Category Archives: Healthier Together

Healthier Together Series: 7A. Nutrition – The importance of calories in

hessam-hojati-M4hazNIyTsk-unsplashWe’ve heard that weight is all about the calories we consume. In fact, someone recently shared with me that she felt betrayed. She had been successfully losing weight eating very low carb, and had not been counting or restricting calories. She had been feeling so happy about her progress and how easy it was and how she had so much more energy that she had now been regularly working out for over 2 years. However, she recently heard that eating very low carb or “keto” was effective for weight loss because it cuts calories. This whole time, she thought it was being low carb that worked, not the calorie restriction. She felt “tricked.” Have you heard this too?

Allow me to clarify. If you are eating carbohydrates and your waistline is enlarging or you are gaining excess weight or you have prediabetes or diabetes or PCOS or metabolic syndrome, you have insulin resistance. Insulin resistance means that your body produces excessive amounts of insulin for the same amount of carbohydrates you consume. So, if you eat carbs, your body dumps too much insulin into your blood stream.

High levels of insulin prevent your body from being able to access your back up fuel source – your fat cells. You will not be able to get fuel from your fat cells. This means that when you need fuel, you will need to provide fuel, to run your body, by eating or drinking it. You know the feeling- you will be hungry or get the munchies when your fuel in your blood stream starts dropping low. Again, you have to eat or drink calories the have the fuel to continue to run your body. If you don’t eat and your insulin level is high, you don’t have access to your back up fuel source, so your cells begin to panic. You get hungry, ravenous and feel your blood sugar dropping and feel very unwell. Eating or drinking carbs (including sugars) is the fastest way to “feel better” in this scenario.

Now, let’s go on the “common” diet of cutting calories or portion size. If you started out eating a standard American diet with lots of carbohydrates and then begin calorie restriction, or cutting calories or eating smaller portions, it usually means you cut back on the fats and eat mostly carbohydrates. Carbs spike insulin. This means you keep insulin pretty high and as a result, you starve those poor cells in your body. Your body doesn’t like starving, so it adapts and starts to cut back on its activities and slows your metabolism to “conserve” your limited energy. With this method of weight loss, weight loss is very difficult to maintain unless you continue to add more exercise and/or continue to cut calories. There’s a limit to how far you can go with this.

When someone pursues a very low carb or ketogenic diet, your body adapts to running on the ketones produced from burning your fat stores (it continues to make glucose too). Good news, ketones act as a natural appetite suppressant- so you don’t need to eat as much or as often. You just aren’t that hungry because with this method, your insulin levels stay lower. When insulin is lower, your body can burn fat for fuel when it needs fuel (burning fat for fuel instead of requiring eating for chronic re-fueling). Also, by eating a very low carb or ketogenic diet, your brain and gut can receive the signals that you are “full” when you eat fat and protein.

Ultimately, by keeping insulin levels in the naturally lower range, when you need fuel, you can easily burn fat for fuel, your appetite is decreased overall, and your brain and gut can receive signals and know when to stop eating. Voila! Less calories in, but it is because you don’t need or want them- NOT because you artificially put your body into a starving panic mode. VERY different reason for less calories in. VERY different body response to less calories in. Long term weight loss and weight loss maintenance is achievable. Pretty cool, right?

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Healthier Together Series: 6D. Putting it all together – Organizing Your Day For Productivity & Success

hannah-olinger-NXiIVnzBwZ8-unsplashToday, we are finishing up our 6th series. You have all the tools and knowledge to make the choices to optimize your health. How do you make it all happen? Here’s how to set yourself up for success. Make adaptations to make it your own. Here’s the basics.

Once a week:

