WE’VE MOVED!

Dear Readers,

My blog has moved to a new site: alanfitness.com/blog

This new location has the same posts you are familiar with as well as NEW ones (posted weekly). My new blog site is part of my new and improved website.

Enjoy your read!

-Alan

How Late Can I Eat?

Frank is a Skype client from the mid-Atlantic United States.  He has become a great exerciser in our time together and is being very mindful in executing his food program.  He feels better than when he started, but the truth is, he really isn’t losing weight.  Yes, he has stopped gaining and because he is eating better and exercising, he is getting great benefit for his health, however, he wants to and needs to lose weight and it isn’t going very smoothly.  So last week, I asked him what he thinks the problem is.  After thinking about it for a minute or so, he told me that evenings and nights are very problematic for him.  So I asked him to specify.

Frank wakes up early and commutes about 45 minutes to work each day.  When he arrives home, he eats supper and after spending a short time with his family, he often goes out to do some errands or attended a local class.  In our last conversation, he then informed me that he always takes something to eat when he gets home (10:15 p.m.) after his busy evening. I asked Frank if he is actually hungry then, given he has already eaten 3 meals and 2 snacks during the day and without hesitation, he said he is NOT at all hungry—it’s just something he does.  And to make matters worse, he always chooses unhealthy food at that late hour.

There are those who will still insist that a calorie is a calorie not matter what you eat or when you eat it.  But research, even going back many years, is starting to tell us a different story.  For now, we are going to delve into the “when” of eating, and in particular, eating late at night and what the possible health and weight gain ramification might be.  Is it possible that late night eating is what is preventing Frank from losing weight and why do I hear this same story over and over again from different clients over the years?

Studies tend to show that when food is consumed late at night — anywhere from after dinner to outside a person’s typical sleep/wake cycle — the body is more likely to store those calories as fat and gain weight rather than burn it as energy, says Kelly Allison of the University of Pennsylvania School of Medicine’s Center for Weight and Eating Disorders.  Some animal studies have shown that food is processed differently at different times of day. This could be due to fluctuations in body temperature, biochemical reactions, hormone levels, physical activity and absorption and digestion of food, says Steven Shea, director of the Oregon Institute of Occupational Health Sciences at Oregon Health & Science University.  “The studies suggest that eating out of our normal rhythm, like late at night, may prompt weight gain” and higher levels of blood sugar, which can raise the risk of chronic disease, Allison says.

In a very old study done on a small sample, people were divided into two groups.  They were fed the identical calories but group one eat all their calories in the early afternoon and group two ate the same calories, but at night.  Group one collectively lost weight and group two collectively gained weight.

Thermic effect of food (TEF) is a fancy name for the energy used up as a result of digesting and absorbing a meal. A study published in the American Journal of Clinical Nutrition found that TEF is higher in the morning than in the evening.  Volunteers were given an identical 544-calorie meal at one of three times. In subjects fed at 9 a.m., TEF increased by 16 percent; in those fed at 5 p.m., TEF increased by 13.5 percent; and in those fed at 1 a.m., TEF increased by only 11 percent. So it’s clear that we burn more calories in the morning.  The effect of calories on body composition is also influenced by the size and frequency of meals. For example, a Japanese study found that boxers placed on a six-meals-a-day weight-control diet lowered their body fat percentage significantly more than boxers who ate exactly the same number of calories in just two meals.

Another factor in night eating is the hormone cortisol.  This is the hormone that is integral to proper function of our stress response. (Someone runs into the street right in front of your car and you slam on the breaks—that is cortisol doing what it is supposed to do).  But when we become over-stressed, which at night can be trying to stay awake against our body’s wishes; that is the over-secretion of cortisol.  Cortisol increases appetite and might also increase motivation in general, including the motivation to eat. Once a stressful episode is over, cortisol levels should fall, but if the stress doesn’t go away — or if a person’s stress response gets stuck in the “on” position — cortisol may stay elevated, and consequently, lead to stress eating.

Frank and I devised some strategies for him to cope with what had become a bad habit.  He now needed to modify a pretty ingrained behavior, but so far, he has been able to do it.  I received an email early this morning telling me that he had to stay up late last night to get some work done and ate nothing!   And since he started being careful about eating at night, his weight has begun to drop slowly and steadily.

For the average person with an average schedule, it is best to set a curfew to finish solid food about 8 p.m. each night.  Yes, there will be exceptions, like a late meal out or a wedding that runs late.  But even in those cases, try to keep the calories down at that hour.  There are also people who have different work schedules and work night shifts.  It is best to consult with a dietician as to how to handle your particular situation.

It’s not just calories—also the timing is a big factor in losing or gaining weight.  Setting a curfew and not eating late will help me keep my weight down, let you sleep better and it will “add hours to your day, days to your year, and years to your life.” 

Not Something to Ignore

On a recent visit to the United States, all of the news outlets were discussing how to prevent the next terror attack. The law enforcement community has been very adamant in using a phrase for the public; “If you see something, say something”.  Good advice.  And when it comes to our health, there are times when you have to implement a similar policy.  If I see something, or feel something, and it is abnormal, I have to do something about it quickly.

I have been helping people prevent health problems for a long time.  I also have clients that have existing health issues and through lifestyle changes including proper eating, activity and exercise, they are able to reverse their disease or illness.  But there is such a thing as an emergency that needs to be tended to immediately.  I am not the kind of person who thinks that we should run into the doctor’s office for every little thing, but sometimes, episodes are not little and need attention. 

What brings me to this article was something that happened to an acquaintance of mine.  This person noticed a pain and overall discomfort in his foot and he even noticed some discoloration and swelling.  He, like many, many people just hoped and figured it would go away.  But it turned out he had an infection and it wasn’t treated in any way.  The end result was a cellulitis-as defined by the Mayo Clinic, Cellulitis is a common, potentially serious bacterial skin infection. Cellulitis appears as a swollen, red area of skin that feels hot and tender. It can spread rapidly to other parts of the body.  But in the end, this person spent a week in the hospital in order to get the proper treatment for what was now a serious condition.  You never know for sure, but it is possible this could have been solved before it got out of hand with some oral antibiotic and soaking.

