents to drink lots of milk, to build strong bones. Athletes are told to drink milk to help build muscle and give them energy. There is even a glass of milk on the picture beside the government's new plate graphic, which replaced the food pyramid. It would seem to indicate that milk should be a part of everybody's daily diet.

It's true that milk is the best thing for you and contains everything you need to grow and be healthy... if you happen to be an infant cow. That is the point most of us miss. Milk comes out of the mammary glands of adult cows, and is meant to be consumed by infant cows. Cows themselves even stop drinking milk within months of birth. In fact, humans are the only mammals who continue to consume milk past the stage of infancy.

In adults, milk can cause many problems. First and foremost, almost 30% of people are lactose intolerant. They lack the enzyme that breaks down the sugar. This leads to bloating, abdominal pain, and gas after eating or drinking dairy products. Why, you ask, would we lack this enzyme? Probably because we are not meant to eat lactose. It is basically only found in milk, which we are not meant to drink after we reach about 12 months of age.

As if that isn't enough, milk proteins can cause allergic reactions. Behind nuts, milk is one of the most allergenic substances in adults. In addition, those same milk proteins in experimental models can lead to the development and promotion of cancer. Animals fed milk proteins developed cancer at much higher rates than those fed only vegetable proteins.

Finally, people suffer from their own misconceptions about milk. If you ask almost anyone what food has the most calcium, they will say milk. Kale and bell peppers have approximately 100 times as much calcium as milk. Ask anyone what the most important thing they can do to prevent bone loss is, and they will say "drink milk." In reality, milk has little to do with bone formation, and load bearing exercise is the most important factor leading to strong bone development. Even if milk isn't actually bad for you, the misinformation which is sold about milk can be.

The last nail in the milk coffin is this simple fact: if the claims are true, and milk is important in preventing osteoporosis, then the countries that drink the most milk should be the ones who also have the lowest osteoporosis rates. Below is a graph of hip fractures (which are mostly caused by osteoporosis) vs milk consumption:

As you can see, the United States, which has by far the highest rate of hip fractures, also has one of the highest rates of milk consumption. Why does Hong Kong, who consumes less than half of the milk of the US have half the rate of hip fractures? Quite simply, because milk does not prevent bone loss.

I have nothing against milk. It just shouldn't be consumed by anyone except infant cows.

M. Jacob Ott

The Role of Hunger

Hunger. It is one of the earliest sensations we feel. Very little in the world has the power to drive us like hunger does. It is something that we can temporarily defer, but will always come back before too long. In fact, it is one of the few things in life that we can truly count on. Hunger will always come back.

How we are able to manage hunger plays a large role in determining our health. If we eat every time we get hungry, and eat typical modern processed foods until we are full, then the result is that we will be obese and unhealthy.

Why is it that this natural sensation leads us astray?

Just like with our sense of taste, the feeling of hunger was made to serve us in a primitive world where food was hard to come by, and getting it was hard work. Animals by and large are hard to catch, and plants while plentiful, often require quite a bit of work to expose or collect the edible parts. Our sense of hunger was designed to be a strong motivator, as a survival aide. We need strong motivation to make the difficult and time consuming search for food seem worthwhile. If we didn't have this, we would eventually have starved to death. For cavemen, hunger was a constant companion, which impelled them to spend much of their time searching for their next meal.

Fast forward to today. We live in a society where food is offered in nearly every building, and where high calorie, processed foods are as close as the next drive through. Animals are no longer hard to catch. They are factory farmed in ridiculous numbers and pre butchered for us. No work or preparation is needed on our part, other than tearing open a plastic wrapper.

Unfortunately, our sense of hunger has not changed at all. We still feel that consuming sensation that we must eat whenever our stomach empties. The problem is that we are no longer filling it up with low calorie veggies. We now eat pastries, meats, and candy as "snacks" to fill us up between our high calorie, processed, and unhealthy meals. Additionally, we now sit at desks all day, instead of working our bodies to catch and prepare our food. Is it any wonder we are obese?

We were made with this hunger sense as standard equipment, and we cannot get rid of it. There is a silver lining, however. We were also given a powerful brain as standard equipment, and it has the ability to override our basic instincts, such as hunger. In order to be healthy in a world full of poor quality calories, we must engage our rational brain.

