Sunday, August 26, 2012

Defining the word "diet": how grammar influences your success


I hate the word "diet". It's so confusing because it's a seemingly simple word, but actually has so many implications depending on the nuances of its use. According to google dictionary, as a verb diet means to "restrict oneself to small amounts or special kinds of food in order to lose weight", but for me that implies a short-term solution. What happens after? Do you go back to your normal "diet" (as a noun) and gain it all back? So why is that diet as a verb makes you lose weight, but diet as a noun makes you gain it back? It shouldn't! As a noun, diet is defined as "the kinds of food that a person, animal or community habitually eats". So why can't our normal diet be how we diet? Or in other words, since we're using the same word anyways, why do we need to think about a short-term solution and a long-term plan as two separate things, the "diet" that we take on should also be the "diet" that we stick to normally for a sustainable healthy lifestyle. Otherwise, we just get trapped in this yo-yoing of weight. So then, how do you know what to eat day to day? There's so many "diet" strategies that it makes my head spin. Instead of endorsing one, let me just highlight why a healthy diet has such a significant influence on weight, and then describe my diet, including characteristics of it that I think make it work for me, and also a snapshot of my meals this week, including some recipes, as an example.

On a fundamental level, weight gain or loss has to be about calories in and calories out. No one can defy the laws of physics, which states that total energy can't be created or destroyed, so all calories in must be used up with exercise or turned into fat and vice versa. With this in mind, I always thought that exercise alone would help me lose weight by increasing calories burned, but it didn't work for me. Why? After doing the math, I realize that for me, and I'd suspect a lot of others since I'm a normal guy, I was in-taking so many calories at baseline, that it was much easier to cut out calories through healthier eating than to exercise enough to make up for everything that I was eating. Stay with me and I'll walk you through it. Let's say I was running everyday for half an hour, that should be enough to lose weight right? For a heavier, slower person like me (12 minute mile) I would burn 355 calories per session. So that's 355 calories/day x 5 days/week = 1,775 total calories burned per week, which would be in addition to the calories I burn on my own throughout the day, which if I calculate my basal metabolic rate, should be around 2100 calories per day. That sounds great, and since burning 3500 calories is the equivalent of losing 1 lbs, that extra 1,775 calories a week I'm burning while running should provide a net loss of .5lbs a week, or around 2 lbs per month...so why didn't that work? Well, let's inspect my diet, which I actually didn't think was that bad. In November 2011, I was on my family medicine rotation at Stanford and was too tired to cook after clinic. Instead, I would regularly run to Panda Express on my way home, where I'd get a 3 item combo, but with the healthy options because I really was trying to be healthy. My typical meal would look something like rice/noodles (500 calories), item 1: Black pepper chicken (200 calories), item 2: Shanghai Angus steak (220 calories), and item 3: Golden treasure shrimp (390 calories) + hot and sour soup (100 calories) + pot sticker appetizer (220 calories) + 2 fortune cookies (32 calories each) + diet drink (0 calories...see, I was making good decisions...anyone?) = 1662 calories. Ok, that might be a lot, but let's say I was good the rest of the day to compensate and only had 300 calories for breakfast (2 eggs, piece of whole wheat toast and an apple) and 500 calories for lunch (a 6" Subway sandwich they advertise as healthy and a bag of chips). So every day, I ate around 2400 calories, except I'm only burning 2100 calories naturally, so overall it would come to 2400 - 2100 = 300 excess calories/day x 7 days/week = 2100 excess calories a week. Luckily, in this hypothetical situation, I'm running 5 times a week, and burning 1775...so 2100 - 1775 = 325 excess calories per week... no WONDER I wasn't losing weight. I still have a hard time believing a little soup and potstickers was about as much calories (320) as running for half an hour (355). It was just a tiny little addition... who knew calories add up so quickly even with small snack items? In retrospect... I probably could have just cut the little things out and seen significant results.

