Can’t We Be Healthier?

I found a new study published by the Mayo Clinic to be quite frightening.  As a health professional, I see many people on a daily basis who suffer from a variety of health issues.  But this study revealed just how widespread the problems are and how much work needs to be done in all areas of health management in order for us as a population to achieve health and wellness.

Before we get to this study, let’s remember that in order to achieve the best chance of sustaining good health as we age and maintaining a good quality of life, we should be putting in about 150 minutes a week of moderate to intense physical activity, we should eat a healthy diet, not smoke and we should try to maintain a body fat of not more than 20% for men and less than 30% for ladies.  We know through multiple studies that the best indicator of longer life, and better quality of life, is our level of cardio-respiratory fitness.  And we all know by now that smoking cigarettes will cut your life expectancy by 10 years and once you get sick with one of the diseases that cigarettes will cause (cancers, heart disease, emphysema and much more), you quality of life will be non-existent and not only will you suffer, but those around you will suffer as well.  People with diabetes will increase their risk for blindness, kidney disease, neuropathy (diabetic pain), and are at greater risk of stroke and heart attack.  So, given all of these unkind outcomes to a lifestyle that includes unhealthy behaviors, one might thing that people would invest in their health—now, the study!

Doctor Charles Lorpinzi and his colleagues surveyed 4,745 adults to see which of 4 parameters, which have been set for good health, people actually accomplish and make part of their lives.  Overall, the survey revealed the following:

• 5% did not smoke
• 9% consumed a healthy diet
• 6% had a normal body-fat percentage
• 5% were sufficiently active
• 7% had all four characteristics
• 1% had none of the characteristics

Women were more likely to not smoke and to eat a healthy diet but were less likely to be active compared with men.  Older people were more likely to be non-smokers and healthy eaters, and were less likely to have a normal body-fat percentage and be active enough, compared with younger people.

Just this past week, someone came into my office to talk about his health.  He works long hours out of the city and just now, at age 47 quit smoking (we hope), is totally inactive, is overweight, and has pre-diabetes and high cholesterol.   He often eats on the run and there isn’t any awareness of how much he eats of the quality of his food.  But his main complaint is fatigue and tiredness which is typical of someone inactive and with other poor lifestyle habits.   The good news is he is considering making some major changes to his lifestyle.  If we turn the clock back a few months, we would be dealing with someone who had none of the characteristics needed for a healthy life.  He smoked, ate haphazardly, was overweight, and wasn’t active at all.

For those of you reading this who are also not compliant in all four areas, don’t get any grand ideas.  These changes are not easily made and it is crucial to make changes one at a time if you expect them to last.  Any progress in any area will be helpful to your health and only by moving gradually will these changes become permanent and made a part of your life.  Changing habits is tough stuff.  It’s so difficult that Rabbi Yisrael Salanter is known to have said that learning the entire Talmud is easier than changing one character trait.

But this is what it comes down to– there is no shortage of information on how to maintain a healthy lifestyle!  We can see a trainer to learn how to exercise and a registered dietician can teach us how to eat.  But then we have to actually do it, and make it part of our lives so that it isn’t just a passing fad.  If we can slowly, one habit at a time, better our eating and exercise, we won’t go back to the old habits because this is now part of our life, and it’s our choice.

One of the things I repeatedly tell my clients who are trying to lose weight, and have a lot of weight to lose is not to think about losing 20, 30, or 40 kilograms. That thought can be overwhelming and can cause one to not even make an attempt.   Instead, remember that each kilo of weight you lose is a kilo of health you gain.  And so it is with our lifestyle habits.  Are you very sedentary?  Then doing 150 minutes of aerobic exercise per week is probably unattainable right away.  But if you are currently doing close to nothing and you start walking briskly for 15 minutes every day, by the end of the week you are already over a hundred minutes.  You will, over time be able to walk 30-40 minutes at a good clip most days of the week, but in the meanwhile, you have done something to improve your health and well-being greatly just by starting.  A client of mine was smoking a pack (20) cigarettes or more per day.  She hasn’t stopped yet but she is now down to 7 per day.  She already told me that her ability to exercise and function has increased greatly since she cut down.  She hasn’t succeeded in quitting totally yet, but look at the improvement.

