Monthly Archives: February 2014

Healthier Together Series: Cycle 1 C. Relaxation & Sleep — There’s an app for that…

Today’s Relaxation & Sleep Notes:

This group of notes will be geared towards how to relax, decompress, reduce stress and/or have more satisfying sleep. As a physician, I often have people come to me looking for a pill to help them relax or sleep or otherwise decrease their mental activity, quiet the mind. They are basically asking me for something to turn the brain’s conscious mind “off” or at least turn it down. Unfortunately, many of these pills are addictive or at least can cause a physical dependence. The media seems to promote these drugs as if everyone is taking it and it is “normal” almost to the point of making these pills trendy.

I am not a fan of pills if they are not necessary. And I am DEFINITELY not a fan of causing someone to become dependent on pills unnecessarily, and especially if there might be an alternative way to take care of them. Many of these pills, other than having dependence and addictive potential, can cause motor vehicle accidents, injuries at the workplace, allow misuse by “sharing or selling” it to others, and they take away your control of your own mind’s abilities to self regulate and calm itself. Also, over time, some of these meds require increasing doses as the body adjusts and needs more. They can have terrible withdrawal. In the worst cases, they can kill.

You can imagine, I wanted to learn other options for my patients–and initially, this search was prompted when I first started interacting with pediatric cancer patients and their family members. The children were scared, anxious or in pain or uncomfortable or dreading treatments. Also, their parents, siblings and close friends were having difficulties watching a loved one go through pain, procedures and fearing suffering and death. I wanted to be helpful.

I looked for options that would actually empower my patients and their families, improve their well-being, allow them to sleep, decrease their anxiety. I searched for options that would be able to be used on the road, at work, in the hospital, anywhere & whenever they needed it. I wanted tools that could be flexible – used for relaxation or for sleep, and that got more effective with time.

Fortunately, I went to a medical school that is progressive and understands the complexity of the human experience and appreciates an integrated model of providing health care. I had the opportunity over 3 years, to get advanced training in Medical Hypnosis. And guess what I found out? Using what I learned in my Medical Hypnosis training, I learned to teach my patients how to quiet their own minds. They learn how to train their own minds to relax, and if they want, to sleep!

Interestingly, there are apps for this also. The key is practice. How do you practice? Repetition.

I recommend finding a self hypnosis app or use Bud Winter’s sleep training or find a trained specialist who does medical hypnosis and chose a single method you like and use it regularly for a period of time. It will become more effective, and work faster, with practice. It’s a way of learning how to allow your conscious mind to talk to your subconscious mind. Once you learn the power of self hypnosis and develop the ability to control your own mind, you can accomplish anything. Relaxation and sleep will be within your mind’s control because you will have learned a way to quiet the mind.

Healthier Together Series: Cycle 1 B. Physical Activity — Workout bonus

lindsay-henwood-7_kRuX1hSXM-unsplashToday’s Physical Activity Notes:

First: I will often use the terms physical activity and workout interchangeably. When I use the terms “working out” & “workout,” I specifically refer to intentional physical activity that is planned for the purpose of being exercise. Working out is deliberately moving for health, fitness –> exercising. Physical activity is anything we do that moves our body and includes working out, exercising as well as other activities we do daily.

Good news: since we wake up in a mode burning our body’s stored fuels, whatever physical activity we do in the morning prior to eating or drinking calories, accelerates our fat burning by using up our muscles’ stores of glycogen (energy stored in muscles). This means that you get to drink or eat a bit more freely after being physically active in the morning. In fact, if you workout vigorously in the morning (if you used up all the glycogen in your muscles), you can add some unprocessed carbs to your meal within approximately 30-60 minutes & your body will put the extra blood sugar (the glucose from digesting the carbs) into your muscles and NOT into fat cells. HOW COOL IS THAT?

Remember, if you eat foods that spike your blood sugar (especially foods like processed carbohydrates including sugars), your insulin will spike and your body will store most of that extra blood sugar in your fat cells! So, your FAT stores will GROW BIGGER…and mostly around your middle. NOT your goal. So, that means if you want to eat/drink that higher carbohydrate food or drink & you don’t want to grow your fat, WORK OUT first! You get the biggest bang for your buck if you are physically active first thing in the morning before you eat or drink any calories (drinking water is better).

