At the beginning of the year, it seems that everyone is interested in “getting back in shape” and “shedding a few pounds”. What is a healthy weight? How do we define it?
Patients tell me that their healthy weight is the weight where they feel good and look good. Most of the time, patients have a specific number on the scale in mind. Physicians often determine a healthy weight by using the body mass index or BMI. This is a simple calculation based on your height and weight. The calculation is as follows:
This calculation is used by doctors, insurance companies, the FDA, and other government agencies. There are tables available to give the BMI based on your height and weight.
Normal weight is in the BMI range of 18.5 to 25. Above 25 is considered overweight and above 30 is considered obese.
I find that the BMI is very limited and is not a good measure for each individual. There are reasons why I feel this way. For one, the BMI does not measure fat or lean body mass. A body builder with 6% body fat will have a high BMI, often above 30. No one will mistake a bodybuilder as being obese.
Also, BMI makes no distinction between men and women. Men naturally have more muscle mass than women, therefore a man’s BMI would be naturally higher than a woman’s. Yet, none of the BMI charts show any difference. In this instance if a man and a woman were both 5’ 9”, the maximum “normal BMI” weight at 24.9 would be 168 lbs. I have several female patients who would feel very overweight at 5’ 9” if they weighed 168.
BMI also does not distinguish between those who have an apple shape and those with a pear shape. Apple shaped people distribute their fat centrally especially in their waist. This is associated with increased health risks including heart disease, diabetes, and high blood pressure. Pear shapes have more of a peripheral distribution of their fat and less fat centrally around their waist.
A better measure is waist to hip ratio. A waist to hip ratio (WHR) greater than 0.95 in men and greater than 0.85 in women are associated with increased risk of heart disease. A WHR less than 0.8 for women and less than 0.90 for men is associated with increased health.
Your healthy weight depends on several factors including age, genetics, diet, and life-style. As we age, we tend to put on more weight. Our metabolism slows and we put on more fat. Much of this is determined by our genetics. Diet obviously plays a major role in our weight. However, it is not just about how many calories we take in every day. Where we get those calories is more important. A diet of simple sugars will have a very bad effect on us compared to a balanced diet even if the total calories are the same. Finally, our lifestyle plays a role. The more active we are and the more we exercise regularly will help us maintain our healthy weight.
Balance: in life we strive for balance in all things.
Ben Franklin once said, “ A perfect day is equal parts work, play, and rest.” Imagine life where each day you work 8 hours, play 8 hours, and rest 8 hours. Most of us skimp on the rest 8 hours part.
Lifestyle is not something we do every once in a while or when we feel like it. Our lifestyle is what we do regularly, week in and week out, month in and month out. Contrast with getting all inspired to lose weight after the holidays and then going to the gym for a few weeks and then quitting. This is not a lifestyle change. When I refer to lifestyle and to changing that lifestyle, I mean real change for the long haul.
Why is sleep important? Sleep is that time our bodies and minds rejuvenate. During REM sleep (deep sleep) our brains release human growth hormone (HGH), which has the effect of making repairs in our body. During sleep, our brains also replenish neurotransmitters to prepare us for the stresses of the coming day. Sleep deprivation is associated with weight gain.
What can be said about exercise that has not already been said? Exercise improves muscle tone, decreases mental stress, improves hormonal balance, improves detoxification, increases our metabolism, reduces fat, improved bone strength, and improves mobility. There are studies that show that mental function also improves with regular exercise.
Our diet should be balanced too.
Balanced, in this case, does not mean equal parts, but rather having plenty of all the food groups. Balance diet means a balance of proteins, carbs, and fats in our diet. For carbohydrates, complex carbs are best and a rainbow diet is optimal. A rainbow diet means plenty of color in our diet and that means fruits and vegetables.
Good fats are the mono and polyunsaturated fats. Avoid all trans fats, which are found in processed foods and fried foods. Some saturated fats are good but too many are not good. Omega 3, omega 6, and omega 9 fats are healthy and should be part of a balanced diet.
Lean proteins include fish, chicken, lean beef. Avoid fatty meats, which have very high saturated fats.
When our hormones are out of balance, we are out of balance.
If our thyroid is not working properly, our metabolism is dysfunctional. Thyroid controls our metabolism. Usually, it is a matter of an underperforming thyroid. This leads to weight gain, low energy, poor concentration, thinning hair, dry skin, puffiness, aches, and several other symptoms. We can test thyroid by using blood tests. Also, a morning body temperature can be indicative of thyroid function. A low morning body temperature indicates a low functioning thyroid.
