Covid-19 pound-emic

In just under three weeks the world turned upside down.  Unprecedented everythings.  Market crashes.  Travel restrictions.  Provincial emergencies.  School closures.  Business shutdowns.

The only certainty in the world right now is uncertainty, and uncertainty is most certainly anxiety provoking.  And when anxiety runs high, our emotions run amuck.  And when our emotions run amuck, many of us (myself included) seek solace from our favorite comfort foods.

Fortunately for me, I am in self-isolation having recently returned from a trip to Florida. Which means, my groceries are being purchased for me by family members who follows the list and skip impromptu buys.  Thus, my favorite comfort foods are not in the house.

There is nothing like being told you must stay home to make one feel restless.  I know I am restless, because even though I know there are no comfort foods in the house, I still find myself rummaging about the kitchen.  The fridge is almost bare, but I check it anyway.  And guess what?  It’s still almost bare every time I look.

Despite all the uncertainly in the world right now, I believe one thing is certain – it’s easier to not gain weight than to have to lose it later when this is all over.  It’s never over – there will always be some excuse.   Right now it happens to be Covid-19 that has us isolated and raiding the refrigerator.  Next it will be celebrations when social distancing is lifted.  Then it will be Thanksgiving.  Then it will Christmas.  Then New Years…

Let’s avoid the Covid-19 pound-emic.  You can emerge from the Covid-19 pandemic a better version of yourself.

But how?

  1. Recognize that heightened anxiety is normal when uncertainly is rampant in the world. Eating is not the solution.  Remember – eat to nourish, not console.  Now is the perfect time to learn how to feel emotions, not eat to avoid emotions.  If you can learn that during these troubled times, then stress eating will be a thing of the past.
  2. Put up a “the Kitchen is Closed” sign. Don’t be poking around in the fridge and pantry – banish yourself from the kitchen except for specific mealtime hours.
  3. If you are new to working at home, if at all possible, do not work in the kitchen.
  4. Get up and get dressed – don’t laze around in your jammies.
  5. Design a routine for your day. If your routine doesn’t work, change it up until you find what works well for your work, your sanity and your waistline.
  6. Drink tea or coffee, they are known to have appetite suppressant effects. (Caution – not too late at night!)
  7. Drink water since we often confuse thirst with hunger.
  8. Remember hunger comes and goes in waves, and hunger is never an emergency.
  9. Don’t snack. When you catch yourself reaching for the abandoned Halloween candy the kids don’t like, remember you really don’t like that stuff either.
  10. Find a way to de-stress. Even when social distancing or self-isolating, you are permitted to take a brisk walk – just keep 6 feet away from others.  Start a deep breathing practice.  Start journaling your thoughts.  Start a gratitude journal.  Skip the news updates every few minutes.  (Covid-19 is not going anywhere in the next 24 hours.)  Insist on quiet time for yourself.
  11. Find a way to stay connected virtually with friends and family. Try using your cell phone as a phone not a camera for a change.
  12. Sleep hygiene is crucial. Get up at the same time every morning.  Go to bed at the same time every night.  Insist on 7 – 9 hours nightly – it allows your brain to reboot.

Covid-19 has toppled and is reordering our values and priorities.  Believe you can emerge from the Covid-19 pandemic a stronger and healthier you!

It is your choice!  And choice is a beautiful thing.

Have a safe week!  Stay home.
Live life, Love life… Always
Dr Karen

Longevity Rainbow

This past week I have been reading I’ve Decided to Live to 120 Years: The Ancient Secret to Longevity, Vitality and Life Transformation by Ilchi Lee.  Interesting concept – to ‘decide’ to live to 120y.  Of course we cannot simply decide to live to 120y, but what if we decide to live our life AS IF WE WILL live to 120y.  Would that change the way you approach your day? Your retirement? Your life?

Interesting thought experiment.

I will confess my initial response was disheartening – why would anyone want to live to 120y?  For me that would mean another 60 years.  Longevity.  Hmm.  Is that such a bad thing?  My thoughts then turned to another 60 years of what?  That is really the thought experiment.  What would you DO – what is your purpose – if you were going to live for another 60 years?

According to Webster’s Dictionary longevity is defined as a long duration of an individual life, but I much prefer the definition given the book The Longevity Solution coauthored by Dr James Dinicolantonio and Dr Jason Fung “Longevity means extending youth not extending old age.”

Such a better perspective!  I’m totally cool with living until I am 120y, so long as I can do so with energy and enthusiasm for my day, independently and with mental clarity.  I know… sounds impossible if not crazy.

Longstanding mental clarity and independence fill the pot at the end of my longevity rainbow, as I suspect is does for most everyone closer to 100 than 1.  And for me, mental clarity is readily attainable but slippery to hang on to.  When I cut the carbs (sugar and flour), my mental clarity soars. I first discovered this toward the end of 2018, when I initially experimented with intermittent fasting and a five day extended fast.  WHOOSH.  Energy and creative inspiration galore, accompanied by a silencing of my inner critic.  Vroom, vroom, vroom – slick thinking.

How can we fill our longevity pot today and every day for a brighter, livelier, and interesting future?

Here is my short list of strategies.