  1. Review what happened last week. Make notes about what you learned, what you need to do, what has to be carried over from last week. Are you making decisions that align with your mission statement and your values?
  2. Brain Dump. Make a list of everything on your mind, everything you need to do, everything you are worried about, anything that is taking up mental space. Empty the brain of distracting thoughts.
  3. Prioritize your goals for the week. What do you need to accomplish this week? Include your goals for nutrition, physical activity, sleep and relaxation as well as any social goals.
  4. Develop action items, or next steps towards achieving those goals. Prioritize them or mark the most important ones so you work on those first. Also, it helps to have  a list of action items that are take less than 10 minutes to complete so that you can easily complete those tasks when you have sudden open moments like when a meeting ends early or you find yourself waiting for an appointment.
  5. Next to each action item, it helps make some notation or color code it to indicate a location. For example, some actions require you to be at your computer (sending an email or creating a powerpoint or editing a document) or at home (pack for trip).
  6. Review your calendar for the week ahead and fill in any of the necessary appointments or usual activities and block out those times. Account for every hour of every day. Remember to include your commute times, food prep, eating, shower, workouts, relaxation times, sleep times, etc. There are 24 hours in a day and remember that you cannot be in 2 places at the same time.
  7. Now you see how much of your week is open for discretionary time. Find the largest blocks of time and block those for your most important projects or creative activities so you can do a dive deep into them. Fill in the smaller chunks of time with errands and To Do’s that don’t require much thought or creativity but take up some of your time.

At this time, you likely have a brain dump list, a prioritized list of goals, a prioritized list of action items with locations and a prioritized list of “10 minutes or less” tasks.

Daily:

  1. At the end of your day, review your day (see #10 below) and then review the weekly calendar for tomorrow. Make sure you have carved out enough time for a bedtime routine and sleep and personal hygiene. Review your list of remaining action items and “10 minutes or less” tasks. Determine which of those items and tasks need to make it onto your calendar- pick the most important ones first. Print out or write your schedule for the day with action items and tasks.
  2. Figure out your foods and drinks for tomorrow and prepare or plan for optimal nutrition. If you are going to eat out, make a plan for what you will have. If you are monitoring or logging your foods, you could enter in what you plan to eat or drink and review the nutrients and macros of your planned foods and drinks. This allows you to make modifications.
  3. Confirm your physical activity plan for tomorrow based on your body state, your schedule and time available. If you drank alcohol, your body will benefit by some exercise tomorrow morning.
  4. Identify a pocket of time for self care and self reflection – whatever will be best for you. Some days, your physical activity plan may also include self care and self reflection.
  5. In the morning, follow your healthy morning routine and check in with your personal mission statement, your goals and your day calendar. Avoid checking email or social media when you wake up. This is to prevent other people or outside demands from taking control of your mind and mood so early in the morning.
  6. Start your day in control and do what’s best for you.
  7. Use your calendar and lists to help you maximize your accomplishments during the day. This will save you from spending time trying to figure out what to do with your time.
  8. If you happen to have an unexpected time that’s open, make a choice to move around, listen to music, draw, sit in nature, meditate or work on your “10 minutes or less” tasks.
  9. Cross off the items or tasks as you accomplish them throughout the day. It feels so good to do that! Write in anything extra you complete or any alterations to your schedule so that you have a log of how you spent your time.
  10. At the end of the day, review your day. Look for patterns and learn from your day. Over time, you may identify patterns of your best, most productive times of the day, or that some things take longer than others, or that other items on your calendar are constantly skipped and may not be a true priority for you.

***Share your wisdom in the comments below.***

Photo by Hannah Olinger on Unsplash

Healthier Together Series: Cycle 6C. Relaxation & Sleep – Focus your mind, Relax your body

camilo-jimenez-mUCnQpBZzXA-unsplashWant to learn how to immediately relax your body and focus your mind when your fight or flight response has been triggered – Naturally- without drugs or medications?

Let me introduce you to the Quieting Reflex, developed by Charles F. Strobel.

  1. Breathe in deeply so that your belly rises first when you breathe in (breathing from your diaphragm) and say to yourself, “Alert, amused mind.”
  2.  Breathe out through your mouth, saying to yourself, “Calm body, ” as you release the tension in your jaw.
  3. Let the tension flow out through your arms and smile inwardly to yourself.

If you practice this now, your mind can learn to respond automatically and become alert, while your body will relax. Then, you will be able to use this when you really need it – when you are overwhelmed, stressed or anxious and you need your mind to be sharp and focused.

Stroebel, Charles F., MD. QT – The Quieting Reflex. NY: Berkley Books, 1967, pp 110-112

Photo by camilo jimenez on Unsplash

Healthier Together Series: Cycle 6B. Physical Activity – 3 Steps to Developing a Daily Exercise Habit

You know you should exercise. You want to exercise. You have a gym membership. You have cute workout clothes. But…You haven’t slept well, so you need to get that extra half hour of sleep in the morning, so your workout doesn’t happen in the morning…You plan to work out later that day but then traffic was bad/work was brutal and you are exhausted/you still have work to do at home/you are tired/your kids need your help with homework/you have a million errands you want to do/you are hungry and have to cook dinner/you just blow it off…You will catch up tomorrow…

Does this sound familiar? Here are 3 steps to improving the odds that daily exercise will become a routine.