If these are out of balance, everything in our lives is affected. In women, this results in menstrual issues that can be debilitating. PMS, endometriosis, fibroids, dysmenorrhea, monthly migraines are all forms of an imbalance called estrogen dominance. We can test hormone levels by either a blood test or a saliva test.
The adrenal hormones are the stress glands. They affect everything. We live in a 24/7/365 world and our adrenals are constantly working. Eventually they begin to falter. This leads to adrenal fatigue. Adrenal hormones are best tested using a saliva test.
This is a hormone that we can actually control. It largely depends on what foods we eat. Since we control the foods we eat, we can control our insulin. Weight loss is dependent on getting insulin secretion in balance since it is a storage hormone and stimulates fat production. When insulin is out of control, we begin to have insulin resistance. Insulin resistance simply means that the body needs to produce more insulin to do its job at the cellular level. As insulin levels rise due to this resistance, our bodies begin to store more fat. A simple blood test can tell us a lot about our blood sugar levels over a 3 month period. This test is the HgA1c. When this number is elevated, we know that blood sugars have been elevated and this means that there is insulin resistance. Another method is to do a insulin-glucose challenge and measure insulin levels every hour for 3-5 hours. Most patients prefer the simpler HgA1c.
Balanced Nutrition & Detox
Our nutritional state is heavily related to our diet, but to be healthy we must be balanced nutritionally. Today, plants do not have the same nutritional quality that they had 50 years ago due to poorer quality soil. If nutrients are not in the soil, they will not get into the plant. Today’s soil is deficient in a lot of minerals that make up healthy soil. This translates into less quality fruits and vegetables.
A great kick-start to changing your diet is to do a 1 week detox. This requires a change in eating lifestyle for 1 week. Anyone can do something for a week and the 1 week detox kit from Orthomolecular called CORE Restore has everything that you need.
Since the soil is not as rich as it once was, we have to supplement our diets. This means take your vitamins!
All supplements are not created equal. There are stores selling mega-vitamins seemingly on every street corner. Which do you choose? How do you know you are getting a quality vitamin rather than just very expensive urine?
I start by only using “pharmaceutical grade” supplements. What does that mean? Pharmaceutical grade means that the supplements have been tested by an independent lab for quality and purity. This will help assure the consumer that the supplement they are buying does not have any impurities and will deliver the supplement in the quantity that is on the label.
The next thing I look for is the quality of ingredients used by the manufacturer. Is the manufacturer using quality ingredients? Do the ingredients make sense scientifically; in other words, are the ingredients used based on evidence-based science? Are the dosages potent enough? Are they bioavailable (do they get absorbed by the body in a form that is actually usable)?
These questions may be difficult for the average patient to answer for themselves. That is why I have taken the time to look into different companies that manufacture supplements and will only recommend what I believe to be the highest quality available.
Once we figure out which companies make the highest quality supplements, it then important to take the supplements that will best help you. As a physician, I make recommendations to my patients based on several things including symptoms and lab results. One lab that is especially useful is the NutrEval test by Genova labs. This test gives me a very thorough and precise snapshot of a patient’s nutritional status. The report itself is 12 pages long! This test gives me information on a patient’s vitamins, amino acids, fatty acids, minerals, important metabolites, and even toxic metals. From this information I can design a very specific nutritional and supplementation program.
Recommended Daily Allowance (RDA)
The recommended daily allowance (RDA) is set by the government as the level to prevent disease, not for optimal health. The RDA’s are broad generalities that do not account for individual variations. The levels to achieve optimal health usually exceed the RDA’s and often by a large margin.
Medications, vitamin interactions, soil depletions, poor absorption, stress, increased need for antioxidants, age, lifestyle, and genetics all play a role in determining which supplements are right for you.
Medications deplete nutrients
1. Long-term use of antacids deplete minerals like calcium and phosphorus and lead to decreased folic acid absorption.
2. H2 blockers such as ranitidine lead to decreased vitamin D activity.
3. Birth-control pills deplete B vitamins, especially folate.
4. Aspirin can deplete vitamin C.
5. Acetaminophen depletes glutathione which is the body’s most powerful antioxidant.
6. Statin drugs for lowering cholesterol deplete CoQ10.
7. Anti-anxiety medications like Valium or Xanax deplete melatonin which lead to insomnia.
Emotional stress can rob us of a fulfilled life. We must understand how to let go of negative emotions that negatively impact our health and poison our relationships. So the question is, how do we manage stress? There are many ways people find to deal with stress and many of those ways are not healthy. Many patients turn to drugs, legal or illegal, to manage their stress. My approach to deal with stress is to address thoughts, to reframe how we look at situations that are causing us stress. When we reframe, the stress dissipates.