This study did indeed come as a shock to me; to know that so many people don’t meet the basic criteria for leading a healthy life. But with some work and effort, it can all be changed and it can be done at any age!  No matter what your state of health is, by taking that first step and gradually and methodically working towards and health lifestyle, you will “add hours to your day, days to your year and years to your life.”

Let’s Get Practical

People like myself, in the field of bettering health, are constantly reading up on the latest findings in areas of diet, exercise and mental wellness and trying to implement them.  Once in a while, we have clients who are already on a good path to health and wellness but they want to refine what they are doing to get it better.  For them we can fine tune what they are doing and move to a higher level of healthy habits.  However, most of the people need a lot of educating and need good techniques for implementation.  If there is one thing I have learned in all my years, it’s that it doesn’t take massive changes to start seeing good results.  Even when people have a lot of weight to lose or have multiple risk factors such as high blood pressure, high cholesterol, high blood sugar, and terrible inactivity, small changes one by one improve a person’s health and quality of life enormously.  That was the case with my client Levy.

Levy fell into this precise category and was ready to give up on himself.  He was on multiple medications and just never felt well.  He felt sluggish all the time and lacked energy even for regular daily tasks.  When I met him and we discussed his long term goals, he was clearly overwhelmed.  I asked him to have patience and that every small bit of progress was a cause for celebration.  Every kilo of weight lost will be a kilo of health gained. Even if it takes years to reach his weight loss goal, all of his other problems would begin to improve and his quality of life would be enhanced long before he gets there.  Just like everyone, we began working on the essentials, one by one.  Even if you aren’t in as bad shape as Levy was, here are the areas in which to seek improvement in order to better your health and quality of life—but don’t bite off more than you can chew—take it one or two changes at a time.  When those feel like something you can keep doing, take on the next one.

1. Get more sleep. Surprise! This is my top choice. Without the proper amount of sleep, most everything else won’t be able to happen like it is supposed to. In today’s world of one big global economy, more and more people are working jobs that require second and third shifts; they are working out of their time zone.  Many are communicating electronically with relatives and friends till the wee hours of the night.  Worries and daily problems keep us from sleeping enough hours or from sleeping soundly. Lack of sleep will disrupt your metabolism and cause you to secrete more of the hormone cortisol.  This increases your appetite and causes you to crave fatty foods, prolongs reaction time and slows cognitive function.  It also may make you irritable.

2. Be active. Before we get to formal exercise, there is so much you can do to enhance your basic levels of fitness and health within the routine of your average day. Just a few changes in activity can also help you lose up to 5-6 kilo a year.  Park the car a few blocks away from your destination.  Get off the bus or train a stop or two early. Use stairs instead of elevators. Try to walk instead of driving wherever possible. A recent study in Japan showed a marked decrease in blood pressures of those who walked back and forth to work (as little as 10 minutes each way) as opposed to those who drove.  It will help you control weight, improve your mood and contributes to your cardio-respiratory health.

3. Eat small meals more often. By scheduling 3 meals with 2 or 3 snacks, and keeping your portions under control, you are less likely to overeat.  Just as important, this will regulate the way insulin is released in your body and keep you from becoming a type 2 diabetic.  And every time you eat, your metabolism elevates, and all of us want our metabolism to be faster and not slower. Make sure you include enough healthy fats also!

4. Water. Water is one of the 6 classes of nutrients that we must ingest on a daily basis.  60 to 70 percent of our body is composed of water.  Without it, chemical reactions that occur all the time in the body cannot take place.  Drinking is essential, as we cannot conserve or store water in our body. Yet, most of us are probably only getting about a third of the valuable hydration benefits we need. And just like with eating regularly, it keeps your metabolism on the high side.

5. Exercise! Lack of cardio-respiratory fitness (your ability to walk fast, climb the hills and get up those stairs) is the leading risk factor of all-cause mortality.  So make sure to do aerobic exercise regularly and include muscle building as well.  It is essential for day to day functioning such as holding your children, your grandchildren and picking up your own suitcase without asking for help.  Try to schedule that 35 minutes of walking 5 days a week and 2 days a week of muscle building exercise.  You don’t have to go to the gym everyday for an hour-long heavy work out to get benefit.  See a trainer to help you get a good routine started.

