In this weeks "Healthy Lifestyles with Kikkan," Kikkan Randall and H Allen Chapman, P.A., discuss proven strategies to manage holiday temptations! Get a head start on the person you want to be in the New Year!
You can do this, we can help!
Alaska Premier Health
Physician Managed Weight Loss
Experience your best days all over again!
Posted by Alaska Premier Health on Thursday, December 8, 2016
Welcome to Healthy Lifestyles with Kikkan Randall, presented by Alaska Premier Health. Now coming to you every week with informative health and wellness advice from Kikkan and the professionals at Alaska Premier Health.
You can do this, we can help!
Alaska Premier Health
Physician Managed Weight Loss
Experience your best days all over again!
Posted by Alaska Premier Health on Thursday, December 1, 2016
We often contribute substantially to the problems and hardships in our lives. We get into the habit of behaving a certain way, and tend to stick with these habits, even when they harm us or make us unhappy. Will Rogers once said, “If you find yourself in a hole, stop digging.” I think it’s one of the wisest bits of advice I’ve ever read. Should we find ourselves in circumstances which make us unhappy or unhealthy, we should strive to do all within our power to stop making things worse.
Our imperfect lifestyle choices usually cause a gradual worsening of our health rather than sudden worsening. We simply accept feeling tired all day, sleeping poorly and being unhappy with our appearance as facts of aging. While the effects of aging are immutable; we can be more energetic, sleep better and look better at any age. We just have to stop contributing to the problem, we have to stop digging.
So what should we do to start feeling better? Be good to your body, it’s the only one you get. Try to lead an active lifestyle and get regular exercise. Walking is an excellent form of exercise and has many proven health benefits. Eat a balanced, healthy diet with lots of fruits and vegetables. Get enough sleep. If you smoke, cut back and work hard to quit. If you are carrying extra weight, try to trim down. Moderate your alcohol consumption. If you need help making lifestyle changes, get help.
Health care providers, personal trainers or lifestyle coaches can help. If you can do it on your own, get cracking. Track your progress over time with a personal journal or smartphone application. If you struggle to make or sustain changes, seek help. Folks with deeply ingrained habits often need assistance making changes. If you want accountability and comprehensive structured treatment, schedule an appointment for a consultation with a health care provider at Alaska Premier Health.
“I didn’t realize how bad I felt until I started to feel better.” I’ve heard many patients express this sentiment over the years. We often don’t realize how good we can feel with a few sustainable changes in our lifestyle. Eat right, exercise regularly, get enough sleep, manage your weight, moderate your alcohol and stop smoking. Stop digging.
A healthy diet incorporates plenty of healthy carbohydrates such as vegetables and fruit. Fruit and vegetable consumption is inversely proportional to all-cause mortality. Simply put, your risk of dying is lowered by each of the first 5-7 servings of fruits or vegetables that you consume daily. Less dying is good. Increased vegetable consumption can help us maintain calorie balance. Vegetables are very rich in nutrients, but have low calorie density. Eat your vegetables and fruit: they’re good for you.
When you eat grains, eat whole grains. Whole wheat bread, brown rice, quinoa and similar foods can be a healthy part of a well-balanced diet. Grains have nutrients which are essential to our ongoing good health. Whole grains are an excellent source of fiber and most have a little protein. Don’t be afraid of having whole grains in your diet.
A healthy diet includes protein. Most Americans tend to eat more protein than they need. We need about 60-120 grams of protein per day. Eating lean meat, such as chicken or fish, cooked in a lean way, is an excellent healthful way to get the protein you need. Other sources of protein are eggs, nuts, beans, legumes, tofu and milk products. There are additional benefits from oily fish such as salmon as it contains omega-3 fatty acids. Eating foods rich in omega-3 fatty acids may reduce risk for heart disease.
A balanced diet includes a modest amount of healthy fats. Calorie intake from fat should constitute no more than 30% of your total daily calories. As I mentioned in an earlier post, you should try to avoid trans fats altogether. Saturated fats should be limited to no more than 10% of total calories. We require fat in our diet for normal body function. You shouldn’t try to completely eliminate fat from your diet. Fish, olives and certain nuts are healthy choices for dietary fats.
Your diet should contain an abundance of fiber. Most adults should consume 25-35 grams of fiber daily, or about 14 grams per 1000 calories. Eating a high fiber diet is associated with decreased risk for heart disease, stroke, diabetes and all-cause mortality (risk of death). Dietary fiber is present in significant quantities in most fresh fruits and vegetables. Crunchy or chewy fruits and vegetables generally have more fiber than soft vegetables or fruit. Fruit juice tends to be a very poor source of dietary fiber.
A healthy diet is a satisfying diet. Your diet should be interesting and varied. The best way to get all of your nutrients is a well-rounded, balanced diet. There is no dietary supplement which you can take that will match the demonstrated benefits of a healthy diet. Eat well and be well.