  • Read about and do new stuff. The ‘do new stuff’ part is crucial here.  I read a lot of non-fiction, believing that reading would keep my brain alive.  As it turns out, reading is not sufficient.  My brain already knows how to read so simply reading new material is not helpful – my brain is not forging new neural connections.  But if I actually DO something I have not done before with that information, then I can make new neural connections.  Unfortunately, simply making new connections is not enough – those connections must be reinforced.

In neuroscience this making and reinforcing new connections is called neuroplasticity.  Neuroplasticity occurs when the brain changes in response to experience.  Simply reading about how to knit, won’t create new neural connections but actually doing the knitting – however cumbersome or awkward it seems, will forge new connections.

Most memory-promoting sites recommend learning and practicing a new language or a musical instrument.  Hence my impossible goal to be able to play Bach cello suites.

  • Watch what you eat. There is so much misinformation on the web these days, it seems impossible to sift out what to eat or not eat.  Plant protein versus animal protein, coffee versus tea, keto versus vegan, intermittent fasting versus multiple meals and snacks.  It’s so confusing. Drs. Dinicolantonio and Fung recommend a predominantly plant protein based Mediterranean diet with nightly 12 – 14h intermittent fasts, adequate healthy fats and salt with inclusion of coffee/tea and red wine.  Check out their book for specifics.
  • Intermittent fasting. Routine nightly fasting of 16 – 18h has been shown to increase the expression of brain derived neurotrophic factor (BDNF), a neuro-peptide important in neurogenesis (new neuron growth) in the brain’s memory center (the hippocampus) improving overall memory.  Intermittent fasting has also been shown to improve sleep, boost immune function and decrease inflammation – all of which can have a beneficial impact on the quality of life with increasing age.
  • Exercise your muscles. As discussed in a recent blog – Twilight Zone Revisited – as little as 20 minutes of moderate cardio exercise daily significantly increases the expression of BDNF in the hippocampus.  Resistance train to counteract age-related muscle loss that occurs each decade after age 30y.
  • Promote flexibility in your joints. Stretch regularly or start a Yoga practice.  Personally, I find Yoga poses too challenging and complicated for my injury-related muscle imbalances. Instead I practice something called Active Isolated Stretching.
  • Enhance/improve your balance. Most people visualize careful execution of various yoga poses for improving one’s balance.  And it’s true, yoga works.  But simply standing on one foot while you prep veggies for dinner is a good place to start.  I alternate from right foot to left foot every 10 – 20 seconds while standing on a flat – side- up Bosu Balance Trainer while I read.  A quick google search on how to improve your balance will yield more than enough suggestions.
  • Exercise your cognitive powers – use it or lose it. Our memory improves the more we challenge it.  The converse is equally true – poor memory is the result of disuse.  As a society we have out-sourced our memory.  The widespread use of smart phones and iphones has been detrimental to our memory capacity. Gone are the days when you could easily recall a 7-10 digit number.  Give your phone a rest – use your memory!
  • Increase mindfulness. We are a distracted society.  Our attention span is shrinking at an alarming rate.  Think about it, it’s impossible to remember anything if you did not notice it in the first place.  Learn to pay attention.  Notice what is happening around you.  Simply by becoming more mindful – to intentionally notice – you will improve your memory.
  • Do something you love and that brings you joy. For those of us closer to 100 than 1, chances are our careers are drawing to a close.  But if you have another 60 years to live, what would you absolutely LOVE to do with your time?  For me it’s to play cello sufficiently well to consider myself a contributing member in our community orchestra.
  • Spends time in nature every day. The impact of solitude in nature cannot be understated.  Appreciate quiet solitude, birdsongs, the magical Northern lights on a cold, clear starry winter night, sunrise/sunset, the wind in the leaves.

I seriously doubt I will live to be 120y, even though longevity runs in my family.  I may well live to 90y though.  Why not choose to spend the next 30 or so years doing something I love and that brings me joy while keeping my brain and body running as smoothly as possible?

What would you do?

Live life, Love Life, Always
Dr Karen

Annoying Brain Paradoxes

 

It’s the strangest thing.

I have been at my goal weight plus or minus 5 pounds for well over a year.   The other day a friend asked, “When are you going to believe you have lost weight?”  Hmm…

“Odd question, why do you ask?”

“You still haven’t bought new clothes.”

Guilty as charged.  I have not bought new clothes.  I am still wearing the same jeans I wore 50 or so pounds ago, granted they were tight then and are loose now.  Since she pointed out the obvious, I have been wondering why not.  Why haven’t I bought myself some new clothes, if not an entirely new wardrobe?

Sometimes our brains present us with such annoying paradoxes.  Well, mine does anyway.  I am done losing weight, yet my brain still thinks I need to lose more.  “Oh just 5 more pounds – you gained 5 pounds when you re-introduced exercise.  Just lose that, then all will be well.”  It goes on…  “Maybe you should stop exercising, get that off and maybe 10 more.”

But then, every time I catch a reflection of my upper arm flab jiggling like semi-set jello, my brain cringes “You need to build some muscle in that flabby jello!”

The next excuse my brain gave was “You hate shopping for clothes.”  “It’s winter and you don’t have appropriate boots to wear with dressy clothes,” and “Seriously, you need to lose 10, maybe 15 more pounds.”