6. Limit the processed foods and junk. If it is processed (most of what you buy ready-to-eat off the supermarket shelves), try to stay away.  In 2010, a Harvard study showed a pronounced difference in eating unprocessed versus processed meats. Eating processed meats, such as deli, was associated with a 42% higher risk of heart disease and a 19% higher risk of type 2 diabetes.  We now know for certain that processed meat cause cancer!  Most of those pop-in-the-toaster items are also highly processed, full of sodium and devoid of nutritional value—no matter what the front of the package says.  Eating whole foods gives you your daily nutrition and fills you up to keep you from being hungry. Keep your sugar to minimal amounts. Sugar includes the white processed stuff, corn syrup, high fructose corn syrup, dextrose, glucose and stay away from artificial sweeteners too.  All processed and canned foods are very high in salt/sodium.

7. Reduce and manage your stress. It is difficult for me to convey just how damaging stress is to your health.  Chronic stressors are thought to be the real villains associated with many health and disease problems.  Chronic anxiety and depression, an overabundance of life changing-events, and a repressed feeling of loss, bereavement, emotional distress, and hostility have been linked to increased risk of heart disease, cancer, infection, suppressed immunity, asthma attacks, back pain, chronic fatigue, gastrointestinal disease, headaches, and insomnia.  A well-rounded exercise program, cognitive behavioral therapy or coaching, and some good problem solving techniques can go a long way in solving stress issues.

8. Stop eating by 8:00-8:30 in the evening. When you eat earlier, you use the calories through daily activity, when you eat late, you just go to sleep soon after and the calories don’t get used up.  You will also sleep better when you eat earlier.  In a study with two control groups, one group ate their daily allotted calories in the early afternoon and the other in the evening.  Group one lost weight and group two gained weight even though they ate identical calories each day.  Best not to eat at all from 2.5 hours before bedtime. So, set yourself a curfew.

These 8 areas are exactly what Levy, myself, and my dieticians worked on together.  After three months of work, his doctor was even able to reduce one medication for high blood pressure, lower his dosage of cholesterol medicine and he avoided having to taking insulin for his diabetes.  He is losing weight and on track, so we expect even better results and even less medication over the next 3 months. Pick one or two of the 8 and get started. Try to add one every week.  You don’t have to wait, today is a perfect day to start to better your quality of life.  Working on these 8 areas will bring you to good health and “add hours to your day, days to your year, and years to your life.”

Make Changes One-at-a-Time

When you get down to it, all the people that I see in my various programs are trying to change some behavior or habit in order to achieve a goal in health and wellness.  In order to lose weight, lower blood pressure, cholesterol, or blood sugar, or become more fit and functional, the chances are good that you will have to work on abandoning some poor health habits while at the same time learn new behaviors that will promote better health.

Tovi, a 36 year old mother of 6 came to me with two main problems.  She was 22 kilo overweight and she had just been told by her doctor that she was pre-diabetic.  Because Tovi had a full time job as a systems analyst in addition to her family responsibilities, she knew that she had to be able to function fully and she certainly couldn’t afford spending time in the doctor’s office on a regular basis. Her doctor explained to her that if she would make the proper lifestyle changes, she would take care of the problem of overweight and get her blood sugar levels down to normal levels without medications and all of the side effects that comes with them.  She was indeed encouraged by the prospect that her future health was in her hands but like anyone else in Tovi’s position, this would require changing some very ingrained behaviors.

Tovi was someone who had to get her kids out of the house early and be at work on time.  So, she skipped breakfast.  At about 11 in the morning, she would be very hungry having only had a cup of coffee and one glass of water when she got to work.  So she grabbed a cheese danish or 3 rugalach together with another cup of coffee depending on what was available in the company snack room.  When it got to the 1 o’clock lunch break, she would eat a very large lunch as she was very hungry.  She had a cup of tea and half a chocolate bar for dessert almost every day.  Her workday was over at 4:00 and she had to get home to make sure she had supper ready for her kids.  Usually while preparing supper, she picked at the food and then after eating with her kids, she might sit down and eat yet again with her husband when he arrived home at 7:30. Tovi was also pretty sedentary.  The company picked her up and others in her neighborhood with a van every morning and she took a bus home.  She worked at her computer all day and didn’t get much movement during her day, other than going between rooms in her office building or to the cafeteria to eat.

