I Can. I Will. I Did my first pull-up.

I wasn't even thinking about doing a pull-up yesterday. I was just stretching. Earlier in the day, when I was on facebook, I noticed Tim, the owner of Crossfit Palo Alto, posted, "Your mantra to repeat today, before and during the WOD is, 'I CAN. I WILL.'" At first, I thought, "That's odd, Tim doesn't normally post about mantras for workouts..." Then, I saw why. The WOD (Workout of the Day) was a hero WOD called "Nutts", named in honor of a fallen Canadian soldier Lieutenant Nuttall. In strictest form, it was a workout to be done as fast as possible of 10 Handstand push-ups, 15 Deadlifts (250lbs), 25 30" Box jumps, 50 Pull-ups, 100 Wall ball shots (20 lbs med ball to 10ft), 200 Double-unders, and a 400 meter run carrying a 45lb plate. In all honesty, this sounded absolutely psychotic, but I'm starting to accept that my own self-doubt tends to be my greatest enemy, so I followed Tim's advice. I told myself, "I can. I will." To prove my conviction, mostly to myself, I decided to stretch in preparation. In doing so, I unexpectedly achieved one of my biggest fitness goals.

I wanted to do a pull-up ever since I started working out. For me, it was an elusive goal, because I've never done a pull-up before in my life. It just seemed like this abstract idea, like telling someone who has never sung opera before to perform an aria. That didn't stop me from trying though, mostly because I remember watching people do pull-ups in high school and thinking, "Wow, how do they do that?" Around July, I gave myself 6 months to do an unassisted pull-up, or in other words, until the end of this year. Before almost every gym session, I would put a band on a bar that helped support my weight and practiced my pull-ups. Last week, I switched bands to one that provided less assistance, the second to last level before I would be with no bands at all. I still struggled with form though, so the Crossfit coaches helped me out by giving me advice on how to refine my kipping swing, find a rhythm, and maximize use of the band. Yesterday evening, I was just hanging and swinging from the bar without any bands. I didn't want to burn myself out before the actual workout by actually doing pull-ups, especially since we had 50 to do, but I could hang and kipping swing to stretch. Then someone said, "Try pulling up!" I laughed, "That's silly. I can't do a pull-up yet." I was still trying to figure out how to do it properly with the new band. After some more encouragement, I figured what's the harm in trying? So I pulled...and I went up... and then I screamed, like I always do when trying a new activity. When I finished screaming (1-2 seconds), I noticed my chin was above the bar. Tim, who was wrapping up the last class asked, "Did you just do a pull-up?" I honestly wasn't sure. A yes or no question shouldn't be so hard to answer. I felt like I was getting pimped by an attending, and I had to think it through before giving a response. I mean, I was holding the bar, and then I pulled, and then my chin went above the bar. That's a pull-up right? "I think I did...," I finally replied. Wait a sec... I did my very first pull-up ever! The rest of gym members clapped in congratulations, I rang the bell indicating a new personal record, and recorded it up on the "personal records" whiteboard. Then I went back and did another pull-up.

I was so happy, and finally, the thought of, "I can. I will." became something I actually believed. I did "Nutts" in 36:35, though scaled down to something I could handle safely. Specifically, I did 5 handstand pushups and 5 shoulder touches, 15 deadlifts with 185lbs, 25 30" box jumps, 50 pull-ups with a blue band for 20 (3rd lightest one) and blue band + red band (2nd lightest one) for 30, 100 wallball shots with a 14lbs medicine ball, 100 double unders and 300 single unders, and then scurried (instead of running, a bonafide scaling option: the scurry) 400 meters with a 35lbs plate. I felt great afterward, not only because I did my pull-up, and finished "Nutts", but also because I'm excited. I'm excited because every reached goal just opens the door for new possibilities, new opportunities, and even bigger goals. I'm thrilled that I was able to finish yesterday's beast of a workout, but it also showed how much room there is still to improve. I haven't set my new goals yet, but I'll be sure to share when I do. I still can't believe I did a pull-up. Me! A pull-up! Wow!

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)

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) 

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.

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