Seriously brain give it a rest, will you?  

Then it moved on… “Maybe you should hire a fashion consultant.  You don’t know anything about fashion.”  As a pediatrican I used to spend considerable time on the floor playing with 2 – 3 year old kids while trying to figure things out.  So I rarely, if ever, wore a dress – too hard to crawl around in.  I didn’t need to concern myself with fashion.

“You don’t need new clothes, you never go out anyway.”  “And remember your New Year’s resolution to stay within your budget this year.  New clothes will blow that out of the water!”

Trickster brain continued… “And who can afford a fashion consultant anyway?  No need for new clothes.  You know your weight will come back as soon as you get new clothes.  That’s how these thing work.”

If these are the thoughts percolating around in the deep and dark crevices of my brain, it’s not in the least bit surprising I have yet to buy new clothes.

Such nonsense.  Seriously brain, enough already!

But my brain is just doing what brains do.  Brains love ‘the familiar’ and want to keep ‘the familiar’ familiar.  For forty years, I believed I needed to lose weight.  So, my brain thinks it’s normal to believe I need to lose weight, so it keeps telling me I need to lose weight, even though I no longer need to lose weight.  In fact, for forty years I did need to lose weight and the more I thought “I need to lose weight,” the more I gained weight.  It’s a crazy paradox.

Like I said, my brain is full of annoying paradoxes.  Really annoying paradoxes.

I will admit this makes me angry at my brain.  And I think thoughts like – “Seriously brain, give it a rest.” or “Seriously brain, enough already.”  This is also not in the least bit helpful.  Being angry at your brain for behaving like a brain is well, simply ridiculous – yet another paradox!

We have the most amazing gift – self awareness.  And it is our self-awareness that creates crazy paradoxes.  We should chuckle at our crazy paradoxes, at least we know they are there.  And when we know they are there, we can change them.

Seems it’s time to go shopping!

Have a fantastic week,
Dr Karen

Solving Snack Attacks Part 3 – How to get fat adapted

In part I explained how our physiology works against us when we are sugar burners.  In part 2, I reviewed some of the physiology of fat metabolism and why it calms carb cravings.

In this part, you are going to learn how to make the switch from sugar burner to fat burner. As I said at the end of part 2, it’s simple, but not easy.

Recently while listening to one of my favourite podcasts, The LowCarbMD, one of the hosts asked a guest presenter, “What do I need to do to live to 120y if not forever?”  The answer might surprise you. It was not to manage stress, get proper and sufficient sleep, eat fish three times a week, eat fresh fruits and vegetables, eat unprocessed organic foods, free range chicken, eggs and beef, stay active with lots of friends and sufficient money.  None of that.  It was keep your insulin as low as possible and avoid insulin resistance.

Banting and Best, (the researchers who discovered insulin back in the early 1900s) would be so pleased.  They unknowingly discovered the fountain of youth!

What a powerful hormone insulin.

To make the switch from sugar burner to fat burner, we must keep our insulin levels as low as possible for as long as possible.

“Okay, yeah, sure I will get right on that.”

I know, I know – it sounds impossible.

It’s not impossible, it’s just not easy.  But like all good things in life, it is well worth the effort.

First off, you need to understand insulin resistance.  Insulin resistance occurs when the cells of your body no longer respond to readily insulin.  Like a key that opens a door, Insulin is the key that unlocks the door that allows glucose to enter into cells.  When the key slips into the lock easily and the door swings wide open, the cells are said to be insulin sensitive.  But when the key gets worn and beat up a bit, it doesn’t fit the lock well and the door doesn’t open easily, the cells are said to be insulin resistant.

But remember high blood sugar is toxic to our cells and organ systems.  So our body, in order to protect itself, will increase insulin levels, in hopes that more keys will open more doors and let the glucose into the cells to be used a fuel.  As we become more and more insulin resistant, our insulin levels get higher and higher, a state that is called hyperinsulinemia (which literally means too much insulin in the blood.)  Eventually when we have high insulin levels and high glucose and insulin resistant cells, we are diagnosed with Type 2 Diabetes.

Let’s avoid that scenario!

As outline in part 1, when you snack, you spike your blood glucose, which in turn spikes your insulin, which can in turn cause a sugar low, triggering a snack attack.  It’s a vicious cycle.

To break the cycle, you need to follow the Fab Four.

1.) eliminate sugar;

2.) eliminate all refined grains (flour);

3.) eat 3 meals a day 5 – 6 hours apart with no snacking; and

4.) fast 12 – 14 hours nightly.

All of these dietary changes will significantly lower your insulin levels.  After 2 – 4 weeks, you will be well on your way to fat adapted and a fat burner.  No more cravings, remarkably little hunger and you lose weight.

Both sugar and flour spike blood glucose levels significantly.  Remove them from your diet, then there is no spike in your glucose and thus no spike in insulin, no spike in insulin means no rebound sugar low and thus, no snack attack.  When you do not snack throughout the day, your insulin levels are able to drop for several hours between meals, and will drop significantly when you fast overnight for 12 – 14 hours.