Instead of just telling her to lose weight and exercise without instruction, Tovi’s doctor sent her to me for professional advice and coaching.  At our first meeting, she seemed very anxious to get going and to accomplish everything as quickly as possible.  It was almost as though she thought we would meet once, including a visit to my staff dietician, and she would be all set.  I explained to her that the only way behaviors are going to change and stay changed is if we take baby steps.  We need to do things one step at a time.  Although Tovi was disappointed, she understood that when habits are so ingrained, there is just no such thing as pushing the “undo” button for a quick fix.  And so we began our journey to good health.  Her first assignments?  Use the staircases at work, get off the bus one stop early on the way home, and walk an additional 20 minutes each night. The dietician had her pack up breakfast each night to bring to work and eat when she got there and to change the morning snack to a yogurt and a fruit.  And so we started.

“Habit” is a word that has become exclusively associated with negatives. Habits have consequences. So bad habits have bad consequences and good habits have great consequences. Habits can make life easier. More accurately, they streamline behaviors to free you from the sometimes excruciating experience of making a choice.  Let’s look back at our client Tovi.  One of the changes we agreed she had to make was to walk 20 minutes every night.  But this was something she had never done and often in the evenings, she would spend that time catching up on things with her husband while snacking on unhealthy choices, like ice cream.  So two things had to happen here:  1) Tovi needed to stop eating ice cream each night and 2) she needed to do her walk.  I enacted 3 of the criteria of behavioral change by Dr. B.J. Fogg.

• Keep the change of behavior small and manageable (a 20 minute walk, not the ultimate goal of 35 per night)
• Make sure there is a prompt for the behavior (immediately after I finish cleaning up the kitchen, I will go for a 20 minute walk)
• Create a method of ensuring positive emotion immediately after doing the behavior ( I had her say to herself after the walk “Tovi, look how much you just accomplished for your health by completing that walk”)

Now we have created a positive behavior.  But what about that ice cream, which will certainly not help her lose weight?  Our client realized that as she was making progress in enacting new positive behaviors, it made no sense to undo that progress.  And this was all reinforced each week when she saw progress downward on the scale.  These were the techniques we used over time to get Tovi healthy.  It didn’t take terribly long before she was walking 35 minutes briskly each night.  Three times per week, she eventually did a small 12 minute routine of muscle building exercises (and I made sure she recorded how good she felt afterward as positive reinforcement). She also began eating 3 moderate size meals daily with 2 small snacks in between the meals and was drinking 10 cups of water per day.  Although we slowly got her to switch over to healthy choices for meals and snacks, twice a week, we built in ice cream for her in small but enjoyable amounts.

3 months after our initial meeting Tovi had dropped 9.5 kilo and her blood sugar numbers, both her fasting glucose and HBa1c were firmly in normal range.  She was functioning better, had more energy and was meeting her responsibilities both to her family and to her boss at work with more vigor and with energy to spare at the end of the day.  Her feeling good was now motivating her to slowly but surely get to her weight loss goal too.  And how did she accomplish it?  One small step at a time and making sure that each behavioral change she chose to make was somehow attached to a behavior that had become firm and anchored.  She also learned how to tell herself or write down a positive emotion after she accomplished each change.

The Talmud tells us in Baba Kama—“Tafasta Meruba, Lo Tafasta”.  In a language we might understand better—“don’t bite off more than you can chew”.  Trying to change a lot of things at once is a recipe for failure, but using Dr. B.J. Fogg’s method and taking tiny steps can bring the desired results and “add hours to your day, days to your year, and years to your life.”

A New Year, A New Time for Inspiration!

As we approach Elul, the last month of the Jewish calendar, and as we get closer to Rosh Hashana and Yom Kippur, it is the time of year for reflection on the past and a look to the future. We will now be praying for both forgiveness and for achieving our potential for the year to come. Just as we can’t repent without looking back at the past and realizing and recalling mistakes, we can’t make the changes necessary for a healthier, and in turn, happier year if we can’t look back and find the various points to fix.