  1. Link one part of your exercise prep to something you do every day. For example, you always brush your teeth every day (I hope so). You always wear a sports bra to exercise or you always wear a certain pair of shoes when you exercise. Then link the two activities. Put on your sports bra or shoes when you brush your teeth. Do that every day. You don’t have to work out if you don’t want to, but just link the 2 activities together.
  2. Have a variety of methods of achieving your goal of daily exercise. Have them different enough that they fit different scenarios. For example, if you are tired or have not time, you need an effective workout you can do at home – try body weight high intensity interval training (HIIT) where you don’t even need any equipment and you can complete the workout in under 5 minutes. If it is a lovely day out and you want to spend time with a friend or loved one, have a walking route that allows you to enjoy each other’s company while walking. Take a bike ride. Dance to music. You can use an app like 8Fit or Sworkit. If you want to take a class, you can go to an exercise class or follow an exercise YouTube or DVD or app. You can always go to the gym if you have time and want to get a complete workout with weights or cardio equipment or take a class or with the help of a personal trainer.
  3. Log what you do and keep track of your progress. My bullet journal is where I write out the plan for my workout 2 weeks in advance. Then, as I complete my workouts, I jot down notes about my day and always end with a positive note to myself, “Feeling great! Went up on the number of crunches! Yeah!” I use my apple watch to monitor my overall activity and aim to close my activity rings every day. Then, I see how many days in a row I can complete all of my rings and I check it out on my phone. This is tremendously motivating since I love the 3 colors of the rings. image1

Basically, you want to lower barriers and make it easy to get started on any single day. Have various options on how you can achieve your goal to work out daily. Track it and celebrate each day’s success. Aim to do something physical every day and it will become a habit much faster. Then watch. Other areas of your life improve too. Sleep gets better, mood improves, eating improves, confidence improves, work improves…you get it. With the inevitable ripple effect of daily workouts, you may find that the rest of your life starts to fall into place and you become more and more successful in more and more areas of your life. Try it.

Healthier Together Series: Cycle 6A. Nutrition – If Food is Medicine, “What should I eat?”

lily-banse--YHSwy6uqvk-unsplashKeep it simple.

INCLUDE  What Your Body NEEDS:

  1. Water
  2. Protein
  3. Colorful and non-starchy Vegetables
  4. Fats

Whole grains and whole fruit may be beneficial in specific doses depending on your weight, exercise routine and other health conditions.

AVOID  What May HARM Your Body:

  1. Sugars of any kind including high fructose corn syrup, agave, natural sugar, etc.
  2. Processed foods including enriched wheat flour, white flour, corn meal, etc.
  3. Sweet beverages & Juice including 100% fruit juice.

 

Photo by Lily Banse on Unsplash

Healthier Together Series: Cycle 5D. Putting It All Together – Words Matter: 7 Steps to Self-Compassion.

tim-mossholder-SR8ByN6xY3k-unsplashWords are powerful. I can see this when I am talking with patients, my children, my spouse and my friends and colleagues. In this post, I am thinking about how powerful words can be to someone who is scared, feeling out of control, or uncertain of what is going on. This situation is common in a doctor’s office and in the hospital where people seek help when something unpleasant is happening that seems to be out of the control of the individual seeking care.

Studies have shown that patient outcomes are often impacted by what they hear from healthcare providers even when they hear something indirectly- if they believe it is about them. Consider this: What happens to a patient in the ER, frightened and waiting for a test result, hearing someone outside of the room saying, “Yeah…he’s a train wreck. It’s not looking good. There’s not much we will be able to do. He will have to follow up with his primary care doctor…”? Later (feels like HOURS to the patient), the provider comes into the patient’s room and says, “Thank you for waiting. Your labs were unremarkable and your chest x-ray came back and you do not have pneumonia. It’s probably just a viral upper respiratory infection. We recommend you follow up with your primary care provider…” Might this person be reassured by this visit?