Heart Attack

We should all be educated enough to recognize signs and symptoms of a serious medical emergency and we should know what to do.  The most common emergency in adults is a heart attack.  How do I know if I am having one and what is the procedure for immediate help?

These are the common signs of a possible heart attack:

• Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back.
• Nausea, indigestion, heartburn or abdominal pain.
• Shortness of breath.
• Cold sweat.
• Fatigue
• Lightheadedness or sudden dizziness.

This doesn’t mean that if you have one or more of these symptoms you are definitely having a heart attack, but caution must be taken.  If you think you might be having a heart attack, do the following: Act immediately. Some people wait too long because they don’t recognize the important signs and symptoms. Take these steps:

• Call for emergency medical help. If you suspect you’re having a heart attack, don’t hesitate. Immediately call your local emergency number. If you don’t have access to emergency medical services, have someone drive you to the nearest hospital.
• Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk.
• Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help.
• Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, however, so don’t take an aspirin unless your doctor or emergency medical personnel recommend it. Don’t delay calling your emergency number to take an aspirin. Call for emergency help first.

If you witness someone having a heart attack, call for help immediately before anything else.  If the person is conscious, stay with them and keep them as calm and reassured as possible.  Tell them help is on the way.  If the person loses consciousness, call for help first before anything else.  If the person is NOT breathing, begin CPR—for laymen now, the protocols are simple.  Do chest compressions at the rate of about 100 per minute.  Only if you are trained in CPR should you be executing rescue breaths as well.  Help should arrive quickly.  If you are not trained in CPR, it is a good idea to take a course in proper rescue and first aid.

Stroke

Another common emergency is that of having a stroke.  Beware of the symptoms:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing or blurred vision in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Every moment counts.  If you have any of these symptoms or are with someone who does, the sooner they get help, the less severe the aftermath of the stroke can be.  Summon help at once through your local emergency number.

Bleeding

In most cases, bleeding is not a serious emergency, however, bleeding from an artery or major vein can lead to hypovolemic shock and death.  If you see someone bleeding, put pressure, preferably with a clean dressing, immediately and hold it there.  Don’t take it off.  In the vast majority of cases, this will stop bleeding.  If it is from a deep cut, then stitches or glue may be called for.  If you are in a situation where you see someone bleeding out, do the following:

• Remove any obvious dirt or debris from the wound. Don’t remove large or deeply embedded objects. Don’t probe the wound or attempt to clean it yet. Your first job is to stop the bleeding. Wear disposable protective gloves if available.
• Stop the bleeding. Place a sterile bandage or clean cloth on the wound. Press the bandage firmly with your palm to control bleeding. Maintain pressure by binding the wound tightly with a bandage or a piece of clean cloth. Secure with adhesive tape. Use your hands if nothing else is available. Raise the injured part above the level of the heart.
• Don’t put direct pressure on an eye injury or embedded object.
• Don’t reposition or put pressure on displaced organs. Cover the wound with a clean dressing.
• Help the injured person lie down, preferably on a rug or blanket to prevent loss of body heat. If possible, elevate the legs.
• Don’t remove the gauze or bandage. If the bleeding seeps through the gauze or other cloth on the wound, add another bandage on top of it. And keep pressing firmly on the area.
• A tourniquet is effective in controlling life-threatening bleeding from a limb. Apply a tourniquet ONLY if you’re trained in how to do so. When emergency help arrives, explain how long the tourniquet has been in place.
• Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.

After you control the bleeding, call your local emergency number if the bleeding is the result of major trauma or injury. Also call for emergency help if you suspect internal bleeding.

(All first aid recommendations for all of the above emergencies are based on the protocols published by the Mayo Clinic)

Of course, it is best when we take care of ourselves in every way possible to reduce the chances of ever having an emergency medical incident.  Exercising and eating right, as well as basic safety measures like wearing a seat belt in your car and a helmet, when you bike can go a long way to helping disease and illness prevention and trauma from accidents.  But in the event a medical emergency is suspected, don’t say “It will go away!”  It might–but it might not.  This is not something we want to take a chance with

Knowing the signs and symptoms of a possible medical emergency will “add hours to your day, days to your year and years to your life.” 

Revisiting Stress

Stress is a subject that I write about from time to time because I see all too often the damage it does to our health and well-being.  I see it from clients and I see it with friends.  And we happen to live in a society where the demands made upon us are unreasonable.  Whether your stress originates in the workplace, school, family relationships, or a host of other areas, what we do know for sure is that long-term activation of the stress response system can disrupt almost all of the body’s processes and increase the risk of numerous health problems.

Max is a client who came for weight loss.  It became very apparent at our first meeting that he was under a lot of stress. He couldn’t control his twitching and his body was tensed up all of the time.  After a few sessions we began to discuss his high stress level and the impact it was having on his weight and general health.

The latest facts and figures on stress out of the United States are indeed frightening.  Let’s start with financial stress.  In a survey of 3,000 adults over the age of 18, 75% reported feeling stressed out about money at some point, with some respondents saying they sacrificed health care because of finances.  But it is job-related stress that sit at the top of the list.  80% of workers say they feel stress on the job and nearly half say they need help in learning how to manage their stress. 42% notice and say that their co-workers need help with stress.  The cost?  Workplace stress causes healthcare expenditures of roughly $150 billion per year.  That is about 7% of all health care expenditures per year.

Certain kinds of stress can indeed be healthy. If we had no stress at all, we wouldn’t get things done and deadlines would mean nothing to us.  But when the reaction goes beyond the types of responses discussed above, not only can it be debilitating, it can be dangerous.  If your stress response is turned on too much of the time, and certainly ALL the time, it will almost always lead to serious issues – both psychological and physiological.