The first step is to realize a basic truth. This truth is simple. In fact, it is so simple, that I did not realize it, because we are taught the opposite so routinely that I never questioned it. Here is the simple truth

IT IS OK TO BE HUNGRY!

Growing up, I was taught that you ate whenever you were hungry. From as early as I can remember to age 29, whenever the feeling of hunger struck, I ate something. I never bothered to question whether or not I needed to eat. I figured that the sensation of hunger meant that I needed to eat. Based on the above discussion, you can see that this is not the case.

In order to be free of the control of hunger, you need to become comfortable with being hungry. Practice not eating when you feel hungry. At first, it will be very hard, and you may not be able to hold off eating for more than 15 minutes. With practice, you will eventually be able to ignore the sensation of hunger for hours. Then it is time to put your rational brain to work. Now that the feeling of hunger does not consume you, when you feel hungry, ask yourself when you last ate, and if you need to eat, or if you merely need to live with the hunger for awhile.

Knowing that it is OK to be hungry, and that you can always eat later (unlike your primal ancestor, your food will not run away), you will be able to consume less per day, and only eat the amount of food that your body actually needs.

If it's so Easy, Then Why is it so Hard?

In my job in a physician, as well as my job as a health counsellor, I try to get people to change. Those people who are uninitiated in the medical world think that the Emergency Department is mainly a place of gunshot wounds, car accidents, and other major life threatening illnesses. In reality, these make up a minority of people who come through the doors of virtually any ED. These days, most of the patients we see are victims of what I like to call "diseases of lifestyle." These diseases are malfunctions of the brain and body caused by various voluntary activities that are not healthful. These diseases include:

Diabetes
High Blood Pressure
Obesity
Heart attack
Stroke
Gallstones (some cases)
Depression/ Anxiety (some cases)
Fibromyalgia or chronic pain syndrome
Cancer (some types and many cases)
Trauma (many types)

The activities that cause these diseases are as follows, in order of importance
Poor diet and lack of exercise
Poor diet and lack of exercise
Poor diet and lack of exercise (this is not a misprint. It is just that important)
Smoking
Excessive alcohol intake
Drug abuse

As such, I spend a lot of time speaking with people about how and what to change. The things that I am asking them to do seem so simple when I say them or write them out: Quit smoking, eat better, exercise a few times a week, pay attention to their health and follow through with routine medical exams. Despite how easy these changes seem, a surprisingly low percentage of people are able to change, even temporarily. Why?

As my wife reminded me yesterday when we were talking about this subject: "change is hard, even if it is from something you don't like." She is correct. Even if I can get someone to recognize that there is a problem with the choices they are making, and that they are responsible to change it (a very difficult proposition), habit is powerful. Even a habit that you don't want, and know is bad, like smoking or poor eating is difficult to change. We as human beings resist change, whether good or bad.

In order to create change once and for all, we must overcome that resistence. Fortunately, we were given one weapon to help us change. It is not our intellect. I can reason with a patient all day long about how smoking is going to kill them, and they will nod, say they understand, and light up the minute they leave the ER. The weapon that we have to aid us is our emotion. Strong emotions, like fear and guilt, can push us to act when we are faced with the necessity of change. Fear can be supplied by a medical scare, like a heart attack or a tumor, or by social consequences. That is why you often hear of people quitting smoking or beginning a diet and exercise plan after being diagnosed with cancer or a heart attack. Similarly, the alcoholic quits drinking when they experience enough pain or fear that they don't want things to get worse (rock bottom). The power of our rational mind is that we can create the fear without the bad consequences. Visualization in the brain is as real to us as reality is. If you explore your uncomfortable emotions and visualize the negative consequences of the decisions you make, it will be far easier to overcome them.

This is how I finally managed to change. I was forced by my circumstances to visualize the fact that my children would have to grow up without their father, and that I would not be around to see the important events in their lives if I did not change. In the span of a second, the change that had eluded me my entire life became simple. So to Christy and everyone else, I submit my version of her quote:

"Change is easy if you have the right reason." Find your reason.

Who Advertises for Apples?