With a little discipline, do these consistently for 3 – 4 weeks, sometimes more, sometimes less and you will have made the switch from sugar burner to fat burner.

When you have successfully switched to a fat burner several things happen i) you get yourself out of fat storage mode, into fat burner mode; ii) all the cells of your body easily make the enzymes necessary to burn body for fuel; iii) you burn body fat for fuel; iv) your cells have a steady supply of energy without demanding a snack; and v) you don’t get cravings… so no snack attack.

You know you are fat adapted when you can easily go for hours without eating and not feel in the least bit hungry.   When you are fat adapted your energy levels are steady throughout the day.  There are no carb crashes, no carb cravings and surprisingly little hunger.

Can you imagine?  No hunger and no cravings?  No snack attacks.

Make the switch from sugar burner to fat burner.  Train yourself to be fat adapted.  It is how we not only survived but thrived for centuries.

It is possible!

Have a fantastic week,
Dr Karen

Solving Snack Attacks Part 2 – A little science on fat

In part one of this short series, I explained why we seem to snack against our own better judgement.  It’s our physiology working against us.  Those of us that are involuntary snackers are physiologically, sugar burners.

Remember sugar burners preferentially burn carbohydrate for fuel and fat burners preferentially burn fat for fuel.

Let’s get a little sciencey for a minute.  In part one I outlined that when we snack, we spike our blood sugar which in turn spikes our insulin.  Insulin replenishes glycogen stores, meets all of our cells’ energy requirements, and stores the excess energy as fat.

In a process called lipogenesis (Lipo = fat; genesis = to make new) our body stores excess glucose as fat in the form of triglycerides.  A triglyceride consists of 3 short chains of fat, called fatty acids that are stuck on a structural backbone called glycerol (not to be confused with glycogen or glucose.) These fatty acids vary in length but most have between 12 – 18 links.  When we ‘chew on body fat’ (burn body fat), a process called fatty acid oxidation, each triglyceride molecule can generate over 300 molecules of ATP, our cells preferred energy source. (To put this into perspective, one glucose molecule generates 38 molecules of ATP.  A single 16-link fatty acid generates 106 molecules of ATP.)

So fatty acid oxidation is extremely efficient, generating loads of energy.  All of the cells of your body can burn fatty acids, except your red blood cells and your brain cells, which we will talk about shortly.  Our cells do not run out of fuel, so… no snack attack.

When you are a fat burner, you can easily access your body fat for fuel.  Instead of demanding a quick supply of energy from sugar, your body can easily chew on a little body fat for energy between meals, so… no snack attack.

In addition, fatty acids and ketones (more on ketones coming up) do not spike our blood sugar, so our insulin levels remain low.  Low insulin means no rebound sugar lows, so…  no snack attack!

While it is true your RBCs and your brain cannot use fatty acids for fuel, there is no need to worry about wilted RBCs and shrivelled up brain cells if you don’t eat every two hours. You will not get short of breath or confused.

The sole job of red blood cells (RBCs), those life-saving iron containing oxygen delivering doughnut shaped cells, is to deliver oxygen to our tissues and remove the cellular waste product, CO2.  They must be flexible enough to squeeze through tiny little capillaries – so they do not have a nucleus or any mitochondria.  Without mitochondria, the energy generating powerhouses of our cells, RBCs are totally dependent on glucose for their energy needs.  This is where the glycerol backbone of triglycerides comes in very handy.  That back bone, very conveniently breaks down into glucose, maintaining our blood glucose levels in the healthy range, keeping our RBCs very happy, even when we were starving between successful hunts.

Fatty acids are large molecules, and as such, do not cross the blood brain barrier – that ever so important filter that keeps all kinds of toxins out of our brain.  But, again, the liver comes to the rescue!  When the liver is depleted of glycogen – its emergency glucose supply, it converts fatty acids into ketones.  Those ketones are able to cross the blood brain barrier and the brain gets lots of clean burning fuel.

Interestingly, only muscles, the heart and the brain can burn ketones for fuel.  RBCs get glucose.  Everyone else gets fatty acids.  Isn’t it amazing how the body prioritizes its energy distribution system?  Enough science for now.

So how can we make the switch from sugar burner to fat burner?  It’s simple, but not easy.

More on that in part 3

Have a fantastic week,
Dr Karen

Solving Snack Attacks – Part One: Snack, it’s almost a four letter word.

Snack.  It’s almost a four letter word.  You want to lose weight and you know sugary snacks and crunchy carbs should be avoided.  And yet, you find yourself at the bottom of a tub of ice cream or licking salty crumbs off your fingers more often than you care to admit.  It seems like you snack against your own will and your own better judgement?  Why?

It’s our physiology, working against us.  As involuntary snackers we are sugar adapted not fat adapted.

Huh?  What does that even mean?  Simply put, sugar adapted means our body preferentially burns carbohydrate (glucose) for fuel and fat adapted means our body preferentially burns fat for fuel.

Those of us who seem to snack against our own will, are sugar burners.  And as sugar burners, our body demands a steady, incoming supply of sugar to burn for fuel.  Incoming because our body stores a very limited amount of easily available sugar, known as glycogen, that needs constant replenishing.  Some glycogen is stored in our muscles for fuel, just in case we need to sprint away from a hungry predator.  Only our muscles can use the glycogen stored in our muscles – they don’t share.