Stress has been linked to a long list of sickness, including heart disease, depression, insomnia, anxiety and if we take the research of Dr. Kenneth Pallatier’s (Arizona Center for Integrative Medicine) research, 85-90% of all illness is stress induced or stress exacerbated.  We now have evidence that chronically elevated stress shrinks the brain.  One of the biggest negative effects of stress is that it almost always causes sleep deprivation, which in turn intensifies our stress levels and that becomes a terrible cycle where one just gets more and more stressed and gets less and less sleep. 

How do we deal with stress and improve our wellness?  Although for many people this is something that needs work and needs professional help, there are certain things we can all do to help keep our stress in check.  There is an analogy I like to use with my clients who are working on stress management.  Imagine a very heavy chain around your neck—too heavy to take off by pulling over your head.  The only way to take that chain off is to remove one link at a time.  It might take some time, but ultimately after enough of those links are taken off, the chain is light enough to deal with.  And so it is with our stresses.  We might be overwhelmed with our problems and issues, but it is only with tackling them one at a time that we can find a solution.

You might have seen this list before of stress reducing steps, but it is worth taking a look again to see which of these will be helpful to you in order to help you control your stress:

• Stay healthy. Maintain a program of healthy eating, good health habits and adequate sleep.
• Exercise! You might not feel like this right now, but exercise anyway. This promotes physical fitness as well as emotional well-being.
• Balance work and play. All work and no play can make you feel stressed. Plan some time for hobbies and recreation. These activities relax your mind and are a good respite from life’s worries.
• Help others. We concentrate on ourselves when we’re distressed. Sometimes helping others is the perfect remedy for whatever is troubling us.
• Take a warm shower or bath. This will soothe and calm your nerves, and relax your muscles.
• Have a good cry. Tears of sadness, joy or grief can help cleanse the body of substances that accumulate under stress, and will also release a natural pain-relieving substance from the brain.
• Learn acceptance. As we mentioned, a difficult problem can be out of your control. When this happens, accept it until changes can be made. This is better than worrying and getting nowhere.
• Talk out your troubles. It sometimes helps to talk with a friend, relative, or mentor. Another person can help you see a problem from a different point of view.
• Do relaxation exercises daily. Good ones include visualization (imagining a soothing, restful scene), deep muscle relaxation (tensing and relaxing muscle fibers), meditation and deep breathing.
• Budget your time. Make a “To Do” list to prioritize your daily tasks. Avoid committing yourself to doing too much.
• Change your attitude. As difficult as it might be right now, develop and maintain a positive attitude.
• Change your environment. Modify your environment to get rid of or manage your exposure to things that cause stress whenever possible.

Implementing any or all of these tips can make a big difference in your stress level. However, please keep in mind that sometimes help is needed from a professional psychologist, therapist, or coach who deals with stress management.

One thing is for sure—DON’T ignore your stresses; deal with them.  Exercise, deal with one problem at a time, treat yourself to some down time that you can enjoy and when you need help, seek it out. Keeping our stress under control will “add hours to your day, days to your year and years to your life.” 

Starting Over Again—Yet Again

We don’t like to let go.  But going back to our mundane lives now has to happen and here we go again!  The holiday season has passed and all of us have been mostly sedentary and we certainly have overeaten.  So what are we going to do about it this time—go on a diet?  Commit to the gym?  Take a personal trainer or go to a weight loss group?  These are all great options, but what can we do different this time to really make a difference that can be maintained and bring the results that we all are looking for?  The statistics for people “finally deciding to really do something” aren’t very good.  In the secular world, every January 1^st, we hear about the New Year’s resolutions.  And taking care of our health is usually one of them.  Gym memberships soar at the beginning of the New Year, yet by March, the drop-out rate at gyms is astonishing.  People who have purchased half-year and full-year memberships are no longer attending.  The initial excitement slowly evaporates and we are all back into our mundane rut and bad habits.   So how do we get out of the rut and really make the necessary changes?  Here are a few rules to help you succeed this time around.  And a reminder, we have just finished the time of repentance and change so keep that in mind and this time, we really want to make it stick.

• The very first good idea for success for you in weight loss and health gain is to drop the grand plan. Slow and steady certainly is the winner here. Most of us put on weight over years and years, so don’t expect to drop an unreasonable amount of weight in a short time.  Keep your weight loss goals reasonable.  Two pounds or one kilo a week is really the maximum average weight loss you should expect for healthful and sustainable weight loss.   It is true that for people who have a lot of weight to lose, you might see a much larger drop the first few weeks, but a lot of that is water and built up glycogen in your muscles.  Once you start to become active, that begins to melt away and you see a larger drop than you would see from just fat weight.  But think about how many years it took to gain weight, and be reasonable about how long it can take to lose the same weight.  If you are on the right type of weight loss program, you will lose slowly but surely, but it will take less time to lose than what it took to put in on.

• Second, consistency is the key to success. Like anything else in life, the only way to get the results you want to see is to put it into your schedule and plan carefully.  If there is some necessity to cancel your exercise time, then make it up by moving it to another time or a different day.  The benefits of exercise are much more pronounced when they are consistent.  And remember that we should be walking 4-5 days a week briskly for at least 30 minutes for our cardiovascular health and dong 2-3 days a week of muscle building exercises.

• The third thing to remember is that if this isn’t a top priority, it will just fall by the wayside like other things you might get excited about but have no staying power. You don’t have to make it THE most important thing and you don’t have to obsess over it, but usually it has to be a top 5 priority in your life if you want this to work.  Learn how to say no to other things that might come along and interfere and also learn how to say no, politely, to others.  Put the word “I” back in your vocabulary and remember you don’t have to take a back seat to others.  You don’t have to make yourself more important all the time, but your health is at least as important and anything else.

