Happy Halloween: My treat is a year's worth of progress

Trish, myself and Andrew after a Halloween Crossfit workout

Happy Halloween everyone!!! I hope everyone has a safe and fun Halloween this evening. I spent my Halloween evening working out with my friends at CrossFit Palo Alto. As always, we still made sure we had our fun (see picture of some fellow members in Halloween costumes they somehow worked out in). As I was recording my results for the evening, I had this feeling that I did the same workout last Halloween too because some of the quirky Halloween-themed names sounded familiar. I flipped back in my notebook, and not only had I done it before, but last Halloween was the first time I ever worked out at Crossfit. It was exciting to compare my results! 

The workout today was called "Hallow-bata". The objective was to do as many reps as you could of an exercise within 20 seconds. Between each 20 second interval there was 10 seconds of rest. We would repeat each exercise for 8 rounds of the 20 second intervals. Then, there would be a 30 second rest to allow us to move on to the next exercise. We did 4 different exercises in total. Our score consisted of the grand total of all the reps we were able to complete. The 4 different exercises and their Halloween-themed names were: 1) "Green Slimey Grasshoppers" - grasshoppers, which I've never done before Crossfit, consist of being in a push-up position and bending one knee and externally rotating that leg at the hip to get your shin as close as you can to the opposite arm; 2) "Headless Horseman" - not sure where this name came from, but I didn't lose my head thank goodness. It consists of picking up a kettle bell from the floor with one arm, putting the kettle bell in the palm of your other arm and then pressing it up. On the way down, you grab the handle with the same arm you used to picked it up and place the weight back on the ground; 3) "Cauldron Jumps" - box jumps, except we jumped over the box to the other side, and; 4) "Deadly Double Unders" - jumping rope with the rope going under twice with each jump.

Comparison of my results 1 year apart

The result? I was able to do 292 reps in total tonight, compared to 119 last year. I was amazed that in one year, I was able to do more than twice the amount of reps. Since it was my very first session last year, I wasn't as good about recording what I was doing (like the actual weight I used). I think it is safe to say, though, that I used less than the 12kg I used tonight, I vaguely remember just stepping up and down on the box instead of jumping, and I absolutely couldn't do double unders yet since I just started doing them a month ago. Today helped me appreciate how far I've come, and how much fitter I am now than I was last Halloween. It is difficult to recognize progress on a day to day basis, but seeing a year's worth of change was shocking! This is the best treat of all. Just to see how far I've come. Sorry I wasn't able to carve a pumpkin this year though... couldn't think of anyone I wanted to carve this year. I'll just share my pumpkin from last year, and maybe next year I'll do another...

My pumpkin carving from last year

I guess I should go to the doctor too...

Lately, I've been curious about what some of my health markers like blood pressure and cholesterol were. Unfortunately, like most young men, I avoid the doctor like a plague. The only doctors I see are my preceptors. Kinda ironic huh? Because of that, I don't have baseline information to see if I've improved, but I can at least report that I'm healthy! I know, based on my family history, that I'm a ticking time bomb of diabetes and high cholesterol, so that's a relief. If I were to guess, I probably had high cholesterol before taking off weight, but I have no way to confirm that. I also wanted to know if this Paleo diet that I'm on is bad for my cholesterol, since there is a lot of fat embedded into the recipes I've been analyzing. Luckily, all is good. My blood pressure came in at 116/65 (normal is under 120/80), which is much lower than what I remember it being when we were checking each other's pressures earlier in medical school, when it used to be 130s/80s. My cholesterol is 185 (normal under 200), LDL - bad cholesterol is 96 (normal is under 130, unless you have other risk factors for heart disease, then its under 100, either way I'm there), and HDL - good cholesterol is 73 (normal is over 40). So far so good! :-) One more thing to check off on my journey to healthy lifestyle - annual check-up, done.

Tiger mom made me fat: Reflection on why I question my ability to succeed

I started this blog to share successful strategies during my journey towards a healthier lifestyle, but I think there's also value in thinking about what has held me back, since I'm guessing most people like me have had multiple barriers that keep us from succeeding. Even if we're not exactly the same, maybe my own realizations will help others reflect. So in the past few weeks, I've noticed a huge barrier that I'm trying to overcome: I often tell myself that "I can't do it..." before I try, and I'm starting to wonder where this self-doubt comes from.