So I was reading in the news the other day about a fight that is going on in Washington. This fight is between the government, who believes it is acting in the peoples' best interest, and the makers of processed foods and beverages, who are sure they are acting in their own best interest.

The fight is over what sorts of food are acceptable to market to children. In particular, the article was about Goldfish Crackers. The government was contending that Goldfish should be classified as junk food, and not marketed to children, on the basis of the fact that they are made with white flower and other processed ingredients, as well as the fact that they have saturated fat in them. The lobby group that represents Campbell's, the company who makes the Goldfish in question contends that they should be classified as 'healthful,' and thus acceptable to market to children.

I think that they are both wrong.

As a father of three, you might imagine that I have very strong opinions on this subject. Lets ignore for this post the association of TV with childhood obesity, and only consider the marketing aspects. What kind of foods should be OK to market to people who have poor impulse control, no or little rational capacity for decision making, and most importantly, no money of their own with which to buy those foods? The answer is none. Yet these corporations market directly to children. My children and yours. It is disgusting.

We all know why they do it. They figure if they implant enough images of their products in the minds of kids, those kids will grow up knowing and using their products, and they will have generations of brainwashed adults. Why not? It worked great with my generation. Earlier this month, I read that fewer than 25% of people my age remember that the USA used to be a British colony, but I'll bet that 80 or 90% can remember the Big Mac song:

Two all beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun

It is clear that marketing is very effective. It is even more effective when done to children, who are more easily influenced and lack the impulse control that many adults possess. Why then does it occur?

I do not think this is the fault of the government. Not because I think the government is doing a good job, but mainly because as is true of most things they get involved in, the government has no role here. The government's job is not to tell people what to advertise and what not to advertise.

The blame goes only in one place: us. We are all to blame for this mess. We, the CEO's and marketers of corporations who should value their customers more than their bottom line, and recognize that they have violated basic ethics by marketing to children AT ALL. We, the people who permit this kind of unethical advertising by watching the TV programs in the first place. Finally, we who do not punish the companies who are harming our children by boycotting their products. Instead, we expect elected officials who listen to the selfsame companies via lobbyists to fix the problem, so that no lifestyle changes will be required by us.

Join me in taking responsibility for that blame, and help guide your children away from TV and advertising, and toward healthy activities and foods. Remember that the foods that no one advertises or lobbies for are probably the best ones for you and your children!

Thag Hot!

You may or may not have noticed the last week or two, but it is kind of hot out. If you live in Kansas, like me, it has been REALLY hot. Burn your feet on the pavement hot.

Heat like that brings up a few special considerations when it comes to health, so I thought I'd dedicate today's blog to dealing with the heat.

First, I will let the doctor in me talk for a minute about heat exhaustion and heat stroke. These are the two main heat related illnesses.

Heat Exhaustion is when you have been out in the heat too long, but not long enough to kill you yet. You begin to feel tired, weak, and sometimes lightheaded. You  are sweating profusely, and feel shaky. Passing out is possible at this stage. The symptoms are not subtle. You will know that something is wrong. The cure is to get out of the heat RIGHT AWAY, and drink something (non-alcoholic).

Heat Stroke is what occurs if you ignore your body's warning and don't (or can't) get out of the heat. You stop sweating (a very bad sign), and can get confusion and loss of consciousness which progress to coma and death. This is obviously not very good.

There. That is the public service announcement part of the show. Dr. Ott is satisfied. Now, on to how to exercise in the heat.

1. Choose a good time: OK, so you may be one of those people who love to run every afternoon at 3:00 exactly. If you have to wait until 3:02, you start to get the shakes. Believe me, I understand this kind of obsession, but temperature speaking, this is probably not the best time to run. Truly, the best time would be around 3AM, when temperatures are at their lowest, but since that is usually not practical, early morning and late evening are the next best choice

2. They invented the treadmill for a reason. I know that treadmills are boring, but they are infinitely better than dying of heat stroke. Trust me. When it gets super hot, sometimes discretion is the better part of valor, and just giving in and running on the treadmill is your best bet.

3. Drink water: Here is a news flash- when it is hot, you sweat. A lot. Those fluids need to be replaced. Unless you happen to be a frog (who can absorb water through their skin), the only way to replenish fluids is by drinking them. Drink water every 10 minutes or so. Drinking water also helps to lower your core body temperature, so it gives you a double benefit.