• Four—don’t overlook the benefits of activity. We all have days where we just can’t do our formal exercise program.  Perhaps there are busy seasons in the workplace, family obligations, Simchas to organize.  But even in those times, and really all the time, it is of great importance to stay active.  Parking your car a few blocks away from your destination, getting off the bus a stop or two early, and using steps instead of elevators can help you lose another 4-5 kilos a year, or at least prevent that much weight gain if made into a habit that becomes part of  your life.  Leave that car at home when you can and just walk to your destination.  This can all make a huge difference in your life in terms of staying healthy and aging well.

• And finally number 5—DON’T GO ON A DIET. So you want to lose weight and automatically, your brain is telling you “go on a diet.”  DON’T!  Diets have never worked well for keeping weight off and why go through that whole losing battle anyway. The failure rate on diets is more that 95% in the long term.  So don’t bother.  Instead, get a food program that includes foods from all the necessary food groups.  Diets or food plans that exclude entire food groups, or make them very minimal.  Everyone is different and the ratio of proteins, unrefined carbohydrates and healthful, monounsaturated fats might be slightly different in each person—but YOUR BODY NEEDS ALL OF THEM. In other words, other than cases of food allergies or certain digestive diseases don’t eliminate nutrients that you definitely need for your health and your energy. And remember, we have to allow ourselves a treat every now and then.  Plan it, keep it reasonable and enjoy it.  Just make sure it fits in to your daily caloric allowance.

The end result? You will function better throughout the day, you will accomplish more and you will FEEL GREAT! Dropping the grand plan, being consistent, prioritizing, staying active with your exercise, and not dieting will,   “add hours to your day, days to your year, and years to your life.”  

Ready, Set…Change!

It’s hard to describe the feeling immediately after Yom Kippur!  Maybe the word is “cleansed”.  We have just poured our hearts out to G-d to forgive us both as individuals and collectively.  We have fasted for 25 hours and ended with one more blast from the Shofar.  There is a sense of joy that we don’t feel at any other time of the year.  Even though somewhat weakened by the fasting, we all feel accomplished and ready to really start the New Year.  Succot is right around the corner and what better way to celebrate our new found status than a Yom Tov full of joy.  We have prayed for good health and for the whole nation, but are we ready to make an effort to improve our health, fitness and general well-being?  As much as we need to pray to the One above for good health, and as much as our doctors can try to help us if we are sick, ultimately, there is a certain amount of effort that we ourselves must do to maintain good health and functionality.  Without that, we can’t maintain great health and well-being.  Remember the letters TLC.

My office staff and I get great satisfaction when we see our clients succeed in changing their health, and life around for the better.  Two of our recent clients chose to try our path in helping to lower their blood pressure and lowering their risk of potentially debilitating diseases.  Within three weeks of changing some unhealthy behaviors, they have already succeeded in lowering their blood pressure to below average!  Someone came into us with terrible, even unbearable lower back pain last week.  As of yesterday, his pain had diminished by about 80% and for the first time in a month, he is totally functional.  Several individuals who completed our 10 Weeks to Health program are seeing great results which are helping multiple health issues they have in addition to just helping them feel better.  What is the common denominator between all of these success stories?  They are all accomplishing their goals with hard work and without medications.  They are using TLC!

TLC—when I was growing up that meant tender loving care.  In today’s world the initials TLC also stand for Therapeutic Lifestyle Changes.  This TLC is the latest term to describe medically based, structured, supportive programs to help people lower their risk and to reverse life-threatening conditions such as hypertension, stroke, diabetes and heart disease. The purpose of this program is to help people improve eating habits, exercise, manage stress, quit smoking, and learn how to lead an active life style.  Unfortunately, due to being inundated with patients and lack of time, the medical profession often ignores TLC.  That is something that is very costly to both the patient and to the economy as a whole.  It is much cheaper to improve your health without drugs or surgery. 

Dr. Neil Gordon, M.D., PhD, who is a preventive cardiologist, headed a study published in 2004 in the Journal of Cardiology, reported the effectiveness of a 12-week community- based lifestyle management program.  This particular program was geared toward people with hypertension, abnormal cholesterol, and diabetes.  Dr. Gordon and his team found that many of the patients achieved their goals–without medication.  Specifically:

• 67% of people lowered their blood pressure to their stated goals
• 39% of people lowered their blood sugar to acceptable levels
• 21% of people lowered the LDL Cholesterol to their goal level

It is important when beginning a TLC program that you are first evaluated to access your current health status and to see what your risk of disease is.  Then you need to state your outcome goals for the program.  Do you want to lower cholesterol, blood pressure or blood sugar?  Do you need to quit smoking?  And now how are you going to reach those goals?  You may choose a combination of dietary change along with a well-rounded exercise program.  You may also need to add some behavioral coaching or therapy into the equation.  Each program needs to be set up individually, keeping in mind the patient’s abilities to exercise, their daily schedule, and their capacity to stick to a program.

It may be easier to prescribe drug therapy for a patient.  If the root cause can be treated and preventative measures can be taken, than TLC should be the first step.  Even if one needs to take medication, those medicines will likely work much better in conjunction with TLC.  TLC doesn’t just treat the symptoms; it treats the underlying problems and works to prevent you from getting unhealthy.  TLC is so effective that 54% of US Corporations have incorporated it into their work place.  The results are more productivity in the workplace as workers take less sick-days, and workers get more tasks accomplished each day.

Using prescription drugs is also expensive. Overall prescription spending rose to $773 per capita for the year 2010— 2011. Prescriptions made up 17.0% of total per capita spending in 2011 and 25.4% of out-of-pocket per capita spending. For 2011, average price for a brand prescription rose by 17.7%.  In 2014, Americans averaged $1,000 per year in both prescription and over the counter drugs.  TLC?  Maybe there is some initial investment, but in the long term, it will end up much, much cheaper.  Imagine if you could save $300, $500, or $800 per month!