A small emergency supply of glycogen is also stored in the liver. When a sugar shortage is detected – the liver shares!  The liver converts its emergency glycogen supply to glucose (our blood sugar) which in turn, is released into the bloodstream and thus available to any cells of the body in need of fuel.  But once the liver’s emergency supply is depleted, in need of more energy, a carb craving is triggered and KaBOOM, snack attack!

We snack and our blood sugar level spikes rapidly.  Insulin levels spike in response, and doing it’s jobs, insulin replenishes the emergency energy supply in the liver, provides all the cells of our body with the energy they need to function and then stores any excess energy as fat.  It’s a beautiful thing! 

Unfortunately, after a rapid increase in blood sugar, the insulin mop-up often ‘over-shoots’ and we experience a sugar low, triggering yet another sugar craving, snack attack.  The cycle repeats and we never break free from the sugar burner snack attack cycle.  We snack against our own will.

As a sugar burner our body i) constantly demands incoming carbs; ii) keeps our insulin levels high throughout the day; iii) is always in fat storage mode; and iv) is unable to access our body fat stores for fuel.  We feel hungry for sweets, cave to our cravings and gain weight.

This makes no sense from a survival standpoint.  Centuries ago we did not have access to a constant supply of carbohydrate laden foods.  As hunter-gatherers were in fact, starving most of the time and had to put a lot of effort into the occasional feast.  During those occasional feasts, our body would store excess fuel as fat, for the inevitable famine.  During those times of famine, our body was fat adapted.  It could easily access our body fat stores for fuel, keeping us alive until our next successful hunt.  We would feast again, store excess energy as body fat and the cycle continued.  We survived, even thrived.

This is where the confusion arises.  While it is true our body will preferentially burn excess sugar, our body is designed to burn fat.  We are actually meant to be fat burners.  Our body only burns sugar preferentially because, high blood sugar levels are toxic to our cells and organ systems.  Our red blood cells (RBCs) become sticky as glucose clings to them.  And sticky RBCs clump together and get stuck clogging up the tiny little blood vessels called capillaries, that supply all of our organ systems, causing widespread damage.   In an attempt to mitigate this damage, our body will release more insulin, push sugar into cells to burn for fuel and store more body fat.  It’s a protective mechanism.

Brilliantly smart body huh?  For sure.

But with time, over decades, the system fails.  We develop insulin resistance and a host of chronic metabolic disorders – obesity, type 2 diabetes, dementia, hypertension, stroke, and heart disease.

If we wish to avoid this scenario, we must break this snack attack cycle.  We must significantly decrease our carbohydrate intake and teach our body to use its stored body fat for fuel.  We must become fat burners, or fat adapted.

More on that in part 2…

Have a fantastic week,
Dr Karen

Calorie Counting Confusion

I must admit, for the longest time, I was very confused and unable to understand why calorie restriction and exercise – the eat less/move more approach to weight loss – doesn’t work.

As a chronic dieter, I followed the eat less/move more approach to weight loss for years.  I was a dedicated exercise enthusiast and I even got myself certified as a Nutrition coach.  And yet, permanent weight loss was elusive.  And like most chronic dieters, I believed it was my fault.  Any weight I lost, always came back.  I was unable to discipline myself sufficiently to successfully calorie restrict and I was unable to discipline myself to exercise without one on one assistance.  In fact, I still cannot.  Clearly, I had a deeply flawed character.

But once I understood why calorie restriction does not work and I changed the way I eat to match my physiology – weight loss was remarkably easy.  I lost the weight I regained after I stopped personal training, and had resigned to my fat fate.  I plummeted through the weight loss plateau 5 years of consistent personal training and attempts at calorie restriction could not budge.

I was not deeply flawed.  My body was responding beautifully to increased exercise combined with calorie restriction.  Exercise increases your appetite and calorie restriction slows your metabolism.  Double whammy – you feel hungry and you burn fewer calories (despite increased exercise.)

It’s just so unfair right?

It’s all about physiology and something called homeostasis.

Homeostasis is the body’s ability to adapt to changes in the environment.  If the environment is hot, you sweat; if it’s cold, you shiver. Your body will keep your internal temperature around 37oC.  Bright sunshine or a dimly lit room – your eyes adjust.  In the same way, your body responds to your caloric intake.  If you eat fewer calories, your body will burn fewer calories.

In physiological terms, that means your basal metabolic rate (BMR) decreases.   Your BMR is the sum total of the energy required to keep your body alive.  It includes things like breathing, maintaining body temperature, keeping your heart pumping, maintaining healthy kidney function, liver function and brain function.  And you have absolutely no control over this.  You cannot will your body to keep its metabolism up any more than you can will your kidneys to stop making pee.

What you can control is your daily total energy expenditure (TEE).  Your daily total energy expenditure includes your BMR, plus the thermogenic effect of feeding (TEF – the energy needed to digest and absorb what you eat), plus non-exercise activity thermogenesis (NEAT – the energy expended with fidgeting, sitting up in your chair, typing, walking to the kitchen etc – any non-exercise related activity) plus exercise.