People can be scared, feeling out of control, or uncertain of what is going on outside of the doctor’s office or hospital.  There are times when our senses hyper-sensitized, when we are on high alert, and what we hear, enters deep into our subconscious mind and begins to influence our feelings, thinking and behaviors. This hyper-alert state is usually when we are feeling strong emotions, when our mind is “wide open.” Words at these times are very powerful. They may be accurate and rational, but they may not be. Sometimes, we are aware of these influences and many times we are not.

In my practice, I see that there is much suffering related to the hostile and negative words we have absorbed at various vulnerable times in our lives. Maybe a parent, family member, teacher, partner, close friend, colleague said something hostile or we misinterpreted some comments which were deeply painful and our brain absorbed it and was altered by it. When I hear hostile and negative words being used against oneself, “I was bad,” “I failed,” “I have no discipline,” “I just can’t do it,” “I’m not strong enough,” “I’m hopeless,” “I’m no good,” “I’m stupid,” “I can’t help it,” “I’m just out of control,” I recognize one of the keys to healing and success will be to develop a capacity for self-compassion.

We have mentioned self-compassion before. When we develop the capacity for self-compassion, healing begins. When we practice self-compassion, success follows. If you use hostile and negative words to describe yourself or your character, stop now. It seeps in unexpectedly and it has no purpose. It blocks your ability to progress and limits your success. Good news! This negative self talk can be phased out and left behind. Replace it with a healthy practice of self-compassion. Here’s how:

  1. Become aware of it if you hear yourself saying something judgmental and negative about yourself. “I was bad (this implies a character flaw), I ate that cake even though I knew I shouldn’t. (a routine character flaw)
  2. Identify it and label it. “That was my negative self talk and it’s not true.”
  3. Reframe it.I feel bad (this implies a temporary feeling). I ate that cake even though I knew it would interfere with my weight loss goals. (a simple mistake)
  4. Reflect. “I have been very stressed and bought the cake to “treat” myself. I don’t actually feel better after eating the cake. My stress is not improved after eating the cake.”
  5. Learn. “Taking a walk outside, listening to music, dancing, calling a friend, drawing, or journaling DOES relieve my stress and also would be distracting me from the desire to eat cake.”
  6. Empower yourself. “Next time, I can try some or all of my other stress relieving activities. If I still want the cake, then I can still choose to eat a smaller piece of cake, but maybe I won’t have it. If I do, I will own it and move on. I will know that I am doing the best that I can, at that moment.”
  7. Reaffirm. “I am doing the best that I can, right now.” If you then hear yourself responding, “Well…actually, I COULD do better…” then smile to yourself and say, “I know you can… And, you will when you are ready.”

Given the power of words, imagine what might happen if you protected yourself from negative self talk. Imagine what your day would be like if you heard warm, loving, supportive comments all day and accepted you are human and humans make mistakes and allowed yourself to regularly reflect and learn how to get better and better. Can you appreciate how much you’d flourish and achieve? When you practice self-compassion, you open yourself to your incredible capacity for success and joyful living.

Let me know how you have conquered negative self-talk or how you practice self-compassion.

Photo by Tim Mossholder on Unsplash

 

Healthier Together Series: Cycle 5C. Relaxation & Sleep — 7 Steps to Using Traffic and Commuting for Self-Care

aditya-chinchure-ghbepAO7BCs-unsplashAfter residency, I decided I wanted to live within 10 minutes from my practice so I would not have to spend my precious time commuting to and from work. I moved within a 7 minute drive from my work, no traffic. I loved the extra time I had on either end of my work day. First, I was exercising more, cooking more dinners, and having time for grocery shopping. It was great! As time went on, I was able to fit other activities into that extra time and I could spend more time doing work-related activities. I could run a few more errands each day and I began taking on more work duties that could be accomplished in the extra time I now had.

As a result of my increased number of activities, the exercise routine became more sporadic. Instead of working out before work, I could “get more stuff done” and then plan to workout in the evenings. Of course, EVEN IF my clinic didn’t run late with last minute add-on patients and phone calls or EVEN IF I wasn’t too fatigued or hungry after a full clinic day missing lunch, my family members needed my focused attention and my workouts would be further “postponed.” I now didn’t have time to workout. Basically, the “saved” time started out as more time for self-care, but ultimately was squeezed out with with more time spent on activities and obligations that I didn’t need to do BEFORE I eliminated my commute and less self-care. Poor planning…Lots of reflection and learning…

Fast forward to my current job that I love but that is far from home. (We can discuss in the future about how to grow into the job you love.) When considering this job, I had to accept that I would have a total daily commute of potentially up to 2.5-3 hours with the common severe traffic. I considered taking the train in. The hospital even offers a free shuttle to drive people to and from the train station. However, I do not live close to the train station, so it would still take me about 2-2.5 hours door to door to take the train, and without the flexibility of coming and going as I wanted. It was clear. With this new job, I would have a long commute to and from work, 5 days a week.