I started noticing my inner voice of defeat around 3 weeks ago when I was doing push presses at CrossFit with Andrew, and he tossed on 25 lbs on each side for the first set. I remember looking next to me and seeing the other guys who always lift more than me putting on the same weight, and saying, "Wait! I can't do that... THEY'RE putting on 25 lbs on each side, are you crazy?!" Andrew scolded me for focusing on others instead of myself, and so I tried... and I did it. Not only did I do it, but I added more with each set. Then there was the 5K run, which I was almost certain I wouldn't be able to finish. I've never even run a mile, how the hell would I run 5K? My old roommate from San Francisco, Peter, was running beside me and not only kept me company, but also kept me motivated by encouraging me and observing that I wasn't just able to complete the run, but was actually passing people too. I don't know why I was so certain I would fail. I'm not one to be clouded by self-doubt too often. In fact, I pride myself in pushing boundaries, which is reflected in my academic and professional career. So why is it, that when it comes to fitness, my first thought is, "I can't"?

A year and a half ago, there was a book called "Battle Hymn of the Tiger Mother" by Amy Chua that chronicled how she tried raising her kids with strict standards and high expectations, particularly academically. This is the stereotype of how Asian-American kids are raised, and it has some elements of truth because I was raised in a similar fashion. In middle school, my tiger parents made it clear that my report card should have nothing but A's in all academic subjects, and I should particularly excel in math. I was told that when my father was in school, he was the best in his class in math, therefore, I could be too. Since then, I've never doubted my ability to be good at math. In High School, I skipped a year of pre-calculus and went straight to AP Calculus. I was confident that I wouldn't need an extra year to prepare for calculus, unlike everyone else. By the time I graduated high school, I had taken 2 years of calculus and a year of statistics. Despite the high expectations academically, there was always one glaring exception, all I had to do was pass Physical Education class. According to my parents, our family was just not athletically inclined, and therefore I couldn't do well. With that in mind, I never tried and came home with consistent C's in P.E., and no one pushed me to do better. I may be overly attributing things to my upbringing, but I do wonder if these initial expectations affect me even today, and if they're the reason that I'm confident in my academic ability, and insecure when it comes to athletic activities.

I share this story for two reasons. One is that in the past month, I learned how much of my ability to succeed is mental. Without even knowing it, I was giving up without fully trying because I just expected to fail, but by expelling negative thoughts, I've surprised myself with what I can do, and I know others will too when they try. I hope if anyone is having a hard time getting started, my story will get some people to try. I’m sure there are others who have their own engrained belief, for whatever reason, that makes them think that they can't eat right, or can't exercise, or can't be healthy. The second reason is to just share a random thought. I don’t know for sure if I’ve been impacted by the initial expectations set as a kid, it’s just a theory, and the title “Tiger mom made me fat” is said in jest. It does make me think, however, about kids that we may actually be impacting by just dismissing their ability to do something, like do well in school, either explicitly discouraging them to try certain things, or implicitly through media, role modeling, or the way we interact with them. Just some food for thought. Speaking of food, here's a new recipe this week for a Paleo Beef Stew with Side of Mashed Carrots and Turnips!

How much more weight do I want to lose?

"How much more weight do you want to lose?" is a common question my peers have asked me recently, but to be completely honest, I don't know. Technically, my ideal body weight should be a BMI of 23, which for me at 5'11" would be 163lbs. I weighed myself this morning, and I'm 179.4 with a BMI of 25.2, so I guess I have another 13 lbs to lose... but in all honesty, something doesn't feel right when talking about everything only in terms of weight loss.

In some ways weight loss is a great metric: it is measurable and specific. However, there's several problems with using weight loss as the only goal. Don't get me wrong, I get happy when I step on the scale and have taken off a few more pounds, but I don't use my weight to set weekly goals like, "I want to lose 2 lbs a week," which is odd because that's what we're taught to tell patients. So, why don't I do it for myself? For one, minute changes in weight over short period of time isn't very accurate. I can vary my weight within 2 lbs in a few hours based on what I eat or drink, or even lose it in a day by fasting, which I might be tempted to do if all I wanted to do is peel off 2 lbs for a weigh in, but an extreme strategy like that isn't in line with the sustainable healthy lifestyle towards which I'm striving. Besides weight not being accurate in the short-term, it also just isn't a fun goal. It might just be me, but the numbers on the scale are so impersonal, boring, and move so slowly, that in all honesty, I feel as though if I focused on it too much, I'd just get discouraged by a lack of weight loss without ever being able to feel satisfied for shaving off 1-2 lbs. My brain can interpret a lack of progress as a failure much easier than it can see a 1-2 lbs change as a big achievement. Also, when weight moves so slowly, big changes seem nearly impossible. Even now, just thinking about losing another 13 lbs is so daunting... that's a lot of weight! I'd rather not think about it as the objective I have to strive towards, because slowly getting there 1-2 lbs a week at a time, would likely be as frustrating as watching grass grow. Finally, at some point, I'd like to think that I will reach a healthy weight, and if all I care about is weight loss I might run into one of two traps: I might continue losing weight to a point where it is unhealthy, or I can become complacent because I've achieved my goal and become unhealthy again. So what types of goals are better than weight loss goals?