I started the Paleo diet in May 2012. You may have heard of it as the newest trendy diet. Some may call it a fad diet, but it's only a fad if you want to treat it as a short-term "diet". The basic tenant of the paleo diet is eating foods that our bodies are evolutionarily accustomed to eating, or foods that were available to us as cavemen, hence the nickname caveman diet. It entails using the highest quality of foods possible in terms of meats, fruits, vegetables and oils with the goal of having nutrient dense meals. In strictest practice, to ensure that you're only eating the best foods, you have to cut out things like processed foods (i.e. products with those ingredients on labels that you can't pronounce), dairy (apparently cavemen didn't have domesticated cows), legumes (including peanuts and soy products, and I'm asian... so I can't have tofu or soy sauce?!), no processed carbs, and no added sugar. Admittedly it sounded a bit crazy and unreasonable when I first heard it, and still sounds a bit crazy when I'm writing about it now, but it surprisingly isn't that difficult. I went on the Whole 30 challenge with my gym (Crossfit Palo Alto) in May 2012, which meant I adhered strictly to the Paleo diet for a month, and admittedly that was a bit of a pain, but when I came out of it, I had shed a lot of weight, and I found myself developing habits to make healthy eating more sustainable. One example includes cooking my own meals and planning what I eat. During the month of May, since the rules are so strict, I had to plan and cook my meals on a weekly basis otherwise I wouldn't have anything "Paleo" to eat and be stuck with the dilemma of quitting the diet or just fasting. I didn't like either option, so instead, to maximize my chances of success, I set aside time to cook with friends every week, which was also a fun way to spend time with people. I got really used to this routine and just cook batches of meals regularly now, which ensures I have healthy food available on a regular basis. Over time, I also found my taste in foods changed. I restricted sweets for the entire month, and now I find myself wanting to eat sweets less often, and also less at a time because too much makes me feel a bit sick. So I talk about eating sweets now, because after that month, the Paleo diet didn't become a short-term "fad diet" but instead just a way that I would eat most of the time. I still go out and enjoy myself with friends on weekends, but even when I do that, since my habits and tastes have changed, I still try to do small things like substitute sides for healthier options or pick out the healthier option on the menu, which combined with being relatively strict during the week is enough to make it a sustainable option that works for me.

Andrew and I with our Paleo meal of the week (8/19/12)
So what does my daily diet look like and what did I cook this week? A picture of all the food is above, but for breakfast we made "Reinvented PB&J Paleo Muffin Frittatas". I love making muffin frittatas for breakfast, an idea I stole from the Nom Nom Paleo blog because it's a great grab and go breakfast. Then for lunch, I've been working in the hospital so just make a salad from the salad bar with olive oil and vinegar and add protein in the form of Graeme' Meatloaf Minis, as well as some fruit. Finally for dinner, I made Korean Short Ribs w/ Rice made from cauliflower (both from Nom Nom Paleo). In the end, this cost around $50 for around 4-5 days worth of meals (though my hospital salads were free), and took around 4 hours to prepare total for the week (1 hour grocery shopping, 3 hours cooking). When I calculate it out, per day, I ate around 2000 calories a day.

Am I recommending the Paleo diet for everyone? No. It works for me, and that's what matters to me, so similarly, what should matter for you, is what works for you. I gave you the reasons it works for me, and if you think that those reasons would work in your favor as well, then I say, give it a shot, but in the end, I stand by what the Harvard School of Public Health advises, "The best diet is the one you'll follow." Stay tuned next week, I'll talk a bit about what I've been up to for exercise with CrossFit!

References:

1. http://www.health.harvard.edu/newsweek/Calories-burned-in-30-minutes-of-leisure-and-routine-activities.htm (last accessed on August 19, 2012) 
2. http://health.discovery.com/centers/heart/basal/basal.html (last accessed on August 19, 2012) 
3. http://www.pandaexpress.com/files/Nutrition.pdf (last accessed on August 19, 2012)
4. http://www.subway.com/nutrition/NutritionList.aspx?id=lowfat&Countrycode=USA (last accessed on August 19, 2012)
5. http://www.hsph.harvard.edu/nutritionsource/healthy-weight/best-weight-loss-diet/index.html (last accessed on August 19, 2012) 

Friday, August 17, 2012

Is diet or exercise more important for a healthier lifestyle? How about neither?

I saw my sister about a month ago, and since she also struggled with weight loss she asked, "So, what was it that worked? Diet or exercise?" I decided neither. Both are necessary, but neither are sufficient. I would go as far as saying even together, diet and exercise are not enough, because what's most important is having a strong foundation from which you can build a healthy lifestyle. Diet and exercise of course will result in better health, but is it sustainable? Sustainable changes towards a healthier lifestyle should be the main goal, and it requires a foundation of being mentally committed to yourself. In the words of En Vogue, "Free your mind, and the rest will follow". I've tried for years to lose weight... but never could do it sustainably. Looking back, I failed because I didn't lay the proper foundation of making a commitment to myself to be motivated, be honest, build a support structure, and set appropriate goals. All four are important, but I'm going to focus on the first two in this post.


Why do you want to be healthier? Knowing your personal motivation is critical, because starting a healthy lifestyle requires will-power, self-control, and conscious effort to deviate from your normal routine. The most difficult step is the first one, and I promise it gets easier as you get used to a certain way of living, but you will need inspiration to keep yourself dedicated while you're adjusting to a new lifestyle. I can spout the various diseases associated with obesity from heart disease, stroke, diabetes, osteoarthritis, liver disease, cancer, etc, but really, unless you have some personal connection to a disease, these are the easy answers. I've shared some of my personal motivations in my first post, such as wanting to be able to lead my future patients to a healthier lifestyle by example, however, I have more reasons. Some are based in improving my sense of self-worth by making myself a priority in my life. I also want to be able to do all the fun activities I see other people doing, like trek up Half Dome in Yosemite instead of having people tell me, "You know that's really hard right?" Those are my reasons...what are yours? I often hear wanting to be healthy for one's kids or boosting one's self-confidence as reasons, both of which are great! Finding your own reasons requires soul searching, and it's difficult to be honest with yourself about what you're really made of, but in the end you'll be stronger for it. When I see a box of donuts in the call room (or office), I think to myself, is that donut worth it? The answer is no because my reasons for wanting to be healthier are more important than a minute of donut induced pleasure. When I'm at a restaurant, I switch out fries for steamed vegetables because thinking of my motivations to become healthy drives me to implement small changes in my life everyday, which in aggregate, yield significant results. So, what drives you?