I began investigating how to optimize my commute time. After trial and error and rapid “quality improvement,” my commute is part of my self-care time. If you have a long commute, here are my 7 steps to achieving a Self Care Commute:

  1. Figure out when you HAVE to be in your office.
    • Can you work from home on some days?
    • Does it matter the exact time you get to work or leave work?
    • Can you adjust your work day start and end times? If no, move to #4.
  2. Figure out your transportation options that agree with your work hours.
    • Do you need personal space and time without other people during your commute? Do you have a car? If yes, move to #3.
    • Are there ride share or public transportation options for you to get to and from your work that you would consider? For example: Uber, Lyft, Train, Subway, Bus, Carpool with neighbor. List them.
    • How long does it take to get from your front door, to your office door for each of those options? Add to your list next to each option.
    • Is your schedule predictable enough that your schedule can match a ride share, bus or train schedule? If no, move to #3.
    • Will you need to travel from one site to another during the day? If so, will it be easier if you have your own car? If yes, move to #3. If no, list your options for travel during your workday. Include the door-to-door travel times and costs associated with each option.
  3. If commuting by car or truck, review the various driving routes to work and traffic patterns. 
    • Waze, ETA and other apps offer anticipated travel times to destinations at various hours of the day. Make a list.
    • Can you find the range of travel times for the times you could drive to and from work for the hours you need to be there. Circle those travel times.
  4. Make a list of the categories of activities you can do during your various commuting options that you would like more time for. For example, Train: knitting, reading, listening to music, audiobooks, podcasts, writing, closing eyes and visualizing. Car: listening to music, audiobooks, podcasts, sitting in silence, connecting and talking to family/friends hands-free, driving through scenic route.
  5. Figure out the options for your activities on the way TO work which may be different than the way FROM work to home. For example, I am focused and my brain is eager to learn early in the morning, so I listen to non-fiction educational audiobooks on the way TO work. At the end of my day, my brain needs to relax. I may process my day by listening to music or thinking in silence or I may connect with others by calling my family or friends or I may want to be entertained and eagerly listen to the next chapter in the current detective series.
  6. Organize your commute times to optimize your commute and productivity. For example, my commute is cut in half if I drive in extra early before my scheduled meetings or clinic. This works great for me since that is when my brain is most productive so I can use that early quiet time in the office to achieve more. On my ride home, my commute is not optimized and is longer (by choice). I love that the longer drive home allows me more protected time to “squeeze” in a chapter or two of a fiction audiobook (which I wouldn’t read otherwise), process my day and connect with family and friends.
  7. Try it out and adjust your daily routines to optimize your commute times. After adapting my schedule and travel times, my commute time is not as long as I anticipated. I am more productive, my time is spent more efficiently and I have protected self care time daily. Despite the long commute, I have better integration of my work life and personal life.
    • Maybe you will have more time to connect with more of your family and friends with hands free phone calls.
    • Maybe you will find a new podcast or book series that make that unexpected traffic delay enjoyable.
    • Maybe you will learn new skills with personal development audiobooks or a recorded lecture series.
    • Maybe you will use the time to process your day, think about your family, consider your future.
    • Maybe you will learn a new language and take that trip abroad or meet new people.
    • Maybe you will work out at the gym near work in the evening before you drive home so that your commute time will be shorter and you will achieve your daily workout goals.

Once you recognize your commute time can be protected time to fit in the enjoyable activities you currently don’t make time for, you will find it is a luxurious time. While sitting in traffic on my ride home, I am forced to slow down. There is no checking emails or texts or getting online. I am in control of and I choose which activity I engage in. I appreciate the extra time I have for those fun activities that I otherwise would not make time for. The traffic ensures that I dedicate more time to self-care.  It’s now my Self-Care Commute.

Photo by Aditya Chinchure on Unsplash