TEE = BMR + TEF + NEAT + exercise

This is where the advocates of exercise for weight loss chime in.  It’s true, if you exercise, you will more burn calories than if you sit quietly.  When you sit quietly, you burn 1 calorie per 2.2 pounds body weight per hour.  If you weight 220 pounds, you will burn 100 calories, sitting quietly.  Moderate walking at 2 miles per hour for 60 minutes, burns approximately 133 calories.

Hmm.  Not much of difference is it?

Exercise accounts for at most 5% of our total daily energy expenditure.  Ninety-five percent of the energy our body burns has nothing to do with exercise.  Advocates of exercise for weight loss will also quite correctly argue, being fit will increase your basal metabolic rate.  Muscle tissue is much more metabolically active than fat tissue.  The more muscle mass you have, the more energy you burn.  But we lose up to 5% of our muscle mass per decade after age 30y.  We must exercise just to maintain our muscle mass.  I’m just not sure how much that is going to change our basal metabolic rate and subsequently our total energy expenditure.  My guess is not a lot given that there is not a huge difference between sitting quietly and walking.

Contrary to popular belief, our appetite is not under voluntary control.  Our appetite is very tightly regulated by hormones including ghrelin (greh-linn), cholecystokinin (CCK; Ko-le-cist-o-kye-nin), peptide YY, insulin and leptin (leh-p-tin).  Ghrelin tells us when we are hungry and should find something to eat, cholecystokinin and peptide YY, tell us when we are full and should stop eating.  Insulin is our fat storage hormone and is secreted by the pancreas in response to eating.  Leptin is our satiety hormone and is secreted by our fat cells.  Leptin tells our brain our fat cells are full and insulin can stop storing excess energy as fat.

This is normal appetite homeostasis – Ghrelin increases hunger, CCK and peptide YY, shut it off.  Insulin stores fat, leptin tells it to stop.  Perfect.

So what is going wrong?

Calorie restriction messes with all of these hormones.  Calorie restriction significantly increases ghrelin – we feel hungry.  Multiple, low fat, calorie restricted small meals daily ensures our insulin levels are always high – we are constantly in fat storage mode.  And most frustratingly, high insulin levels stop leptin from telling the brain to shut off fat storage.

Calorie restriction makes us feel hungry, promotes fat storage and interferes with satiety.  No wonder weight loss is a problem when we calorie restrict.

So in response to calorie restriction our body 1) decreases our metabolism, and 2) messes with the hormones that regulate our appetite.  Neither of which are under our voluntary control.

Calorie restriction creates a vicious cycle.  We eat less and lose some weight.  Our metabolism slows and our hunger increases.  We start to regain weight.  Determined, we double down eat even less (or at least try) and increase our exercise.  We get hungrier and our metabolism slows even more.  Our weight starts to increase again.  This nasty cycle continues until we are miserable.  We are hungry, and because our metabolism is slow we are cold and lethargic and most likely irritable.  We give up, return to our old way of eating and we regain all of our weight plus some.

This was exactly my story.  I joined a popular weight loss program, lost about 30 pounds, and slowly I started to regain the weight.  So, I joined the gym, lost my weight regain, plus a little more.  Slowly I rebounded.  Doubled down – more exercise.   Lost a bit.  Gained a bit.  Lost a bit.  Gained a bit.  Over and over for 5 years.  More hunger.  More cheating.  More self-reprimand.  Until one day – I simply burst into tears during a training session (sincere apologies to my trainer at the time.)   Shortly thereafter, I was done.  No more training.  No more calorie restriction.  I was ready to resign to my fat fate.

And I did.  No more exercise, no more calorie restriction and guess what?  The weight returned – almost all of it.  Then I learned why it was not my fault.  And that, made all the difference.  And it can make all the difference for you too.

Weight gain (and weight loss for that matter) has nothing to do with willpower or lack of moral fortitude – you are not deeply flawed because you struggle to lose weight.  It truly is, not your fault.  It’s your physiology working against you.

Have a wonderful week,
Dr Karen

Twilight Zone Revisited – Exercise and brain health

Last week I admitted I no longer believe exercise is a useful weight loss tool.  Seems I stirred up a little tempest in a teapot.

So I decided I would do a little research into why exercise is crucial if we want to live a long and vibrant life.  A quick PubMed Search – aging and exercise – and I was drowning with just under 20,000 articles.  Add in review, human, and brain health, down to 66 – a much more manageable list!

My conclusion… Physical exercise is quite likely one of the most underutilized, most inexpensive and non-invasive tools available to enhance brain health.

How does exercise enhance brain health?  Spoiler alert – it’s not via weight loss!

During moderate physical exercise, blood flow is redistributed.  Blood flow to the gut, liver and kidneys decreases.  Blood flow to the skin increases to help with cooling/sweating.  Blood flow to the muscles increases up to 100 fold!  Blood flow to the brain also increases but not to the same extent as to the muscles.

From an evolutionary perspective, this makes sense.  We needed blood, which delivers oxygen, to flow to our muscles so we could make a run for it when we lived in a hostile environment.   ‘Hungry mammoth, run!’  Plus we wanted to learn and remember ‘this is where the ‘hungry mammoth lives’ so we could avoid it in the future.  We don’t need more blood to go to the kidneys because stopping for a pee when encountering a hungry mammoth could be fatal.