At the onset of this journey, I wanted to become healthier. For me, being healthier means eating better and exercising. Every week, my goal is to eat very healthy 80% of the time (I allow myself some breaks the other 20%). For exercise, I continue to strive towards improved fitness by setting goals to successfully perform new tasks that I haven't been able to do before, such as lifting more, doing an activity faster, or just doing an activity at all. Every time I achieve a new fitness goal, it gives me more satisfaction than 1-2 lbs, and I feel like I can reliably use my achievements as a proxy that I'm more physically fit, and therefore healthier. For instance, this past weekend I ran my first 5K  (3 mile) run: The Palo Alto Weekly Moonlight Run. I've never run a race before, and honestly didn't think I could. My goal was just to finish. Throughout the entire race, I kept thinking to myself, "Don't stop," and in the end, I finished without stopping at a pace of 10:48/mile. That's a faster mile than I could run in high school even for just 1 mile, let alone 3! Awesome! So what are my next goals? I'd like to work towards participating in a 200-mile relay with friends in May 2013. I want to row 500 meters in less than 2:00 minutes next time. I also want to be able to do an unassisted pull-up sometime in the next 6 months, something I've never been able to do, even as a kid. These are things I'm working towards to improve my fitness level, and these goals are fun, because I can see myself improving towards them, I'm not obsessed with a fluctuating measure that I can't relate to, and when I do achieve a goal, it's a lot of fun to be able to do something completely new, kinda like advancing to a new level on a video game! Doing more of something, doing something faster, or just being able to do something at all is still specific and measurable, so if these types of goals work better for me in this endeavor, maybe they'll work for others too. (If not...by all means, 1-2lbs a week is good too, whatever works!)

My friends and I at the Palo Alto Weekly Moonlight Run & Walk 2012

My results from the Palo Alto Weekly Moonlight Run & Walk 2012

When I worked in public health, I often criticized those that only use process measures instead of outcome measures... and I guess when communicating my progress to others, I still use the outcome measurement of weight. However, day to day, my goals are to achieve process measures of eating healthy and exercising, because that part, I can control. In short, my main goal isn't to lose more weight, but instead, just like when I was running, I'm telling myself: "Don't stop."

Sorry for the length between posts. Had to do residency applications recently, but here are some new recipes as well from a few weeks ago: Paleo Pumpkin Pie Protein Muffins for breakfast, Greek Salad with Marinated Baked Salmon for lunch, and Paleo Chicken Cacciatore for dinner. Next week, I'll talk about more potential barriers that might have held me back from adopting a healthy lifestyle earlier.

It takes a village to raise a child... and make me exercise

As I share my regimen for healthy living, it would be remiss if I don't talk about my workout regimen, though in all honesty, it wasn't an individual effort. I joined a CrossFit gym in October 2011 and go 3x a week for an hour. My philosophy of exercise is very similar to my thoughts on diet. I'm an advocate of whatever works for you, but no matter what that is, regular activity is important for our health. I personally love CrossFit mainly for its community, but will share my experience and the characteristics of CrossFit that makes it right for me.