I've already mentioned the importance of being honest when thinking of your own motivation, but let's go one step further by looking at other ways we lie to ourselves and self-sabotage our efforts to become healthier. I'm guilty of it. Lies that I've told myself include, "This is just the way I am, I'm already eating right and working out, so it doesn't matter because nothing works for me". I've been "regularly exercising" for a decade, and I just couldn't lose weight, so I was obviously genetically prone to obesity...or thick boned. It's amazing that I could just ignore that both my parents are skinny. If you're not becoming healthier with effort, then it's time to re-examine what's really happening. Just last Friday, I saw a patient who shared in my plight. She was a morbidly obese patient in her 40's who was frustrated in clinic because despite doing everything she's supposed to, she gained 10 lbs since her last visit. According to her, she worked out every day, ate only fruits and oatmeal in the morning, salads at lunch, and cooked vegetables with some meat at night. For a few minutes, I was baffled, until repeated questioning prompted her husband to reveal, "Well... she does have a sweet tooth...". In the end, I learned she ate frozen yogurt 4+ times a week in the evenings and I can't help but wonder what else she wasn't being completely honest about to herself or to me that was impeding her success. Humans have an amazing ability to rationalize what goes on around us to perceive our environment in a way that conforms with what we want to believe is reality. I've done it too, so I'm the last person who can judge, and can only sympathize and hope to support others. Another lie I used frequently was, "I work so hard...so I'm entitled to this big mac combo with large fries...and 10 chicken nuggets... and a mcchicken (plus it's only $1.00 more!) just this once." Sadly, this is actually what I used to get at McDonald's when stressed, which earned me the nickname of "Big Mac" by my neighbors' son when I was studying for the MCATs for med school admissions. First of all, rewards are supposed to be good for you, but that aside, the lie really comes from thinking it only happens once... binge eating horrible food is a gateway drug to more bad habits. I'll share one more lie I told myself: "I don't have time". This one is the worst of them all, because what was I really saying? That I didn't have time for my own well-being? That there were things more important than me? Like what? Studying to get 2% higher score on a test? Doing another extra-curricular activity? And frankly, if I want to do well in the things that I was involved in, I should be taking care of myself. I was just using time as an excuse, because if it's important, you make time. For me, I thought about how I could make time by integrating other activities that are important to me. When I examine what's important in my life, my friends are high on that list, so I found a way to make healthy activities and healthy eating a social activity, and suddenly, I'm multi-tasking and taking care of my mental well-being as well! So what are the lies you tell yourself that are serving as your personal barriers to success? The first step is being honest with yourself, then we can start thinking about ways to work around perceived barriers instead of using them as excuses.

Two more equally important components of a strong foundation are having a good support structure and appropriate goal setting, but like an out-patient doctor's visit, we can't address everything today, so I'll save it for a future post. My post next week will be a sample of my weekly diet regimen, some initial thoughts about diet, and some fun recipes.

Saturday, August 11, 2012

Welcome to my blog about my journey to become healthier, random musings on healthcare, and fun adventures

Hi all!!! Welcome to my blog page!

When I hit 30 in 2011, I got my version of a mid-life crisis and decided to prioritize myself, my wellness and my happiness, with one big goal of becoming healthier. It seemed particularly relevant for me as a med student going into primary care, since it's a little hypocritical for me to try to get patients to take on positive lifestyle changes when I myself was a little bit on the rounder side of things. Oh who am I kidding? I was obese, even if my friends would never say it, "No no no, you're not THAT big, you're beautiful the way you are". I love my friends and how they always tried to boost my own self-image, but technically I had a BMI of 30 weighing in at 215lbs and being 5'11"ish... and this is something I struggled with for years. I hired personal trainers, I tried to eat better, and no matter what I did, nothing seemed to work. So in the past year, I decided to really focus, and I lost 30lbs so far! Here's a before and after picture set almost exactly a year apart (last picture taken July 2012)! So the primary point of this blog is to document my continued effort to be healthier and happier through sustainable lifestyle changes, and share my advice so it can help others through philosophies, recipes, and personal achievements that hopefully can inspire others.


In addition, I'm noticing that as I'm getting older, I'm also developing a strong perspective on things, particularly topics that are healthcare or leadership related. I also seem to get into more oddly awkward situations than the average medical student... I don't know why, maybe I'm just awkward. Point is, expect a few other fun posts mixed in to share my perspective, comedy relief, or general life observations! My goal is a post a week or so, so stay tuned! Thanks! 

Best,

Raymond