4. Take breaks as needed: You have your 20 mile long run scheduled for Friday. It is 100 degrees on Friday. That doesn't necessarily mean that you have to cancel your run (but you should consider it). You could instead break it down to four 5 mile runs, with a 10 minute inside break (to cool off). This strategy would keep your core temperature lower, so that you can finish, rather than overheat.

5. Protect yourself from the sun: If heat stroke doesn't get you, skin cancer might. Melanoma is the deadliest form of skin cancer, and your chance of getting it is greatly increased by sun exposure. Be sure to wear a had, and technical clothing which has a high SPF (a cotton shirt only has an SPF of 5, but you shouldn't be wearing that to run outside anyway, as it does nothing to wick sweat away). Wear sunblock, but don't be fooled by the hype- while it will prevent you from getting a sunburn, studies have not ever shown it to be effective in preventing melanoma.

Remember these steps, and your run in the heat will only be painful, but not deadly :)

Thag Write?

There was a great article in HealthDay today about food journaling. As part of my job, both as a physician, and as an health and weight loss advocate, I spend time reviewing the medical and lay literature for new developments, or ideas that may help my patients and my readers lose weight.

Food journaling is not a new idea, and it is one that I have long been a proponent of. I thought I would revisit the topic, since I read about it today. Like many things in our society nowadays, the mainstream idea is right in principle, but hits off the mark. Using a food journal as most nutritionists recommend will help you lose some weight. Effective food journaling, on the other hand, will help you lose A LOT of weight. Other than actually eating right and exercise, a food journal is probably the most important weapon in your weight loss arsenal.

Let me explain. A conventional weight loss journal would include things like what foods you ate, what times you ate them, and the calorie counts of those foods. If you use a pretty advanced food journal, it might also help you calculate your protein, fat, and carbohydrate intake. By looking at how many calories you have eaten, you know how many you have to go, and the mere act of writing down the foods you eat helps you to think about exactly what you are eating, so that you will hopefully make better choices.

This is all well and good, but it misses the point.

What you should really be journaling about is not only what you ate, but WHY you ate it. For most overweight people (myself included), the reason you carry extra weight is less about the what than it is about the why. I spend a lot of time talking about how the food culture in America sets up for failure, and it does. There is just too much food. We, however, set ourselves up for failure as well. I, for example, used food as an emotional coping device, entertainment, and a comfort aid. Most of my overeating occurred when I was stressed, bored, or lonely, but I never really realized it.

Part of the reason I write this blog is to share with you what I did wrong, so that you can hopefully benefit from my mistakes. One of my biggest is that I assumed that being overweight was purely a proposition of eating too many calories. Until I learned that there were triggers for my overeating, and how to avoid them, I had no chance.

When you write your food journal, I want you to concentrate on three things: what, why, and how. Write down:

1. What you ate- Write down everything you ate and drank, so that you can accurately review and eliminate poor food choices.

2. Why you ate- Write down why you chose that time to consume food. Were you hungry? If so, how hungry, on a 1-10 scale? Was it a mealtime, a planned snack time, or an impulse snack?

3. How you were feeling- This is the most important. Write down what emotions you were experiencing. Particularly note the negative ones, such as boredom, sadness, loneliness, or anger.

Finally, once a week or so, review your journal, and try to focus on patterns. Note if a particular emotion or reason stands out as an eating trigger. If so, whenever you feel that way, avoid food like the plague. You can't fight what you can't see, so this knowledge is key in your fight against obesity!

Thag Change

Let's face it. Change is hard.

Well... that's not exactly true. Change can be pretty easy, under the right circumstances. We can probably all remember times when we have made a change which seemed nearly effortless. In fact, sometimes the change almost seems to make itself, then we can hardly imagine doing things like we used to.

So why is it that some changes are so hard, while others seem so easy? What is different about the changes that we make without much effort?

There are several factors which go into changing or not changing a behavior. If you want to make the changes that lead to weight loss, you must understand those factors. They are:

1. Fear. We are our own worst enemies. Many times the biggest obstacle to change is our own fear. This can be fear of what others think, fear of the unknown, or fear of failure. Fear is paralyzing, and has a powerful effect upon us, when we listen to it.