As outlined in my last post, I really do believe that a healthy diet probably has a bigger impact on "weight loss". The amount of calories we eat tends to sneak up on us, and small changes can cut more calories than a lot of us can reasonably burn with exercise. That doesn't mean exercise isn't important though, because the goal is to be healthy, not just losing weight. I'm on my neurology rotation this month, and this week saw an MRI of the brain for someone in their 50s coming in with a stroke. The stroke itself was a pencil circumference white spot on the MRI, but there were also all these tiny white spots scattered through out. When I asked if they were part of the stroke, I was told no, those spots were damage from uncontrolled high blood pressure that's accumulated over time. No single incident would be noticed like a stroke, but over time the tiny dots would accumulate to accelerate cognitive decline or dementia... all from high blood pressure. Guess what helps lower blood pressure... exercise! Just half an hour of moderate exercise (getting your heart racing and sweating a bit, even if from just walking around), 3-4x a week, will lower your systolic blood pressure (the bigger number) by 5-10 points... which is as good as any medication we have. Point being: exercise is important for your health in general, in ways you might not even notice in your day to day, and has beneficial effects in seemingly unrelated ways, like preventing depression, gallstones, and cancer, as well as has health benefits that might be more intuitive, like heart health, preventing osteoporosis, and controlling diabetes. In addition, I find that as I've exercised more, I've begun to build strength and endurance to do more, and as that happens, I imagine I'm burning more and more calories to contribute to weight loss.

Even knowing the health benefits, the only time I've been able to workout regularly was when I hired a personal trainer back when I still had a income before becoming a student again. Left on my own, it was too easy to go, "I'll do it tomorrow instead," which turns into next week, then next month, and a regimen of exercising once every 1-2 months.  I suspect many people also struggle with motivating oneself as well, otherwise people would already be exercising regularly right? Wanting to change this, I decided to find a personal trainer again, and searched "gym Palo Alto" on yelp, and just started calling about prices. I came across a gym called CrossFit Palo Alto, and remember not really understanding it. Was it a gym? Yes... except I could only go during my designated time. Huh? That sucks. So is it like a class then? But why would I do that when normal gyms offer group classes? And what is a CrossFit workout? Oh, a little of everything and it always changes? Great... that makes no sense. And the website has pictures of rings people use in gymnastics... I can't do stuff like that... is this for super fit athletes? The person on the phone insisted it wasn't. I was curious so I went in for the free introduction, after all, what did I have to lose?

I started CrossFit in November 2011 and have been a member since. It wasn't a panacea though, and I faced the same challenges I did before. For example, I first joined the 6pm class, and kept skipping because I couldn't make it out of the hospital in time. To adapt, I switched to the 7pm class in early 2012, which helped a lot. Now that it's been close to a year, and I've integrated it into my regular routine, let me try to explain CrossFit in my own words. First and foremost, I feel CrossFit is about community. I remember being a little nervous about being judged by the veterans my first few sessions because I was so out of shape. Instead, those scary veterans were cheering me on by name to keep me from giving up. Since everyone attends the same times, I've gotten to know the members of my class, who have become my friends that keep me accountable to show up and give good effort. CrossFit is also about doing what I can safely, but always trying to improve. For instance, at first, when everyone else ran 400m, I would be advised to walk around the block (240m), but always had a goal to work towards doing more, which for me, meant walking faster, then jogging, and then trying to jog the full 400m with walking breaks, and then cutting down the number and length of walking breaks. This happens with every activity at CrossFit. I do what I can, but always with a longterm goal in mind, and seeing my friends give full effort inspires me to do the same. Finally, what is a CrossFit exercise? Typically it is around 20 minutes of stretching, 20 minutes of a strength/skill exercise that includes working on improving my form on some activity, from olympic weight lifting to gymnastics or normal pullups. In the last 20 minutes, we do a WOD (workout of the day) that is a mix up of skills we've worked on, and maybe some running or rowing as fast as you can. Depending on the activity, we also add a weight that we can handle. At the end, we take a few minutes to stretch again. What I appreciate about CrossFit workouts is that there's a mix of cardio and strength, that a lot of the exercises involve my own body weight like pull-ups, push-ups, lunges, running, etc., and the variation of activities in WODs keeps things new.

Photo of me performing deadlifts courtesy of Trish (@TrishPM on Twitter)

In the end, I guess all I had to lose from going to that introductory session was a few pounds, a few misconceptions, and a lot of self-doubt. I'm not saying CrossFit is for everyone, but it's what worked for me. The most important thing is to find a way to exercise regularly, safely, and rigorously enough to impact your own health, in whatever manner that works for you.

References:

1. http://www.mayoclinic.com/health/high-blood-pressure/HI00027 (last accessed on September 9, 2012)
2. http://www.uptodate.com/contents/overview-of-the-benefits-and-risks-of-exercise (last accessed on September 9, 2012)