Remember, the “physical activity” can be:

1. Low intensity movement for a longer duration – like walking for 30-40+ minutes or an activity that is at a perceived exertion level of 5-7 or heart rate approximately 60% (+/-10%) of your personal maximum heart rate. *see previous blog about perceived exertion and heart rates for more info.

2. Spurts of higher intensity activity for a shorter duration (even 4 minutes counts!). This might mean boosting your perceived exertion closer to 8-10 or 80-90% of your maximum heart rate for very short spurts, no longer than 30-60 seconds, interspersed with 2-5 minutes of lower intensity such as level 5-6. Basically, you go hard for 30 seconds then easy for 2 minutes, & repeat a few times. I like 4 cycles. — Another option, look up the 7 minute workout online.

The key is to deplete or significantly lower your body’s storage of glycogen with exercise and voila! You now have created an empty space (your muscles and liver) where your body will put the extra sugars in your blood (from the carbs &/or sugars you have consumed) & it is NOT going into your fat cells for storage. It is getting burned up in your muscles immediately. If you have eaten protein & fat within a low carb “break-fast,” you will just continue to be burning fat.

Bottom line: If occasionally, you are craving extra berries or a sweetened cup of coffee or tea or other starchy carbohydrate with your breakfast, & you don’t want to worry about it increasing your weight, work out first thing in the morning! It’s a workout bonus!

Photo by Lindsay Henwood on Unsplash

Healthier Together Series: Cycle 1 A. Nutrition — Make one change…

hisu-lee-bQLCyj-9-tk-unsplashThis week’s nutrition notes:

In an earlier a post, I mentioned how our body starts out in our personal best metabolic state…basically after >6 hours of sleep, not eating or drinking anything, our body is burning stored fuel (glycogen and/or fat) for energy (which is possible because our insulin levels are lower). We like that. Most of us have enough fat on our body that we can spare to burn some for fuel. Our body’s insulin levels are meant to drop down while we are sleeping (A.K.A. fasting) & therefore, we are more likely to wake up in a fat burning mode. Use this to your advantage.

This week, make sure your first meal of the day, “break-fast,” has protein. You can add leafy veggies too. You can add fat too. So that first meal, whenever it is, might include organic free range eggs, nitrite free bacon, left over meats/chicken/fish from night before, avocado, butter, spinach, mushrooms, hard cheese, etc. ***The key is to avoid the starchy carbohydrates (potatoes, bread, pancakes, waffles, crepes, anything made with wheat flour, etc.) and sugars.

If you eat protein & fat for that first meal, your blood sugars remain stable, you DON’T have an insulin surge, so your body can continue in a fat burning mode from overnight & you continue to nourish your body with nutrients. Also, you may notice that your hunger levels are better later in the day and you have more energy the rest of the day.

So, look for low carbohydrate “breakfasts” with natural proteins, fat with or without leafy veggies and water, tea, or coffee (with cream if you like, but hold the sweetener). Make your breakfast work for you.

Photo by Hisu lee on Unsplash

Perceived Exertion & Heart Rates — How to use them

This doctor’s Perceived Exertion Scale

Scale of 1-10.
1 laying in bed or propped up
2 sitting up
3 standing
4 standing & / or jiggling
5 walking
6 brisk walk/slow jog – point of breaking a sweat, could keep doing this for hours; equivalent of 60% of max heart rate
7 sweating, still able to have a conversation; 70% of max heart rate
8 breathing faster through mouth, sweating more; 80% of max heart rate
9 not able to sustain for long time, breathing hard, conversation has to wait; 90 % max heart rate
10 hard as you can go, balls to the wall, takes concentration on working it…this is your personal maximum heart rate

Keep perceived exertion in mind…

I’m a fan of the heart rate monitor when I am working out. I like numbers. I use a polar heart rate monitor even though I don’t care to wear a chest strap. I have just found it is the most reliable and it is easy to use. If you work out at a gym, it will often “talk” to the motorized gym equipment like the treadmill, elliptical, stepper, stationary bike, etc.