2. Benefit of our current situation. Though you may be dissatisfied with your life at present, you are getting something that you want out of it, or you would do things differently. For example, when I was overweight, I was very dissatisfied with my body, but I enjoyed eating very much, and I also used food as a coping mechanism, eating when I was sad, lonely, bored, or disappointed. Even though I did not realize it, I was getting a lot of validation from myself for overeating.

3. Lack of motivation or inertia. In order to overcome the first two, and do work to reach a different state, even one that we find desirable, we must have motivation. I call this motivation combined with positive motion "inertia." Inertia has a power of its own, and tends to build on itself once started, but in order to get the ball rolling, you have to be motivated.

All of the factors involved in the process of change can either work for you or against you. Fear, for example, can either paralyze you or impel you forward. Why is it that most people change only when they hit "rock bottom," or they have some sort of health complication? Because they experience fear over the possible consequences of their lifestyle, and that is enough to overcome any other fear or negative inertia. Therefore, in order to make a change, you must understand several factors:

1. What are you getting out of where you are
2. What fear(s) are keeping you from moving forward
3. What fears or factors could you use to motivate yourself? To assist with this step, think about all of the worst case scenerios that you can come up with to associate with not changing.

Once you understand all the forces at play with a difficult decision, it is often easier to take that first step, and once you take that first step, an avalanche of change often results.

Courage

Most people have a list of things the want to accomplish in their lives. This list can include the grand and world changing, such as get elected president of the United States, or the small, such as learn to ride a horse. You can have many or few things on the list, but rare is the person who has absolutely no goals that they wish to accomplish.

Goals are great, as they help to create momentum and positive change in our lives. Without goals, I would still weigh 350 lbs and I would not be writing this blog. In fact, many studies have shown that people who have written goals accomplish far more in their lives than people who have none.

The problem is not with the goals. It is with the reasons. Lying next to that list of goals in our heads, many of us have a list of reasons that we do not accomplish them. Here was my list of reasons for not losing weight:

I don't have time to exercise
I don't have time to cook, so I go for the easier fast food
I am addicted to food
I have a genetic predisposition to weight gain
If only I could start over, I would be able to maintain my weight
My life is too stressful. I have to eat to cope

As you can see, although I called these "reasons," they are really just excuses. If you examine why you have not achieved all of your goals, you will probably find a similar list of "reasons."

When you come right down to it, virtually none of these excuses are true. The reason behind the excuses is fear.

Though I had (and believed) my list of excuses, the fact of the matter was that I was afraid to really commit to losing weight. What if I failed?

I was afraid of what my friends and family would think of me.
I was afraid of what I would think of me. Did that make me a failure? I was afraid of being a failure.

Fear is a powerful emotion. It's power is mainly rooted in its ability to paralyze. When you are afraid, you will not act. This paralysis kept me from taking productive action against my obesity for years.

Fear is also weak. Though it seems all consuming, it is often based upon concerns or ideas which are just plain wrong. Yet when we believe them, we cannot move.

Thus, there is an antidote to fear. It is called courage. Courage is the ability to act despite fear. We usually ascribe courage to heroes, who run into burning buildings, and falsely believe that they are not afraid. They feel fear just like you and me, but have a reason for acting that is stronger than the fear. Thus, they act in spite of it.

Overcoming fear is a two step process:

1. Examine your reason for fear: Often times, if you simply ask the question "what am I afraid of?" you will notice that your reason just doesn't make sense, or is something minor that you don't need to be afraid of.
2. Act: Even if your reason for fear is valid, if the goal is something that you want to achieve, just moving in the right direction can snap the paralysis and reduce or eliminate the fear.

The most important thing to remember is that fear should be a counselor. It is there to warn you of a potential danger identified by your mind. It should not be a jailor. It should not keep you from acting to achieve your goals. Identify the fear, and its source, and you will find the courage to overcome.

The Pursuit of Happiness

We hold these truths to be self-evident. That all men are created equal. That they are endowed by their Creator with certain inalienable rights. That among these are life, liberty, and the pursuit of happiness.