What is a healthy diet? This is a question which can only be answered with caveats. A healthy diet for a person with diabetes, food allergies or celiac sprue is different than for someone without these ailments. The subject of this blog is a healthy diet for someone without a chronic disease which requires special dietary restrictions. This blog also isn’t about losing excess body weight. This information is about what a healthy, calorie balanced, content balanced, weight maintenance diet should contain.
Caloric balance is essential to maintaining a healthy weight. Overeating can lead to becoming overweight or obese. An extra 100 calories per day will cause a ten pound weight gain in a year. Obesity is the most common diet related health issue. Obesity is associated with increased mortality and increased risk for many health problems including heart disease, diabetes and cancer. Regular self-monitoring of weight is the best strategy for judging energy balance.
Eat a balanced diet. Your body needs carbohydrates, protein and fat every day. Carbohydrates are the main source of fuel for your body and are required for brain function. Every cell in your body contains a layer of fat which is essential for cell function. Proteins form our muscles, are involved in the transportation of hormones, essential nutrients and other substances within our bodies. The recommended balance of macronutrients is: 45-65% carbohydrates, 10-35% protein and 20-35% fat.
We should avoid fad diets which exclude entire categories of healthy food. There are some nutrients, however, that we should try to exclude from our diet. We have no metabolic need for trans fats or sugar added foods, and there is ample evidence that consuming these substances increases risk for chronic diseases which can shorten our lives. Trans fats are contained in many baked goods, margarine and partially hydrogenated oil. Sugar sweetened drinks are the most common sugar added food.
My next post will contain more specific information on healthy food choices for carbohydrates, fats and proteins. Like most things in life our choices matter and actions have consequences.
We all dream of a better us. We dream of getting back into shape again, feeling fit and strong, eating better and being thinner. It’s a long journey back into the skinny pants. We feel great and full of energy after a few months of regular exercise, better diet, and weight loss. Then we hit our goal weight, stop exercising, slide back into old eating patterns and gradually regain back to our old weight.
This was not a part of our dream. To live our dream we have to learn to think and behave differently. When we lose weight and get back in shape we should never think of ourselves as done. We should either be striving mightily toward our goals, or living the life of the person we want to be, not the person we used to be.
Keeping it off. More than 90% of people who maintain a healthy weight following a substantial weight loss are regular exercisers. The largest study to assess this issue, the National Weight Control Registry, recommends an hour of exercise most days. This same study shows that about 75% of successful weight maintainers eat breakfast daily and weigh themselves at least weekly.
Only you can do it for you. Only you have the power to make healthy changes in your lifestyle; you just have to decide to do it. Once you get started, be the boulder rolling downhill. Nothing can stop you but you. Choose to do what is necessary to accomplish your goals, then live the life of the person you aspire to be.
Your future belongs to you; own it.
Contraindications. In an earlier post, we discussed indications for the use of weight loss medications. It is important to understand the presence, or history, of certain medical conditions, the presence of drug allergies or intolerances and current medications may affect the appropriateness of a particular weight loss medication or even class of medications. The final decision regarding the use of a medication and the choice of which medication is recommended will be between you and your health care provider.
Sympathomimetic amines (Phentermine, Phendimetrazine, Diethylpropion). These medications have been around for many decades. All are available in generic form and are relatively inexpensive (<$50/month). Phentermine is the most commonly prescribed weight loss medication in the US. This class of medications works by directly suppressing appetite. Depending on the drug and dose, it works for six to twelve hours. Most patients eventually develop tolerance to sympathomimetic amines. Qsymia (Phentermine + Topirimate). This medication has been out for a couple of years, is not available in generic form and costs about $135 per month. The Phentermine component works as described above. The mechanism of action for Topirimate is unknown. Qsymia may help patients with obesity and binge eating disorder gain control of both problems. Qsymia produced more weight loss than any other weight loss medication in clinical trials (8%). Saxenda (Liraglutide). Liraglutide has been available in various formulations for several years. Saxenda is an expensive medication, about $1300 per month. Saxenda is an injectable medication with once daily dosing usually in the morning. Saxenda works on a hormone (GLP-1) which helps us to feel satisfied with smaller portions of food. Saxenda is the only weight loss medication proven effective when initiated in patients who have already lost a substantial amount of weight. There are other medications available for the treatment of obesity, but are prescribed less commonly than the medications outlined above. Medications for weight loss are truly adjuncts to diet and exercise. If you want to lose weight, you must restrict your calorie intake. If you want to keep it off, you must embrace a habit of daily exercise. The whole process is more efficient if you embrace the need for lifestyle change. In the end, like achieving most things of value, you have to work for it.
“In the middle of the journey of our life I came to myself within a dark wood where the straight way was lost.” Dante Alighiere, Inferno
All of us will eventually go through rough times in our lives. It isn’t the strife that defines us; it is our response to our travails that demonstrates the depth of our character. We must strive to live up to our own principles of behavior, even, perhaps especially, during trying times. We can choose to believe in our ability to overcome obstacles and prevail. We can choose to live a life we’re proud of despite challenges we face.