Here is how I use my heart rate monitor. First, I rate my perceived exertion at the level of exercise I am doing – & see what my heart rate is. This lets me know my own heart rate zones for different levels of perceived exertion so I know how vigorous any activity is for me. Then, I look at what my heart rate is when I am going 10/10 & note that as my personal maximum heart rate. Then, I can figure out my approximate heart rate which correlates with each level of perceived exertion. Now, I can see how I am doing.

What I find is that as my fitness improves, I can do more for the same heart rate response. For example, I can walk 3.6 mph at a 4 degree incline on my treadmill and I am at a level 6 that correlates with a heartrate in the 120’s. Previously, when I first started my current exercise program, that same setting on my treadmill felt more like an 8 on perceived exertion and my heart rate was in the 160’s.

Also, as the fitness level improves, the time it takes for your heart rate to come back down gets shorter. In other words, your recovery time gets shorter. Instead of 10 minutes to cool down, it only takes 1 minute.

Finally, when you know what your resting heart rate is, you can objectively see if your body is under more stress (ie. fighting a brutal cold) & adjust your workout accordingly. So, given my resting heart rate is in the 50’s, if I have a cold & my resting heart rate is in the 70’s or 80’s, I know I may not want to exert myself too much. In fact, I can just gently walk slowly & see my heart rate will rise quickly. OR I can just do some stretches or some gentle yoga and make sure I am getting my fluids and taking care of myself in other ways.

We are all scientists when it comes to our own bodies. It helps to learn of more ways to understand what it is telling us. I suggest keeping a log of your observations. In this case, write the date & time, write down your activity (including duration and settings) and your perceived exertion and heart rate. I include my average heart rate and my maximum heart rate also. Then I include some notes about how I was feeling. I always finish with a positive note & then I review what I will do next time. Numbers make it easier to follow your progress. It’s so fun to look back on all of the successes!

In a future blog, I will discuss how to use this information to organize your workout plan – how to evaluate your workout and how much time you will invest into working out.

Photo by Markus Spiske/Unsplash

Insulin. Letting your metabolism work for you.

rodrigo-ardilha-TYtbqZdYtc8-unsplashWant to learn to be a fat burner? What if I told you that your metabolism starts off in its most ideal state when you first wake up after at least 6 hours of sleep? What if I told you that you could keep your metabolism humming along throughout most of the day, and that it could burn the excess unhealthy fat off your body? What if I told you that you would also have more energy and your mood would be improved along the way? Would you be interested? Well, I’m going explain…

One of your body’s fuel sources is glucose. Glucose is the sugar in your blood that is like gas in a car.  (I will use the word “sugar” instead of “glucose” for the rest of this post, but I’m talking about glucose.)

Your body needs the right amount of fuel to work well, and if it has too little, you can die and if you have too much, you can also die. Actually, before death, if you have too much sugar, it acts like a slow poison…everywhere in your body. It attacks your brain, blood vessels, your eyes, your nerves, your kidneys, your heart, your immune system, your skin, EVERY part of your body.

This is the case with diabetes, where there is too much sugar in the blood most, if not all of the time, and it is damaging the body. You can imagine, if sugar is so powerful in your body, and too much of it is poisonous, your body will have created something VERY powerful, as a defense, to manage that extra sugar…It has. It’s called INSULIN. Insulin brings down the blood sugar.

How does insulin work? Well, it is created by your pancreas and gets pumped out when your body senses it has TOO MUCH sugar in the blood. Insulin is released proportionally to the level if sugar in the blood*. The more sugar in the blood, the more insulin is released. Insulin lowers your blood sugar.

*Side note: The older you get, or the higher you regularly push your blood sugars, the exponentially more insulin will get pumped out relative to the amount of sugar in your blood. In other words, the pancreas gets a little over-reactive & will go overboard and pump out LOTS of insulin. We will come back to this.