There is no doubt that there are times when drug therapy is the only recourse.  But always ask you doctor if you can try TLC first.  Go and see a wellness coach or personal trainer and try it first.  Be in contact with the American Heart Association and Medline Plus for some help and guidance.  Even if it doesn’t work completely, it can lower your drug dosages substantially.  Take a moment and think of the savings in both not suffering the side effects of most of these drugs and the financial savings of reducing or eliminating the need for them.  Even if you are perfectly healthy, TLC is the best preventative medicine around.

At this time during the Jewish year, we are often reflecting on our lives and certainly on our lifestyle.  As we start a new year, we can take upon ourselves a few changes that will make the year more productive in every single way. And when better than a time of joy—after Rosh Hashana, Yom Kippur, and as Succot comes to a close– to take something new upon us! Write down a couple of TLC changes that you feel  you can start with.   Using Therapeutic Lifestyle Changes is great way to “add hours to your day, days to your year, and years to your life.”

A Story for Rosh Hashanah

Prior to writing my columns, I always try to think through an idea before I put it to paper.  This column was to be no exception and I actually began mapping it out in my mind several weeks ago.  Just when you think you have it all down, something comes along that you can’t ignore and it’s time for a rethink.  And so it happened last week as I was leaving the office for the day, my phone rang.  I saw the number identified as an old personal training client of mine from many years ago.  As a matter of fact, I can tell you that he is one of my original clients from when I was a relatively new fitness trainer.  Although we are in touch every now and then, his call was unexpected and unusual to say the least.

Simcha (not his real name) came to me more than 15 years ago.  He was a vice president of marketing in a high-tech company when high-tech was a new and budding field.  He was under chronic pressure and stress trying to help this start-up company succeed.  It meant long hours at the office and constant travel abroad to their American office, and all over the world, in order to sell their product.  There was hardly an economically viable place on the planet that Simcha hadn’t been to.

But he came to me because he was overweight, and his doctor told him to try me out because his blood pressure was too high and if he didn’t want medication, he needed to make the lifestyle changes necessary and to lose weight.  We began to work together on exercise and diet and Simcha was an incredibly focused and compliant client.  He ended up losing more than 20 kilo over time.  Just as important, he began exercising on a regular basis and went from being sedentary and totally unfit to a very in-shape and healthy person.  Not only did he avoid having to take blood pressure medications, he learned how to handle his stress better.  I still remember at one juncture, his company needed to lay off some workers.  He told me that in the past, after a day like that, he would have gone out to a fast food place for a burger and fries before going home to eat a full supper.  Now, he was coming to me for a workout and taking care of this stressful situation by exercising, not eating out of control.

Simcha stayed a training client of mine for a few years but then moved on and joined a local gym.  He still exercised 3-4 times a week and kept his weight off, albeit with the normal fluctuations people have.  His blood pressure remained normal and he eventually changed jobs so he could work from home more and see his family more.  Unfortunately, a few years ago Simcha came down with a rare neurological problem and it inhibited his ability to walk normally.  Although still trying to take care of himself, he was now limited.

Now, back to the phone call.  Simcha called me up and said that he was sure I was wondering why he was calling.  So, he told me that he called me to thank me.  I couldn’t imagine what he needed to thank me for after all these years.  THIS IS WHERE THE STORY GOT VERY INTERESTING!

Simcha proceeded to tell me that a few months ago, he developed a deep vein thrombosis (DVT—blood clot in his leg).  I suspect his limitations in walking may be related, but without much warning, this clot moved right up into his lung and he now had a life-threatening pulmonary embolism.  Before he even had time to realize what happened, he was in cardiac arrest—his heart stopped beating.  He was resuscitated for more than 10 minutes before he was revived.  In other words, he was clinically dead and brought back.   A true, G-d sent miracle!

So why did Simcha call me to thank me?  Although I am a former CPR instructor, I wasn’t there to resuscitate him.  A little bit about the physiology of the heart and brain—when they don’t receive an adequate supply of oxygen, as in, it stops beating for a certain amount of time, or you are being resuscitated for a long time before your heart returns to a normal rhythm, there is a likelihood of damage even if you survive.  Simcha was released from the hospital and the doctor told him that he has an unusually strong heart.  As a matter of fact, he couldn’t recall after any similar story that one’s heart was undamaged.  It was the exercise.  All these years of exercise helped Simcha survive an incident that many don’t survive and not only survive, but he remained totally intact! 

I don’t take any credit; I was simply the right person, at the right place, at the right time.  Simcha was the one who executed the program and saved himself.  But his “thank you” affected me deeply.  First off, his realization that his commitment to his own health over the years allowed him to survive.  Unfortunately, not everyone realizes the good they are doing to themselves, and their loved ones, by undertaking the commitment to good health.  Secondly, I felt very privileged to have had a part in Simcha turning his life around.  For some reason, this phone called caught me off guard and I was, for a few days overwhelmed by it.  To think that it was under my auspices the Simcha accomplished what he accomplished– which ultimately helped him live again (Thank G-d) — is probably not something that most of the readers of this column may ever experience.

I love what I do, and I am passionate about the need for each and every one of us to take our health into our own control.  You have read here time and time again—exercise on a steady basis (it doesn’t have to be intense), proper eating (it doesn’t have to be perfect) and learning how to control our stresses will go a long way toward being able to lead a life where we have wellness, happiness, and productivity.  We don’t have to spend our older years in the doctor’s office.  We can take that time and put it into learning, giving, and being good parents and grandparents.  But when you are sick, you can’t do what you want to do whenever you want to do it. It pays to take care of yourself.

Rosh HaShanah is upon us again.  Each year, all of us try to commit to changes.  Most of the time, we try to take on too much and the changes don’t stick.  So I ask all of you—pick one change on the exercise front, one meaningful change in your eating, and figure out what you can change in your life that will decrease your stress levels.  Write them down and if you need to, write down a plan on how you are going to accomplish those changes.  You might be surprised at how a few small changes can make all the difference in your health.