The exercise induced increased flow of oxygen to the brain also stimulates the expression of BDNF (brain derived neurotrophic factor) and stimulates neurogenesis (new brain cell growth) in the hippocampus – the part of the brain responsible for memory and learning.   With exercise, we learn and remember better.

BDNF has been dubbed miracle-grow for the brain by Dr John Ratey.   In his book Spark, he details the impact of exercise on the brain specifically as it pertains to learning, mental health (ADHD, anxiety and depression) and addiction concerns that plague our society.  It’s a fascinating read.  BDNF is a neuropeptide (a little protein) that helps our neurons (brain cells) sprout connecting branches as we learn something new.  The more connecting branches between our brain cells, the stronger the memory.  If those connecting branches are reinforced we remember, if they are not, we forget.

Increase exercise, increase BDNF, increase neural connection, improve your memory – what’s not to want here?

In addition, freshly oxygenated blood pumping through the dusty crevices of our brain can clear out the metabolic toxins that can make our thought processes sluggish.  Those metabolic toxins (known reactive oxygen species) are byproducts of cellular reactions required for normal brain function and contribute to neuro-inflammation.  Get the brain blood flowing and those inflammatory reactive oxygen species are flushed away.

The result?  Our mood is better, our thoughts are clearer, our stress is down and freshly inspired we are ready to tackle anything.  At least that has been my experience with a 30 – 60 minute bout of cardio.

Furthermore, and this was the kicker-convincer for me, physical activity has also been shown to delay age related cognitive decline, which is the medical term for a severe case of where-are-my-keys-forgetfulness.  What’s even more intriguing, exercise may slow, or perhaps even reverse, some of the neurodegenerative changes associated with dementia.   WHOOSH!  WHAT?!?!?

As an aging society, second only to financial insecurity, we are terrified of memory loss/loss of independence.  Dementia – Alzheimer Disease and other non-Alzheimer dementia – is one of the fastest growing irreversible scourges of the elderly.   It affects everyone.  One in three adults is afflicted, and the rest of us are their caregivers.

Moderate exercise i) improves learning and enhances memory formation; ii) decreases neuro-inflammation; iii) improves our mood; iv) delays age related cognitive decline, and v) can potentially reverse symptoms of dementia.

What is not known, yet, is how much exercise – the dose – to prescribe.

The American College of Sports Medicine 2018 Physical Activity Guidelines for Americans currently recommends:

Adults:

  • 150 minutes (2.5 hours) to 300 minutes (5 hours) moderately intense or 75 minutes to 150 minutes of vigorous intensity aerobic activity or an equivalent combination of moderate to vigorous aerobic activity, spread throughout the week;
  • additional health benefits are gained by engaging in physical activity beyond 300 minutes;
  • muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on 2 or more days a week;

Older adults:

  • multi-component physical activity that includes balance training as well as aerobic and muscle strengthening activities as listed for adults.

As a recently reformed ex-fitness enthusiast, I whole heartedly agree.  Exercise is crucial if we want to live a long and vibrant life.

Do it often for your brain, not for weight loss.

Have wonderful week,
Dr Karen

Twilight zone

Exercise.  I’ve mused about this before and I will likely continue.  I think I will start calling it the exercise and weight loss quandary.  Quandary – a state of perplexity… I am perplexed.  I feel like I am in an episode of The Twilight Zone.

I dedicated a lot of time and effort to exercise in an attempt to lose weight.  Five years of personal training 3 – 4 times per week.  My gym even presented me with a medal and certificate for my dedication.  It collects dusts in a drawer, forgotten.  Like many, I joined the gym to lose weight.  I got stronger, absolutely, and fitter.  But weight loss was minimal.

I recently read the book Why We Get Fat, by Gary Taubes.  And in it he presents the evidence (or lack thereof) for exercise as an effective weight loss tool.  He notes that in 2007 the American Heart Association and the American College of Sports Medicine recommended thirty minutes of moderately vigorous physical activity five days per week to maintain and promote health.  Sounds like great advice and it may well be.  But that recommendation says nothing about weight loss – it is to maintain and promote health.

In the same guidelines, they go on to say “It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures.”  Again, this says nothing about weight loss – it refers to not gaining.  They then go on to conclude “So far, the data to support this hypothesis are not particularly compelling.”  Umm… NOT compelling?

Somehow, these recommendations supported with not compelling data have morphed into the Move More part of the Eat Less/Move More weight loss gospel.  And that gospel has been indoctrinated into society for more than 50 years.  Suggest otherwise and you are politely dismissed.

I absolutely believe exercise is crucial for our long term health and well being.  But I no longer believe exercise is helpful for weight loss.  If we want to live a long and vibrant life, we must exercise.

So, though I stopped exercising for weight loss several years ago, about 5 months ago I started up again.  I now consistently cycle 30 – 40 minutes daily (I get my heart rate to around 140 and keep it there for 30 minutes – I break a sweat for sure!) and at the start of the New Year/New Decade, I added Active Isolated Strengthening – a form of therapeutic muscle strengthening (more on that some other blog) to help me correct some muscle imbalances.  And most annoyingly, I gained weight.  Only 5 pounds but hey, I am a weight loss coach… what’s this about?