So, when there is lots of sugar in the blood, there is lots of insulin that is dumped into the blood. When high amounts of insulin are circulating in your body, your body listens. Insulin is ALL POWERFUL. It is trying to prevent high levels of blood sugar from poisoning the cells. So, insulin is the Boss. It is your body’s defense. It is all about survival. It is trying to prevent the cells from being poisoned.

To clarify, when insulin levels are high, the cells stop listening to other signaling chemicals in the body. High levels of insulin act like a fire alarm. It tell the cells in the body, “We are about to be poisoned!!! The NUMBER ONE PRIORITY is to LOWER THE SUGARS in the blood!” So, how does it do that?

First, insulin causes your cells to shut off their use of other fuel sources (such as fat) and tells all of your cells that it can ONLY burn the SUGAR in the blood for fuel. This allows the extra blood sugar to be used up so the blood sugar goes down to normal healthy (non-poisonous) levels. This is good. This works very well if we don’t overload the system…

However, if there is way way too much (glucose) sugar in the blood and you are not more active, it cannot burn off enough of it, fast enough. It doesn’t need that much fuel. It cannot bring the sugars down to a “good” or “safe” level fast enough or it may not be able to bring it down much at all (type 2 diabetes). To protect itself from being poisoned, the body responds with extra insulin* and it has another back up option.

The back up? Insulin forces the body to store all if the unused sugars as glycogen (in the muscles and liver) and FAT in your body. If you have not used up the glycogen in the liver and muscles (which can be done by fasting or with physical activity or exercise), they are likely already full. So the back-up storage space is our fat cells. So, insulin causes fat cells to grow and multiply to protect us from very high poisonous sugar levels!

Key point: High insulin levels = Fat burning is shut off & you are now growing. If you have stopped getting taller, there is only one other way to grow…you will be growing your fat cells and your body cannot access the fat on your body for fuel. It can only burn sugar in the blood.

As mentioned earlier, as we age, or if the body has high blood sugars often, huge amounts of insulin keep being produced by an increasingly over-reactive pancreas. With time, the cells start ignoring the insulin- they become INSULIN RESISTANT. The pancreas then starts over-reacting even more, and responds by pumping out even more insulin. The cells become even more insulin resistant, and it becomes a vicious cycle.

Signs that your body is developing insulin resistance include the development of more skin tags or discoloration around the neck, and even more consistent, is an enlarging waistline. As your waistline grows, you are becoming even more insulin resistant and you will start gaining fat weight faster and faster (unless you make some changes).

With high insulin levels, fat burning has been turned off. So, you cannot easily burn the fat off your body. In fact, this extra insulin often leads to further hunger, as your body is storing the fuel and at the same time, shutting off access to the stored fuel (the fat cells). When you are running on empty, your body craves more sugar, for immediate fuel, because you are running out of sugar. All because of an over-production of insulin from your previous cycle. This is the insulin resistance roller coaster that gets steeper and faster over time.

Good news: You can get off the insulin roller coaster and even avoid it all together. If you don’t get on the insulin roller coaster, you will be able a fat burning machine and have steady energy. Here’s what you need to know:

When you wake up first thing in the morning, if you haven’t eaten overnight, your body starts off in a fat burning mode. Since you didn’t eat foods that cause blood sugars to go up, your insulin levels got low, so your body switched from sugar burning to fat burning for fuel! You start off as a fat burning machine. If you think about what you eat in the morning and keep your sugars low, you can keep your body in the fat burning mode! You can have a fresh start every day.

If you start your day with foods that cause blood sugars to jump (like starchy carbohydrates and sugar), remember you will dump lots of insulin in the blood, which will turn off your fat burning & you may grow and start on your insulin roller coaster for the day. If you choose to avoid those starchy carbs and sugar, you avoid getting on the insulin roller coaster and you can stay in your fat burning mode!

In short: When insulin levels are high, insulin acts like a growth hormone. And if you are done growing taller, there is only one other way to grow…so anything you can do to keep your blood sugar levels stable and in the healthy and safe range, the better off your whole body will be and the more likely you can maintain a healthy weight and body.