We are all overjoyed that Simcha will be joining us this year on Rosh HaShanah.  Let’s make sure that each and every one of us will be able to enjoy Rosh HaShana this year and in years to come.  Let’s all pray this year for G-d to give us the ability to “add hours to your day, days to your year, and years to your life.” 

When You Don’t Sleep Enough…

It wasn’t long ago that the standard advice for good health was: eat right, exercise and don’t smoke.  However today, health care professionals are adding another very important element to that list—get enough sleep.  It is interesting to note that before the electric light bulb was invented, people averaged about 10 hours of sleep per night!  But in today’s world of one big global economy, more and more people are working at jobs that require second and third shifts.  They are working out of their time zone.  Many are at their computers until late at night.  In addition, stress, worries and problems can all keep us from sleeping enough hours and from sleeping soundly.  How many of us are actually getting the requisite 7-9 hours of sleep each night? Nevertheless, it is very important that we sleep enough.  Recent research has shown that there are even more negative effects of sleep deprivation than we previously thought.

According to research done at the Mayo clinic, not sleeping enough results in impaired memory, slower reaction times, lack of alertness and grumpiness.  Tired people are less productive at
work, less patient with others and less interactive in their relationships. And according to the National Highway Traffic Safety Administration, more than 100,000 crashes each year are due to drivers falling asleep at the wheel.  Needless to say, for those of us who exercise regularly, we all know how unproductive a session can be when we have failed to get a good night’s sleep.

We now also know that sleep deprivation can contribute to both higher cholesterol and type 2 diabetes.  It turns out, as shown by research at the University of Helsinki in Finland, that inadequate sleep may affect the way the body metabolizes cholesterol.  According to the data in the study, the genes that regulate cholesterol were less active in sleep deprived individuals compared to those who got enough sleep. Also, sleep deprived individuals had lower HDL (good cholesterol) which is the one cholesterol number we like to see high.  What was amazing about this was that it only took 5 nights of sleep deprivation (4 hours of sleep each night) to yield this result.  In other words, sleeping enough –ALL THE TIME– is important.

The number of diabetics in the world is increasing all the time.  In 1980 there were 180 million diabetics in the world and as of 2014 there were 422 million and projections say that by 2025 more than 700 million people on our planet will be diabetic.  We all know by now that eating correctly—meaning the right foods in the right amounts and the right times is integral to controlling diabetes, as is proper exercise.  But it seems that sleep deprivation and stress both play a role in type 2 diabetes.  And just as with cholesterol, it doesn’t take much sleep deprivation to already see problems.

Diabetes arises when the body can’t properly break down blood sugar or glucose, leaving your cells starved for energy. One thing that greatly increases your chances of a blood-sugar malfunction is being overweight. Excess fat makes it harder for cells to properly use insulin, a hormone that helps keep glucose levels normal.

So what does sleep have to do with any of this? According to James Herdegen, MD, medical director of the Sleep Science Center at the University of Illinois, “When you don’t get enough sleep, your body appears to require more insulin to maintain normal glucose levels.  Sleep deprivation seems to alter the sympathetic nervous system — the body’s stress-control center — and hormonal balances, all of which affects glucose regulation.” Eventually, sleeplessness causes insulin-producing cells to stop working properly, elevating glucose levels and leaves you wide open to diabetes. “Adding to the problem is the fact that fatigue also jolts the sympathetic nervous system into high gear, throwing off its ability to regulate blood sugar,” Dr. Eve Van Cauter says. Indeed, numerous experts point out that it takes just two nights of sleeping four hours or less to temporarily disrupt the process.

Two current clients of mine have both been experiencing fatigue and tiredness, often affecting their day to day ability to function. One of these clients (actually a Skype client from overseas) has several medical issues—including diabetes and high cholesterol—in addition to being very overweight. With both of these clients I stressed this recent research and the importance of a full night’s sleep. Here is the advice I gave to both of them, based on the advice of Dr. John Shepard Jr. (who runs the Mayo Sleep Clinic), on how to get a better night’s sleep.

• Stick to a schedule. That means not sleeping much more on weekends or holidays.  Make an effort to go to sleep and wake up about the same time every day.

• Don’t eat or drink a lot before bedtime. Try to stop eating about 2 hours before bedtime.  And remember that drinking too much before bed will cause you to wake up several times to urinate in the middle of the night.

• Avoid Caffeine and Nicotine. Addictive stimulants will keep you awake.  Don’t have caffeine at least 7-8 hours before bedtime.

• Exercise! Exercise and regular physical activity enhance the quality of sleep.

• Keep the room cool. A room that is overheated isn’t good for sleeping.  Keeping the room cool mimics your internal body temperature at night.

• Sleep at night. Avoid daytime naps and if you do need to nap, do so before 3 o’clock in the afternoon and never sleep for more than one hour.

• Keep it quiet. Silence is more conducive to sleep.  Don’t keep the TV or radio on as you fall asleep.  Use earplugs or a running fan if need be to eliminate background street noise.

• Your bed is for sleep. Make sure you bed is comfortable and only us it for sleeping.  Go there when you are tired and turn out the lights.  If you can’t fall asleep within 30 minutes, go somewhere else and do something else, like reading until you get tired.

There are always events, obligations, and even holidays that create a challenge when it comes to getting a full night’s sleep. Lack of sleep will also disrupt your metabolism and will cause you to secrete more of the hormone cortisol.  This will increase your appetite and cause you to crave fatty foods.  If you try all of the tips we have suggested here over a period of time and you still can’t sleep, seek professional help from a sleep center or a physician that specializes in sleep disorders.  Getting adequate sleep is a key ingredient in order to “add hours to your day, days to your year, and years to your life.” 

I’ll Drink to That!