Over the past years, I have had the privilege of helping people who have decided they wanted to change their lives. I personally have been very inspired by their hard work and dedication. I share this with you so you can see that it can be done! Keep in mind that not one of these people turned their lives around over night. It began with small but consistent steps that eventually turned into a new existence. Everyone can make a small change here and there in order to change their quality of life and overall health for the better. Read about a few of these people and be inspired!

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Y. is a 48 year old mother who has to travel quite a distance to see me. She started her journey to good health with our program. Although she lost an amazing 20 kilo, there was more work to be done in order to reach the range of healthy weight. Now she has become a daily exerciser. Her husband got a one-time bonus from his job and offered to buy her a gift. She asked for the only thing that she really wanted—to begin Personal Training. Y. has now lost 48 kilo (105 pounds). Y. was an insulin dependent Type 2 diabetic and is now completely off insulin and any other medications. She is also coping with some of her life’s stresses much better.

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A.B. is a 23 year old Yeshiva Bachur.  When his mother called me 8 months ago, she was very frustrated.  Her son was carrying a lot of weight—his Body Mass Index was close to a whopping 44. Yet what frustrated A.B.’s mother most was that A.B. had been to a dietician a year earlier, lost 40 kilo and gained it ALL back.  We gave A.B. a food program where he wouldn’t be hungry, but would still lose weight. He also began daily walks, and as the weeks went on we added a little bit of muscle building exercises, too.  Where A.B.’s previous attempt at weight loss had not addressed behaviors and habits, our program helped him deal with these challenges. Currently A.B. has lost 22 kilo and understands that when you lose too much too fast it’s not a good thing.  Exercise, proper diet and behavioral changes are doing wonders for A.B and he is well on his way to doubling what he has lost so far.

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5 months ago, D.Z. (61 years old) went to see her doctor and was told that she would have to use multiple medications if she didn’t tend to the underlying causes of her high blood pressure, high cholesterol, pre-diabetes, and also lose some weight.  D.Z. began our 10 Weeks to Health program, combine that with personal training, hoping to see results that would help improve her health.  2 weeks ago, D.Z. went in for another blood test: her sugar, cholesterol, triglycerides, and blood pressure are all so significantly improved that the doctor told her—NO MEDICATION!

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In most aspects of life, taking giant steps in any direction generally is not a long-lasting way to achieve any goal. On the other hand, using baby steps, as did the people you just read about, and doing things incrementally usually brings a better long-term and permanent result. When it comes to weight loss, exercise and eating a healthy diet, this is always true. We need to look back and isolate the causes of bad health, and one at a time, start making changes, that over time will bring us to improved health and ultimately, good health.
Look back at your health habits and choose one or two aspects that need improvement. Start slowly. Perhaps you can get an additional half hour of sleep at night. Cut out late night eating. Substitute water for sugary or diet drinks. Increase vegetables and fruits and in your diet and cut back on cakes and junk food. And perhaps most of all, leave that car at home and start walking from place to place and even schedule a walk daily, because that will help you as much as anything else. Step by step, you can make all of these changes over time.
This is the season where we strive to change ourselves for the better. Don’t leave your health out of the equation! And start now—that way you can manage the coming weeks and not make the mistake of waiting until after all of the holidays are over in order to get started. Avoid further damage by making the changes NOW. Taking small steps, one at a time, to improve your health and well-being over the long term will “add hours to your day, days to your year, and years to your life.”

A Time for Change—Get Inspired!

As Rosh Hashana and the Aseret Y’mei Tshuva and Yom Kippur approach, it is the time of year for reflection on the past and a look to the future. We will now be davening as best we can for both forgiveness and for achieving our potential for the year to come. Just as we can’t repent without looking back at the past and realizing and recalling mistakes, we can’t make the changes necessary for a healthier, and in turn, happier year if we can’t look back and find the various points to fix.