4 Keys to deal with Anxiety
There are several things I tell patients in regards to anxiety. Anxiety is caused by your interpretation to a set of circumstances. It is caused by how you see a situation, by your perspective.
1. Question your assumptions.
In all situations, we have a set of assumptions or beliefs. This belief can cause anxiety. Simply ask, “Is it really true ____________?” 90% of the time, the belief is not true. If you answer, “Yes, it’s true.” Then ask, “What proof do you have?” Do you have any objective evidence that your assumption is true? That usually takes care of 9/10ths of the remaining 10%.
2. Previous experience.
Many times, a current situations is “just like” another situation from the past. In that case, we often bring all the same anxieties from the previous experience because we believe that this one is just like that one. However, that is not true. Your past experience is just that, in the past. Just ask Rafiki!
If you are going through an experience that is ‘just like’ a past experience, simply ask yourself, “What did I learn in that past experience?” It’s time to break out what you learned last time and apply it now.
3. Manage your expectations/stop trying to control what you don’t control.
How many times do we just want everything to go our way? Or we want a situation to be ‘just so?’ We must realize that we do not have any control over anything EXCEPT our own minds and our response to what happens. We do not control other people, situations, or outcomes. If holiday did not go as you thought it ‘should’ you need to stop focusing on the outcome and focus on your response to how things went. When we spend our energy trying to control outcomes, to control what people do or say, to make sure everything turns out the way you think it should, you waste a lot of energy and actually increase your anxiety.
Why? Because your subconscious knows you are trying to control what you have no control over and this increases your stress. You may as well spend your time trying to control the sun! Focus instead on what you do control. Let go of what you do not control, and focus on controlling your response to what happens. Your anxiety levels will drop like a stone.
4. Positive Self-image
Finally, the last thing you bring into any situation is your own self-image. If you feel that only bad things happen to you, they will. If you feel that only good things happen to you, they will. You can change your self-talk. Why tell yourself that you are no worthy or that you suck? The world is already telling you things like, “You can’t”, “You’re not good enough,” etc. Why tell yourself the same? Change the dialogue. It is a self-fulfilling prophecy. You decide what your dialogue should be.
You are worthy. You can do it. You can change the dialogue. Start now. Don’t stop.
The self-image you bring into a situation will either give you confidence or make you anxious. Confidence cancels out anxiety. Where you are anxious, you lack confidence. You get confidence by doing. Start with small things to build your confidence, then move onto the bigger stuff. This will fill your reservoir of confidence that you can tap into when things get rough. And believe me, they will get rough. That’s life, so arm yourself with confidence not just for the good times, but to get you through the bad times.
How do you change your self-image? Simple. Tell yourself a different story than the one you have been telling yourself. Picture a different picture of yourself in your mind. Do this every day. Over and over. Change little things in your life. Those little successes will boost your confidence and make you feel better about yourself. Remember, it is a process and will take time. When someone tries to remind you that you are less than what you think you are, do not accept what they say. It is ok to say “No” even to loved ones who may try to keep you down.
This is how you reframe how you see a situation.
4 Golden Questions: Ask yourself these questions to help you get clear about a situation.
1. Do I want to continue the experience that I am having?
When dealing with anxiety, the answer is obviously “no”.
2. What do I want instead of what I’ve got?
You have to be specific. Saying to yourself that you “want to be happy” is not specific enough.
3. How will I know when I have what I want? What’s the evidence that I have what I want?
You have to be specific. Then you can measure progress, and set up parameters by which you measure success.
4. What is stopping me now from having what I want right now?
This question requires honesty.
To achieve a healthy weight and a balanced life requires a comprehensive approach. We have many things in balance all at the same time. Often there are only small changes needed to achieve balance in some areas, but in other areas there are major changes that need to be made. Regardless, getting our lives in balance is a process that takes time to achieve. Adjustments to our lifestyle begin with a decision to do so and then the required effort. Though it may sound very complicated, the simpler we keep things, the easier they are to achieve. What is important is that we make steady progress rather than trying to achieve balance all at once.
As a physician, I can help you achieve balance with an ultimate goal of optimal health, and a better you. On behalf of the OC Medical Tustin Staff, I hope to see you soon. Be sure to schedule an appointment today or give us a call at (714) 442-6642 so we can help you Get Well! Live Better!