Sam, in his mid-40s, came into my office a few months ago with some pretty standard complaints that we see these days. He just has no get up and go—he has general fatigue.   He works a long day, 6 days a week.  But in spite of that, he tries to eat healthy food, eats 3 meals a day with a morning snack and generally doesn’t eat late at night.  Although his exercise is less than the recommended weekly requirements, he still does brisk walking 4 days a week for 35 minutes.  But he can begin dosing off later in the day and needs to go to sleep earlier at night than he used to.  We took a good look at what Sam was eating and drinking.  We found that his consumption of fluid, particularly water, was lacking.  He started his day with a cup of coffee and had a second cup late morning.  His first cup of water was only with lunch and a second cup during the afternoon.  Upon arriving home there was another cup of water and then one more coffee after supper.  This was the extent of his fluid intake on an average day.

We’ve spoken about the importance of drinking water before.  But two new studies have shed light on just how important the consumption of water is to our health.  Let’s first review what we have known until now.  Water is one of the 6 classes of nutrients that we must ingest on a daily basis.  60 to 70% of our body is composed of water.  Without it, the constant and necessary chemical reactions that occur all the time in the body can’t take place.  Constant consumption is essential, as we cannot conserve or store water in our body. Yet, most of us probably get about 1/3 of the valuable hydration benefits we need.

Water comprises over 70% of solid body tissue and helps regulate body temperature, carry nutrients and oxygen to cells, remove waste, cushion joints, and protect organs and tissues. Insufficient water consumption leads to headaches, grogginess and dry, itchy skin. Severe dehydration affects blood pressure, circulation, digestion, kidney function, and nearly all body processes. A healthy body maintains proper hydration by balancing fluid intake and output. You normally lose about 2 ½ quarts (10 cups) of fluid daily through perspiration, urination, respiration and bowel movements. This amount needs to be replenished daily.

Now, two new studies show just how imperative it is to our health to be hydrated properly. The first study shows a link between dehydration and cardiovascular health.  Mild dehydration can impair vascular function nearly as much as smoking a cigarette, according to new research in the European Journal of Nutrition. Though the study sample was small (just 10 subjects), results indicate that hydration levels—even mild dehydration in healthy, young males—play a role in the risk of cardiovascular disease.

Stavros Kavouras, PhD, FACSM, associate professor and coordinator of the exercise science program at the University of Arkansas, led the international team that published the study, which found a connection between minor dehydration and negative endothelial function (the inner lining of your arteries) with impaired cardiovascular health in humans. The endothelium is the inner lining of blood vessels. It plays a critical role in cardiovascular health. Atherosclerosis is the loss of flexibility in the blood vessels that leads to hardening of the arteries, a known contributor to cardiovascular disease.

“You could be mildly dehydrated without knowing it while you have endothelial impairment similar to smoking a cigarette,” Kavouras said. “The degree of dehydration when these changes occur is at less than 2% dehydration, which is around the threshold when people start feeling thirsty.”  In other words, not drinking enough can up your chances of heart attack and stroke.  In older research done many years ago, Dr. Michael Mogodam of the George Washington University School of Medicine and Associate Professor of Medicine at Georgetown University Medical School, found that people who drink more than 5 glasses of water each day decreased their chance of a fatal heart attack by 51% and men and women who had more than 5 glasses per day had a 44% lower risk of fatal strokes.  Among the reasons he found are that water dilutes blood enough so clotting is less likely and that a hydrated person passes a lot of urine, which also makes blood less prone to clotting.

A second study, also recently released shows that plain water boosts dietary benefit. Drinking just 1–3 more cups of plain tap water per day can help people control their weight by reducing their intake of sugar, sodium and saturated fat, reports a study in the February issue of Journal of Human Nutrition and Dietetics.

Whether the 18,311 U.S. adults studied in the NHANES cohort consumed plain tap water or drank from a cooler, drinking fountain or bottle, the majority of those who increased their water intake by just 1% also reduced their total daily calorie intake and consumed less saturated fat, sugar, sodium and cholesterol.

Those who increased their daily water consumption by 1, 2 or 3 cups decreased their total daily energy intake by 68–205 calories and lowered their sodium intake by 78–235 grams, according to study authors Ruopeng An, PhD, and Jennifer McCaffery. Subjects also consumed 5 to nearly 18 grams less sugar and decreased daily cholesterol consumption by 7–21 grams.

“The impact of plain water intake on diet was similar across race/ethnicity, education and income levels and body weight status,” said An, University of Illinois kinesiology and community health professor. “This finding indicates that it might be sufficient to design and deliver universal nutrition interventions and education campaigns that promote plain water consumption.”

Although we did have to make a few revisions to Sam’s diet and exercise routines, the biggest change we made was getting him to drink enough water.  We got him to start following standard protocols for consuming enough water.  We asked him to consume a minimum of 8-10 cups of fluid per day.  This was in addition to the water he got through eating solid foods.  For example, a baked potato with skin is about 70% water.  Eating fruits and soups is another way to ensure that you are staying hydrated.  Water is certainly the best way to achieve this goal.  Milk and juice are about 90% water, and also are good sources of fluid. However, be extra careful as juice is often sugared and even natural juices are high in calories. It is important to note that caffeinated beverages not only don’t meet your fluid requirements, but because they act as a diuretic and expel fluid from the body, they can be harmful in terms of staying properly hydrated. 

We also explained to Sam that when exercising, he should follow the guidelines issued by the American Council on Exercise. One should drink 2 cups of water within an hour before exercising, consume 4-8 ounces of fluid every 10-15 minutes during the workout, and consume 2 cups of fluid for every .5 kilogram lost during exercise at the conclusion of the workout.  One should never lose more than 2% of his body weight due to dehydration.  This is dangerous and can affect your performance.  Also, remember that in hot and sometimes very dry climates, one must be extremely careful to drink enough, especially in the summer months.

Most of all, do not rely on your thirst reflex to tell you when to drink. If you are thirsty, you’ve already waited too long before drinking. Urine that is a dark, gold color indicates that you are not drinking nearly enough.