Over the past years, I have had the privilege of helping people who have decided they wanted to change their lives. I personally have been very inspired by their hard work and dedication. I share this with you so you can see that it can be done. Keep in mind that not one of these people turned their lives around over night. It began with small but consistent steps that eventually turned into a new existence. Everyone can make a small change here and there in order to change their quality of life and overall health for the better. Read about a few of these people and be inspired:
Y. is a 48 year old mother who has to travel quite a distance to see me. She started her journey to good health with our Lose It! program. Although she lost an amazing 20 kilo, there was more work to be done in order to reach the range of healthy weight. Now she has become a daily exerciser. Her husband got a one-time bonus from his job and offered to buy her a gift. She asked for the only thing that she really wanted—to go to Personal Training. She has now lost 48 kilo (105 pounds). Y. was an insulin dependent type 2 diabetic and Baruch Hashem, she is now completely off insulin and any other medications. She is also coping with some of her life’s stresses much better.
S. is a 24 year old currently learning at a Baal Tshuva yeshiva. He has a past history of obesity as well as addictions. He did the Lose It! program originally and lost over 30 kilos. But he too still had a long way to go. He began a combined program where he was seeing our therapist for an hour a week and began Personal Training as well to up his intensity in exercise. At one point, he had to return home for a week to attend a wedding of an old friend. He exercised on his own, was polite to his old friends without engaging in dangerous and destructive behaviors, seemed to have enjoyed himself and has really “passed the test”.
A. is 20 years old. She has always wanted to be a normal weight but getting there caused disordered eating. She hasn’t finished Lose It! yet, but she is eating healthfully and ordered, and she is exercising on her own. But that isn’t all. We recently spoke about career planning. She is so turned on to her new-found health and wellbeing that she is considering this as a career…to be continued.
B. is a Rav who is very involved with the needs of the community, particularly with our youth. He needs to be in good health and to have the energy it takes to do his job. He was a type 2 diabetic, on the verge of getting medicated. It isn’t just the 25 kilo he lost. He exercises, drinks far more water everyday than he used to, eats well and most of all, he can stay up late nights to deal with all of his cases and handle his phone calls from times zones abroad 10 hours away. That enables him to save precious Neshomas in Klal Yisrael.

M. is a Yeshiva Bachur, who’s eating was truly out of control. That was coupled with almost no activity or exercise. His parents got him to come to Lose It! when his weight was approaching 150 kilo (330 pounds). He has lost over 35 kilo (77 pounds). More than that; he is learning better than he has ever learned before and he has control over his life in general.
A divorced mother of 2 takes medication for mental health problems as a result of a bad marriage. Now that she has completed our intense 3 month program combining Exercise, Behavioral Therapy and Dietetics, her new Psychiatrist (whom we recommended) has cut her medication in half twice. She is coping with life much better and continues to improve.
5 Years ago, a 37 year old man came to me totally unfit, with blood sugar almost twice the acceptable level and his triglycerides were “through the roof”. He has an impossible schedule, learning a full seder every morning, running a high pressured business in the afternoon and evening, and spending his evenings tending to Chesed cases. He started slowly but was determined to get his health back, especially at such a young age. After 12 months, there was a drop of 205 points in his triglycerides and 98 points in his blood sugar. He lost more than 30 kilo of weight. He hasn’t been with me for a couple of years now, but continues to exercise and has given himself a whole new lease on life.
In most aspects of life, taking giant steps in any direction generally is not a long-lasting way to achieve any goal. On the other hand, using baby steps, as did the people you just read about, and doing things incrementally usually brings a better long-term and permanent result. When it comes to weight loss, exercise and eating a healthy diet, this is always true. We need to look back and isolate the causes of bad health, and one at a time, start making changes, that over time will bring us to improved health and ultimately, good health.
Look back at your health habits and choose one or two aspects that need improvement. Start slowly. Perhaps you can get an additional ½ hour of sleep at night. Cut out late night eating. Substitute water for sugary or diet drinks. Increase vegetables and fruits and in your diet and cut back on cakes and junk food. And perhaps most of all, leave that car at home and start walking from place to place and even schedule a walk daily, because that will help you as much as anything else. Eventually, step by step, you can make all of these changes over time.
This is the season where we strive to change ourselves for the better. Don’t leave your health out of the equation. And start now—that way you can manage the coming weeks and not make the mistake of waiting until after all of the holidays are over in order to get started. Avoid further damage by making the changes now.
Taking small steps, one at a time, to improve your health and well-being over the long term will “add hours to your day, days to your year, and years to your life.”