Truthfully it is absolutely fine that I gained weight.  My eating patterns have not changed – the only difference has been the addition of exercise.  And as I just said, exercise is crucial for our long term health and well being.    And our long term health and well being is so much more important than some number dictated by a cheap bathroom scale!

What’s the quandary?  People look at me like I have square eyes when I tell them the Eat Less/Move More weight loss gospel is wrong.  People look at me with disbelief when I tell them exercise does not work for weight loss.  People think I am crazy when I suggest they should increase the amount of fat they eat.  People smile politely when I tell them I routinely fast 16 -18 hours daily.

Of course, they do.  The experts have been telling us for 50 years to eat less and move more.  For 50 years the experts have been telling us to limit the amount of fat in our diet.  For 50 years the experts have been telling us to eat 5 – 6 (or more) small meals and snacks throughout the day. For 50 years we listened to the experts.  And for 50 years we have been getting fatter and fatter.

Maybe the experts got it wrong.  Maybe it’s time to question the advice we have been following.

Twilight zone…

Something worth questioning/pondering.

Have a wonderful week!
Dr Karen

Impossible goal update

About a year ago, shortly after I started this blog/musing, I shared my impossible goal for 2019.  It was to learn to play Bach Cello Suite #1.  My year-long attempt to learn to play this solo cello suite was incredible.  I learned so much, and I even got better at playing cello!

Let me refresh or introduce the concept of setting an impossible goal.  I highly recommend you consider setting yourself one for 2020.  You may be wondering why any sane person would intentionally set an impossible goal.  Why would anyone decide to fail on purpose?

Because when you know and accept you are going to fail but choose to go for it anyway, you set yourself up for exponential learning and growth.  And that exponential growth comes in the form of strategic byproducts.  A concept attributed to Dan Sullivan, strategic byproducts are the unanticipated ‘side effects’ of setting an impossible or unrealistic goal.  Unanticipated is the key word here.  You cannot predict the result.  I expected to get better at playing cello – and I did.  But I learned so much more than cello technique and those beyond-cello-technique side-effects were unanticipated but most welcome!

I’ve also learned that reaching a specific goal though quite the achievement at the time, loses much of its meaning as time passes.  Sad fact but true none the same.  PhD… tick, lots of people have them.  MD… tick, lots of people have them…  Lose 75 pounds… tick, lots of people have done it.  Hmmm.

So, if the importance of actually reaching a goal fades with time, why not set impossible goals and gain all those strategic byproducts?

What were some of my beyond-cello-technique strategic byproducts? In no particular order…

  • Consistency.  When I first started cello, I practiced inconsistently.  Sometimes days would pass, and I never picked up my bow.  Now I practice every single day without fail.
  • Focus.  Some aspects of learning something new can be not so fun.  Like scales and long tones.  I have learned to focus intently – listening for intonation, smooth sound and tension free vibration.  Initially my happy-wanderer mind would drift imperceptibly.  Where is Molly?  Is the laundry done? Whose car is that driving by?  Now I catch my mind wandering and redirect it.  An hour can go by and I’m still working on scales and long tones.  It’s so fun to be lost in concentration!
  • Discipline.  There were times when I just didn’t feel like practicing.  I have no doubt you’ve experienced this – it’s an annoying default of the brain.  It’s the ‘I-want-this-but-I-don’t-want-to-do-this’ paradox.  Now, practicing cello every morning is just what I do.  There is no discussion, no internal argument, and no convincing required.
  • Considerably less frustration. This is huge.  Initially I would get so frustrated with my lack of progress, or my dreadful intonation, or the tension is my shoulders, hands and wrists, grumbling I would give up, promising to return later but then not return.  That rarely happens now.  Rarely.
  • Tempering of my inner critic. This was a real eye opener.  I was always critically judging my ability or complaining about my lack of progress.  I would say things like “I always miss this shift,” “I never get the pitch accurately” or “I worked on ‘x’ all week and still it’s no better.”  One day my very patient cello teacher called me on it.  It’s not true that you never or always do anything.  This was well into my journey to accept myself and to stop my self-criticism.  Somehow criticizing my skills was acceptable, where criticizing myself was not? Hmm.

All of these unanticipated side effects have permeated into other aspects of my life.  My frustration tolerance for computer tech is much higher.  I have added daily cardio to my morning routine, no convincing required.  I can redirect my mind with greater ease.  I can maintain my focus longer.  My inner critic is not so accurate with her punches and her punches are considerably less frequent.  I no longer argue with myself about doing things I want to do.  Incredibly, I have shut off the want-to/don’t-want-to toggle switch in my brain.

What you learn and become along the path to your impossible goal is more far more important than the accomplishment of the goal itself.  Adopt an I-am-all-in-attitude and plan to fail for the sake of learning and growing.  Since you have already accepted that it’s an impossible goal and you will fail, you have nothing to lose and so much to gain.

And no, I cannot play Bach Cello Suite #1… but I can hit all the notes in the right order, sometimes even in tune.  So fun.

Now to decide my next impossible goal… What about you?

Have a great week.
Dr Karen