Here’s a good tip for being sure to get enough water in your system daily:  Upon awakening, drink two cups of water.  Add another two cups before each meal and one cup with each of your daily snacks.  That alone will give you 10 cups per day.  And drinking prior to a meal will also help you eat a little less by filling you up.  Many times we mistake thirst for hunger and eat unnecessary calories.  By keeping you full and by helping to keep your metabolism running higher, water is a big help in weight loss as well.

Sam came for a follow up visit one month later and felt like a new person—just from drinking more water.  Staying hydrated will “add hours to your day, days to your year and years to your life.”

TechnoStress and your Health

When it comes to stress, we all understand the dangers involved to our health.  When it comes to dealing with stress, things can get complicated.  Sometimes, there isn’t much to do about a situation that is causing stress. But what of behaviors or habits that I can change?  Those can be dealt with.  The technology we have today is wonderful in many respects but it can also cause undue stress and ultimately be harmful to your health.   Readers remember a time when the whole idea that everyone could be available to anyone’s beckoned call anytime, anywhere was unheard of.  Now, we are available all the time unless we have put limits on ourselves and that can create stresses previously unknown.  And not only that.  People without cellular devices and phones can be affected in a negative way.

We’ve all been there.  You are attending a concert, the singer and orchestra are singing a beautiful song, and then all of a sudden, the guy sitting three rows in front of you down to the left has a loud, disruptive ring coming out of his pocket.  Your moment is ruined!  And then there is that conversation you are having with a friend that gets interrupted when her pocket book starts ringing.  We live in a very different world, and it is a world that has change much because of the advancement of technology, but not all of that change is positive.

Mobile technology has brought unprecedented advantages, but excessive electronic stimulation produces negative consequences. Digital distraction can harm mental health and cause physical injury from accidents. Some scientists think that our constant engagement in media and telephones is one of the most serious threats to humanity.  On the other hand, some experts think that multitasking with electronic devices may increase the brain’s processing speed.

Distraction from electronic devices is not only real, it is increasing weekly. Although we generally refer to use of multiple devices, or using one device for multiple tasks as multitasking,
there really is no such thing.  “Nobody truly multitasks except in rare situations.  What we are doing is “task switching” according to Larry D. Rosen PhD at California State University.  “We tell our brains to focus on something different for a moment or longer, then we try to go back to our original task.  The problem is that digital technology is highly engaging and lures our attention away easily-and when we return, we need to reconstruct what we were doing and hopefully have enough time to complete the task.”

What is the real impact of digital distraction?

There is more stress. 49% percent of employees who use the Internet or email at work say that technologies such as the Internet, email, cell phones and instant messaging have increased job stress (Madden & Jones 2008). Early research on “technostress” showed that frequent introduction of new software, rapid changes in workplace technology and more time pressures from technology increased workplace stress (Arnetz 1997).

There is more anxiety. More individuals are suffering from “phantom vibration syndrome”—the perception that a cell phone is vibrating when it isn’t. This has been suggested as evidence of anxiety among those obsessed with mobile phones (Rosen et al. 2013). Some individuals suffer anxiety when they can’t check devices and/or social media frequently, but researchers have yet to determine whether this anxiety harms health (Durocher et al. 2011).

It’s difficult to disconnect from work. Among professionals and managers, increased technological connectivity leads to longer work hours and more challenges disconnecting during nonworking hours (Madden & Jones 2008). Those aged 30–49 have the most difficulty disconnecting fully from work, and this is impacting their life balance.

People find it hard to concentrate. Only 38% of employed adults who go online, use email or own a cell phone say technologies have made it harder for them to focus at work, while 50% of those who own a PDA or Blackberry note problems concentrating at work (Madden & Jones 2008). These statistics, however, predate the proliferation of iPhones and other smartphones. The typical U.S. worker is interrupted every 3 minutes (Silverman 2012).

Sleep is disrupted, and depression sets in. In a study of 4,100 young adults aged 20–24, conducted at the University of Gothenburg in Sweden, heavy mobile-phone use was linked to an increase in sleeping difficulties among men and an increase in depression in both men and women. Heavy computer use was related to increased stress, sleeping problems and depression in women and to sleeping problems in men (Thomee 2012).

There’s an increase in distracted-driving and distracted-pedestrian accidents. Nearly 400,000 people are killed or injured each year in distracted-driving accidents in the United States. Distractions include anything that diverts manual, visual or cognitive attention from driving. Since texting includes all three, it is of particular concern (NHTSA 2013). Pedestrians who use mobile phones while walking also cross unsafely into oncoming traffic significantly more often than other pedestrians (Weksler & Weksler 2012).

The ability to learn is being undermined. Theories of how humans learn emphasize the importance of downtime, which allows the brain to process new information. Some experts are concerned that constant stimulation interferes with this learning process (Richtel 2010b). Students who accessed Facebook more frequently when studying had lower grade-point averages than those who avoided it (Rosen et al. 2013a).

Spending unnecessary time in front of computers slows your metabolism and leads to weight gain. Spending unnecessary time on ANY electronic device can harm your most valuable relationships.

As someone who has done much of his exercising outdoors, I can’t emphasize the great benefits of leaving that cell phone behind and enjoying the fresh air, the green trees and letting your mind relax and not having to worry about that phone ringing.  It is very rare that any of us deal with true emergencies.  It is understandable that a doctor may have to be connected most of the time and possible security personnel.  But for you and I, disconnecting for certain times daily is vital. People can leave a message and you can call back later. It was a mere 25 years ago that the idea of having to be available all the time was practically non-existent.  You don’t have to be!  Give yourself a break.  So be careful and be aware.  Disconnecting is the best favor you can do for yourself, your family and your friends.

Digital technologies has advanced many areas of life and can even save lives, but don’t be enslaved by it.  Keeping your digital distractions to a minimum will “add hours to your day, days to your year, and years to your life.”