Within the military it is a truism that a soldier’s character isn’t really known until they make the choice to put their own life at risk for the good of their brothers in arms. This is the ultimate test of character. Most people never serve in the military, but the example may help us to put our own life stressors into perspective. Most stressful events don’t involve potential serious bodily harm or death, but even during the roughest of times we must strive to live up to our own standards of behavior.
If we catastrophize every inconvenience, we render ourselves less capable of dealing with truly important stressors. If you are feeling overwhelmed, just ask yourself: “How much will this matter to me in a year?” This question helps us to realign our priorities so they more closely match our values. Truly important things will be important today, tomorrow, next week and next year. Things that are unimportant next year are probably not important enough to lose sleep over tonight.
Courage isn’t being fearless; it’s doing what must be done in spite of our fear. With the right attitude, you can overcome adversity in your life. When your priorities are aligned with your values, you can separate important from unimportant tasks. Choose to be strong, prioritize what must be done, and work toward accomplishing things that are truly important. Keep your head up and your feet moving. You are tougher than you think.
In Western medicine we separate the study of the physical brain, neurology, from the study of the mind, psychiatry. There is some overlap between the two disciplines, but they are distinctly separate. Today we will discuss one way of conceptualizing the thinking mind. We are unaware of many of the decisions, actions and reactions that occur without conscious thought because of how our mind works. This isn’t a problem unless our behavior is making us unsafe, unhealthy or unhappy.
An example will help to illustrate the interaction between the conscious and subconscious mind. When we first learn to drive we have to think about every action we take. We are competent drivers only when we pay conscious attention to what we’re doing. Once we’ve been driving for many years, our mind offloads much of the work of driving safely to our subconscious mind. We become subconsciously competent at driving. This frees up much of our conscious mind for other tasks.
Sometimes we develop bad habits which become ingrained in our subconscious mind. If we aren’t fully consciously engaged, we behave in ways that are unsafe or unhealthy. Another driving example would be following too closely, especially during inclement weather. With regard to food, some examples would be: mindlessly eating popcorn during a movie or eating more than we should while conversing with our spouse at dinnertime. I’m sure you can think of other examples in your own life.
When we develop bad habits and hold onto them long enough to make them subconscious habits, we must use conscious thinking to overcome them. We call this mindfulness. Adults can and do change their behavior when they pay conscious attention to the habit they wish to change. Retraining our subconscious mind into a new pattern of behavior takes time and persistence. Mindful eating is a topic worthy of an entire blog of its own and will be addressed more fully in a future article.
Our self-image is a powerful force when we attempt to change our pattern of behavior. If we believe we are not capable of change, our self-image will guide our subconscious mind toward failure. Believing we are capable of change is no guarantee of success, but believing that we aren’t capable almost always leads to failure. Success leads to improved self-image, which in turn makes future success more likely. This is why setting and achieving small goals along the path to a larger goal is so valuable.
To change our habits we have to engage our conscious mind. When we identify a habit we want to change and accept that we the power to make the change, we have to consciously replace our old habit with a new one. It is much easier for us to choose to do something, like eat more vegetables, than to not do something, like eat less junk food. To sustain change, we have to remain aware and mindful of our behavior. Mindful eating promotes sustained positive change.
Sometimes we can better understand a concept by illustrating the opposite. So, what is mindless eating? When we go out to a movie, my wife just loves movie theater popcorn, and she likes to get a ridiculous sized tub-o-popcorn. If I hold the popcorn in my lap during the movie, I will eat it, continuously, without conscious enjoyment. After a few handfuls I don’t even like it anymore, and yet I will continue to eat it unless I remove it from my lap. That is mindless eating.
How do we overcome mindless eating? Distance is your friend. The tub-o-popcorn on the floor is no temptation. In your lap, it’s a different story altogether. If you choose to eat, pay attention while eating, don’t multitask. Savor the treat, enjoy it, pay attention to your sensations, and stop eating as soon as your craving is satisfied. Use single portion sized containers to aid you with portion control. Lay’s potato chips once used the slogan: “An open bag is an empty bag.” It’s often true: buy a smaller bag.
Mindful eating doesn’t mean never eating decadent foods. It means making a conscious choice whether to do so or not. If we do choose to indulge ourselves, it should be a conscious choice. When eating mindfully, we appreciate the flavors, aromas and sensations the food provides to us. Then we consciously decide when we’ve had enough and stop eating. Last we experience no guilt over the decision because it was a decision made consciously.
We aren’t striving to be perfect, just good enough often enough. We don’t need to have a perfect relationship with food to become thinner and healthier people. Through mindful eating we can reduce the frequency and magnitude of our dietary imperfections. When we have more perfect minutes and hours, we have more good days. More good days translates to more good weeks, months and years. Mindful eating is an excellent strategy for becoming the thinner, healthier you that you’ve always dreamed of.