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.

Thag Lift Stuff!

So I went to the gym yesterday, as I do when the weather is bad. As I was working out, I became aware of a big problem: there were scads of people using the cardio machines. Now don't get me wrong, I think it is a great idea for people to exercise and become fitter, but most of us go about it in totally the wrong way.

It's not the fault of the general public. "Experts" have been leading us astray for decades. Go back to the 80's, and most people, especially women, were told to avoid weights in favor of aerobic or cardio training. "Experts" noted two reasons for this:

1. It burned more calories in the allotted time for exercise
2. It made your heart stronger and reduced your chances of heart attack

not to mention, they would say, lifting weights would make you bulky and muscular, like one of those body builders, and what normal person wants to look like that (because body builders totally use NO performance enhancing steroids whatsoever ;) )

As usual, the "experts" did not know what they were talking about. Recent studies have shown that weight training burns as many calories as cardio training, as well as adds lean muscle mass, which increases your basal metabolic rate, so that you burn more calories just sitting and reading the paper. There is also evidence to show that weight training increases your resistance to injury. Finally, resistance training increases bone density. Since osteoporosis is such a big problem in America, particularly among women, the "experts" should not be telling women to avoid weight training.

Now hear me right: I am NOT telling you to avoid doing cardio! Cardiovascular exercise has many benefits, some of which weight training does not confer, such as the aforementioned lowering of heart attack risk. There is still plenty of reason to run, row, or swim. I merely want to encourage you to add resistance training to your usual regimen to gain those additional benefits.

My next post will have a few sample workouts, or consult your personal trainer for ideas on how to add resistance training to your exercise routine.

M. Jacob Ott, MD

Stress and Weight Loss

For many people, yesterday was one of the most stressful days of the year. Tax time can be very difficult. For that reason, I thought I'd address the effect of stress on weight loss.

Let's face it. We live in a stressful world. We have jobs, conflict, deadlines, and many other stressors that affect us directly. As if that wasn't enough, we can also worry about wars, terrorists, earthquakes, radiation, and a variety of other natural and man made disasters.

Of course, cavemen had their stressors too, but their stress came from a different type of danger, one that our bodies are more capable of processing. Most of the stress for cavemen came from one of two sources: lack of food or direct physical peril. In response, our bodies produce two distinct stress hormones:

Epinepherine (Adrenaline): comes from the adrenal gland, and is the one which predominates in situations involving physical peril. When the bear is chasing you, it is epinepherine that helps you escape. It raises your heart rate and blood pressure, dilates the pupils, reduces fatigue, and primes the muscles for action. In short, it amps you up to deal with the physical danger, whether that means fighting it or running away from it.

Cortisol: is a steroid (cholesterol based) hormone, which predominates in times of famine. Your body releases cortisol when it feels like it is not getting enough nourishment, as well as in times of physical danger. Cortisol is the conservation hormone. It tells the body to save and store. The body stops breaking down fat stores, and begins converting as much of the ingested food it can into fat stores, to prepare for the famine ahead. It also stimulates the appetite, prompting you to eat as much as you can, to maximize the storage.

That is all well and good, if you live in a world where you can be attacked by saber tooth tigers, and food is very hard to come by. Fast forward to today, when the stress comes from traffic on the interstate, your jerky boss, or the low balance on your bank account.

Fighting or running can do little to reduce these dangers, so the epinepherine just leads to feelings of anxiety, and high blood pressure. Since we are practically drowning in calories, when the cortisol is released due to the stress, you follow your biologic imperative, and eat. Your body then stores, thinking that you are being chased by a predator, and about to run out of food. The result: you are overweight, and chronically anxious and stressed out. Know anyone like that?

The good news: There is a solution! Your body has a natural way to dissipate the stress and block the effects of cortisol. That way is exercise. Look at our caveman. When the tiger pounced at him, what did he do: fight or run. Either way, he exerted himself. The exertion releases endorphins, which relax you, as well as a cascade of other hormones and chemicals which increase the metabolism and promote fat breakdown to liberate energy for activity. It is no coincidence that people who have a high level of activity also have lower stress levels. They are merely following their inner caveman. Follow yours, and the middle of April might go a bit easier next year.

Caveman Children and Pregnant Women

I get asked many questions about being a vegan. Hands down, the most frequent is "where do you get your protein?" Due to many repeated inquiries, I have a response for that question. If you want to read about it, click here.

Other than the protein question, the next most frequent question is about children and pregnant women. It usually goes something like this: "I want my family to become vegetarian, but I am afraid it will hurt my children [or fetus]. Is it safe for them?"

In a word, yes. All of the nutrients required for growth and development of body tissues can be obtained from plant matter. It is true that there is not one single plant source of all eight essential amino acids required for life (an essential amino acid is one that our bodies cannot manufacture from raw materials). This would be a big problem if you intended to feed your children only one type of food day in and day out. Fortunately, if you follow caveman rule #2:

Eat a wide variety of fruits and vegetables, and very little if any meat, eggs, or dairy

then you will not have a problem. The variety will ensure that you get enough amino acids, as well as a full compliment of antioxidants, vitamins, and minerals. If you also follow caveman rule #1:

Eat foods like they grow in nature

your kids will not be exposed to the processed crap that fills most vending machines, school cafeterias, and restaurants. On the whole, they will be much better off than the rest of the population, eating genetically modified, hormone and antibiotic laden meat. Not only will they develop just fine, they will probably avoid early onset puberty, and the behavioral problems associated with a diet high in meat and processed foods.

Really the only nutrient you need to worry about is vitamin B12. Since we clean our food thoroughly, and B12 comes from the bacteria in the dirt, there is no good vegetable source of B12, except for nutritional yeast. Fortunately, you don't need very much B12. Adding nutritional yeast to one of your meals a couple of times a week, or a weekly B12 supplement will provide more than enough of this vital nutrient.

You may be wondering if I walk my talk. What do I do with my kids. They are not vegan, nor are they completely vegetarian, but we do follow caveman rules 1 and 2. They eat about 90% vegetable matter, and very little processed food. Most importantly, they are learning lessons about good nutrition and healthy eating that they will hopefully carry for the rest of their lives.

M. Jacob Ott, MD

Multitask the Burn

OK. So cavemen did not mow lawns. They didn't even have lawns. If they did, they would probably try to mow it with something like this:

In the modern era, most of us do have lawns, however. Mowing the lawn is a task that large numbers of people have to deal with weekly during the spring, summer, and fall. Since that is the case, why not get the most out of it you can?

Most people mow their lawns with fancy riding mowers, or self-propelled push mowers. These devices make quick work of the grass, but they do nothing to help us mow down our own fat tissue. This is my lawnmower:

Since you have to mow the lawn anyway, why not get in a bit of a workout while doing it? Foregoing convenience devices can help you build additional effort and calorie burning into daily activities. I have to work much harder to mow the lawn with my dinosaur of a mower, but that is the point. I also don't use any gasoline, or have to maintain any sort of engine. I AM the engine.

You can use this principle in many areas of daily living. Take the stairs, rather than the elevator. Park as far away from the store as you can, rather than following people around the lot to find the closest spot. Use one of the carry baskets at the grocery store, rather than a cart. Carry the grocery bags out to the car yourself, rather than having the bag clerk do it. Walk the half-mile to the office, rather than driving or taking a taxi. By multitasking your burn, and building additional effort intentionally into daily activities, you will see more success with weight loss more quickly, and perhaps save some money and the environment as well.

M. Jacob Ott