The approach of the Fourth of July got me thinking about this historic document. I know what you are thinking. This is a health and weight loss blog. What does the Declaration of Independence have to do with health. As it turns out, everything.

Mr. Jefferson wrote that we all have the inalienable right to the pursuit of happiness. I think that most people hear the last part of this statement, but not the first part. When you ask most people what they think of this passage, they will invariably answer what we are all (wrongly) taught in school: that it guarantees our basic rights. This is a vast oversimplification of the truth.

If you read the Declaration closely, you will notice that it does not guarantee us happiness, as most people think. It merely identifies our right to the PURSUIT of happiness. Mr. Jefferson does not say that someone will come and give it to you, or even that you will succeed in getting it. He says that part of our endowment as human beings is the right to go after it. In fact, he is not giving you a gift, but a great responsibility. No one is responsible for your happiness but you.

Mr. Jefferson was probably not thinking about obesity when he wrote this, but it is a universal principle. Until we take responsibility for our own lives and destiny, we can never change our circumstances. Until you realize that your obesity is not a product of anything but your own actions, you can never change it. That is what he meant by the pursuit of happiness. That we are in charge of our own lives, and that no government, king, or other person can take that away from us, unless we give it to them with our consent.

Join me this Independence Day in reflecting on the circumstances in our lives, and how, good or bad, they are the result of our decisions. Then exercise your personal independence to change your actions, and through them, your life! Leave a comment about how you can use your independent will to change your life circumstances.

Old Habits Die Hard

This is a true story. The names have been changed (minimally) to protect the guilty.

I was on the way to an appointment today with someone I spend a lot of time with. Lets call her "Bristy." Bristy and I were in a gas station store. It doesn't matter which one. Let's call it Tuick Qrip. We had just stopped in to buy an iced tea, to take to our appointment. We went in, marveled at the ridiculously large number of beverage machines, from icees to milkshakes. We then got our iced tea and left.

After leaving the store, my wife, oops, I mean Bristy, remarked to me that even though she had just eaten lunch, she was tempted to buy a snack. She was not hungry, and had no reason to buy one, but the sheer presence of all of that food made her feel like she should buy something. Given both of our histories with being overweight and struggling with nutrition, she made a good choice, and only got the iced tea. She also made a very good point.

Weight control and weight loss are a struggle. The struggle does not end when you reach your goal weight. It continues throughout your life. From time to time, temptation will rear its ugly head. The decisions you make in those moments will be the difference between weight loss and a life of obesity. Bristy tells me it is like a whack-a-mole game, where you have to keep beating the temptation down with a mallet, I hate whack-a-mole, so you'll have to take her word for it.

Either way, since in America, you can find food in almost any store you walk into, and most of it crap, the temptation is likely to be there always. That is definitely not how it should be. It just is. As such, if you are not prepared for the temptation, you will often eat when you don't want to, or shouldn't. Here are my keys for avoiding temptation:

1. Eat before you leave the house: If you are not hungry, you are much less likely to pick up a snack cake just because it is there.

2. Avoid food when you are emotional: if you are highly emotional (happy or sad), avoid places with convenience food. Times of high emotion are eat and store triggers for cavemen, because they equal times of famine.

3. Avoid food when you are tired: ditto for tiredness. You release Cortisol when you are tired, which increases appetite, as well as fat storage.

4. Avoid food when you drink alcohol: alcohol is a dis-inhibitor. It makes you FAR more likely to engage in poorly considered behaviors, such as eating too much (other poorly considered behaviors are possible, but beyond the scope of this blog).

Take something with you: put some sort of less perishable food, such as an apple, in your car or purse, so that you can resort to something healthy if temptation is just too strong.

As always, before you eat, remember to ask why you are eating, and why are you eating THIS. If you do, hopefully you will drop the snack cake before it is too late!

New Name, Same Old Crap

 I was watching some TV this morning while working out. I saw a comercial for the brand new "corn sugar." Yes, you heard me right. Corn sugar. During my weight loss experience, I have trained myself extensively in nutrition, but I had never heard of corn sugar before. Since this piqued my suspicion, I decided to do a literature search on the topic. The result did not surprise me.