Every day, you get a fresh start when your body is burning fat for fuel. So the key is to learn which foods and how much of those foods cause your blood sugars to spike and to limit those. Then, your body can continue to burn fat and your waistline will shrink. In addition, if you can eliminate those insulin spikes, you will find your mind is clearer, your mood improves, and you have more energy. You may find you even WANT to be more physically active than before! It is a win-win for you!

Isn’t the body amazing? Next time, we will review how to reverse the aging process with regards to metabolism…



Photo by Rodrigo Ardilha on Unsplash

How Can I just “DO IT”? (Part 4)

Now, you understand about brain energy, resilience, transitions and activation energy. So, “How can I just DO IT?”

Feel free to read this a couple of times to think about it and consider what it means for you. This is putting it all together.

First, let’s review and go back to the car analogy: The first time you try to get to a new destination you are more likely to succeed if you have a large full tank of gas and plenty of time in case anything unexpected happens. This means: To incorporate a novel transition, you are more likely to succeed if you have lots of resilience & maximum brain energy. You set off on your drive (using your activation energy). You may not yet know the “best” route. In fact, you may get lost or end up in construction and traffic (using still more activation energy). In other words, you will need more energy to do something new, and you only have a set amount of energy to start with every day. Plan your day accordingly. More “new” or “unusual” events planned, the more energy you will drain.

You are better off if you have a large full tank of gas because you still have other places to go (more transitions or activities to do) after your first destination, and there may not be a gas station nearby. In the future however, each time you go to that destination, you will likely do it better and faster. The more frequently you drive there, the more efficient your drive will become. In other words, the more “routine” something becomes, the less activation energy required for it.

Concept #4. Hectic days can sabotage our good intentions.

A hectic day has more novel transitions & is often complicated by the requirement that there are specific times those transitions have to be completed.Remember that novel transitions are transitions that are not a regular occurrence. The more novel the transitions, & the more of them that you have in a period of time, the more activation energy is required for each event, the bigger the drain on your brain energy, and the more hectic your day will feel. A hectic day is really like a day with lots of novel transitions scheduled into it – rapidly draining your energy.

Going back to the car analogy when you are over-scheduled with lots of novel transitions over several days: Effectively, you are just DRAINING your gas tank and throwing rocks into the tank too effectively shrinking the size of the tank and decreasing the amount of gas you haave. You will be running on empty pretty quickly. Hectic days have the potential to sabotage your good intentions without warning.

Bottom line, hectic days are days when you just have lots more going on & they are not your usual routine. These are dangerous days. Mistakes happen and good intentions fall by the way side. Often, we end up in survival mode and not being our best selves. We may stop taking the time to take care of ourselves. We are in danger of burn out. These are times when you eat the foods you know aren’t good for you, when you are stressed out, when you consider skipping your workout.

Remember, if it is a novel transition and/or it needs to be done at a certain time (ie. getting to a new appointment), it will deplete more activation energy and may become part of a hectic day. Now you know this. You can prepare for this. It means you will need to plan for more frequent recharging times, more breaks, more times to decompress and slow down. You may choose not to add in too many novel events in a week if you have that option.

In my house with teenage boys, there are certain times of the year that are just full of predictable hectic days, and they revolve around the boys’ schedules. To prevent burn out and to make sure I continue to take care of myself, I create a plan ahead of those predictable times to boost my resilience and brain energy around those times so that I maximize my time and what I accomplish then. I also try NOT to plan “new activities” or “novel transitions” at those times if they are not necessary.

There is a good argument for regular exercise, healthy nutrition and for taking care of your brain energy and increasing your resiliency: If you are fit and you have been taking care of yourself (mentally, physically & spiritually), you will have more resilience, have more brain energy and therefore, more activation energy available to you & you can do so much more before you have exhausted your supply of activation energy and your total brain energy.

With knowledge, planning and preparation, you can achieve your goals and continue to move forward towards new ones. You will achieve much more in life. So, you can now say, “I will DO It!”