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