As it turns out, corn sugar is our good old friend High Fructose Corn Syrup (HFCS). The very same friend that gives us obesity, diabetes, bad teeth, and many other health problems, just under a different, friendlier sounding name.

How, you may ask, were they able to do this? Thank the USDA. The USDA, who controls how food and beverages are labeled, granted permission to the makers of HFCS to call it "corn sugar." They did this because of the (well deserved) bad press that HCFS has gotten lately. By calling HCFS corn sugar, the manufacturers are hoping that lay people will not be able to recognize it, and the stigma will vanish. Its almost as if cigarette manufacturers got permission to relabel their product "happy sticks," and sell them to children.

Corn sugar is not the first example of creative product relabeling based on public opinion. About 40 years ago, it turned out that rapeseed oil was not very popular due to the unfortunate name, so it was changed to canola oil in order to improve marketing. There are other examples as well.

The corn sugar debacle seems somehow more sinister. They are not just changing the name because it no longer matches the time, but because it is associated with significant problems, and rightly so. I feel violated and misled. If there are health problems associated with a particular product, we know about them, and changing a name to prevent that seems sneaky.

The HFCS manufacturers do have a point. Their product is not any worse than sugar. In reality, you should try to avoid both, especially when they occur in abnormal quantities in processed foods. The only place that sugar is really OK for you is naturally occuring in fresh foods (i.e. fruits). The problem I have with all of this is that a conscious, health minded consumer looking for safer processed foods may be fooled into thinking that corn sugar is somehow safer than HFCS, and be tricked into eating processed crap.

This is my attempt to raise public awareness of the name change, so that we can all avoid being victims of advertisers and manufacturers, and make independent healthy decisions. Good luck!

Thag Fail

Most of you have probably heard the old time management addage:

Failure to Plan is Planning to Fail

This is an old addage, but very true. I have talked many times about how you need a plan for what to do, otherwise you will just flounder and spin your wheels. I have another saying that is equally important:

Those Who Don't Plan to Fail Will Quit

If you are going to strive for any sort of difficult goal, failure will be nearby. In fact, if you try for anything even remotely difficult, it is highly likely that you will experience failure at some point. Nobody succeeds at everything they attempt. Colonel Sanders, the founder of KFC, took his chicken recipe to over 900 different restaraunt owners before someone took a chance on it. That means that he had 1 success to over 900 failures. If he was a baseball player, he would have a batting average of 0.001. That's not too good, but his story is one of the greatest success stories in all of commerce.

This is just one example, but if you examine the background of most successful people in the world, you will find a lot of failure. I have a third addage for you:

Failure is an Event, not a Person

Just because you don't succeed on a particular attempt, does not mean that YOU are a failure. It only means that you probably learned something important, such as how not to do what you wanted to do. The true failure comes in if you then stop trying, or if you don't apply that knowledge to your future attempts.

Now I am not making a case for pessimism. Quite the contrary. I want you to expect to achieve your goals, but unless you have a realistic view that takes into account that every day will not be a resounding success, you will give up the first time you experience a setback. Thus, you must have an understanding that failure will occur from time to time. When these failures occur, you must get up and strike back. I suggest that you SLAP failure. The steps to failure recovery are as follows:

Stop- Insanity is doing the same thing over and over, expecting different results. If it is clear that something isn't working, STOP!!! Don't keep running into the same wall.
Learn- After you stop, the first thing you should ask yourself about the failure is "what did I learn from this?" To do this, you have to turn off the embarassed, overwhelmed, and sad voices in your head which tell you that you cannot succeed. We all have these, but the people who succeed have learned how to quiet them.
Alter- Using the experience that you gained from step two, you must now alter your course. This could mean anything from making a minor tweak to changing your entire world view. The important thing is to recognize that a change must be made, and make it.
Persevere- Winston Churchill made a speech during World War II, when the British people seemed on the brink of losing to Hitler. In this speech was the iconic phrase "never, never, never give up!" Mr. Churchill knew that the most important component to the success formula is perseverence. If a goal is truly important to you, then how many times you "fail" should not matter. Just pick yourself up, dust off, learn what you can, and try again. Even if you have already failed 900 times, that next time may be the one that puts you over the top!

So good luck to you, and never, never, never give up.

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.