Tag Archives: Weight loss

Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Musculoskeletal System

musculoskeletal-system
The second part of this series on how your body changes with age is about your muscles. This section combined with the previous skin section explains why you wrinkle. As before, I’m going to go through system – changes – challenges – solutions. If you’re keeping score, especially focus on the take home messages within solutions. I welcome any questions or comments.
Changes: Did you know that muscle cells are unable to replace themselves once they are formed? Therefore, muscle cell loss is permanent. Plus, muscular response gradually slows with age. That said, the loss of muscular capabilities over time is by far the result of cell loss due to inactivity. As muscle cells are lost, weakness and slowness increase. Plus, some of you don’t exercise at all, or as much/vigorously as you used to, so you’re not building up anything new.
Challenges: The effects of these changes on our health status are mostly due to the fact that the muscles are the main tools for effecting strong circulation throughout the body (i.e. muscular contraction pushes blood around). As the muscles become smaller, including the muscles in the face, and as fat tissue accumulates, including in the face, the entire appearance changes to that of an older person, with all the ramifications described in the post on the description of skin changes with aging. In addition, as muscle fibers decrease, weaken, and slow, it becomes increasingly difficult to keep up with younger people, who may make allowances, but who may also become avoidant. Your recognition of this creates a vicious cycle, and you eventually settle into ‘being old’.
Physical Therapist Working with Patient
Solutions: In two words – exercise & activity. A well designed, consistently followed exercise program addressing both strength and response is indispensable for the maintenance of muscle cells, and of good health over time. A personal trainer is a pretty good idea after a certain age. You neither need to under nor overdo your weight lifting regimen. In any event, move those muscles as much as you can, whether via walking, yoga, running or sex. Being a couch potato is never a good thing.
Post-scripts:

elderly-couple-stretching

  • Another thing that very few of us do is stretch. Those old muscles are tight, and the tendons/ligaments are short and ready to pop. You really must stretch before your weekend warrior events or most any big exertional activity. That’s a big part of why yoga promotes longevity.
  • Fortunately, the main muscles of the heart and the diaphragm (your breathing muscle) do not lose muscle fibers with age because they are continually active. Yet, your heart and lungs have their own problems besides the muscles. That topic is forthcoming. All that said, be mindful that through ongoing exercise and training, you can stem the tide on these changes.

Young is as young does.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, AmazonBarnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight No Chaser In The News: New Weight Loss Pill On The Market, aka The Problem With How We Approach Our Health

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The headlines say that the U.S. Food and Drug Administration (FDA) has approved a new weight-loss pill. The marketing will attempt to convince you that your health can be secured by what’s in a pill bottle. The Straight, No Chaser view is this roll out illustrates a few of the problems with our approach to health.

weight loss Miracle-Cure-Pill

Problem #1: We react after the fact and look for miracle cures.
There are now three weight-loss pills approved by the FDA. They all are appetite suppressants. Aside from the fact that safe and healthy ways to control one’s appetite exist, I’ve told you on many occasions that you won’t find your health in a pill bottle. The medicines you take are largely meant to treat disease. Even your vitamin pills can be replaced by vitamins in the healthy foods you eat, and you don’t need those pills unless you have a documented vitamin deficiency or have been directed to take them by your physician.

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Problem #2: We don’t try hard enough to simply reverse what caused the problems we’re having.
Diet and exercise, exercise and diet. If you are not beginning and ending the conversation with these considerations – and only incorporating any supplements or medications as bridges to facilitate the transition to a healthier lifestyle – you are going to be disappointed. Look at this quote from the manufacturer’s press release: “When used as directed in combination with a healthy lifestyle that includes a reduced-calorie diet and exercise, (New Drug that I’m not promoting) provides another treatment option.” The quote could have just read the following: “…a commitment to a healthy lifestyle that includes a reduced-calorie diet and exercise will always give you the best chance to produce the results you desire (and certainly more than any reliance on medication)…”

weight loss 1 day diet SERIOUSLY?

Problem #3: The purported solutions don’t fully address the problem they claim to address.
You don’t even have to read the fine print. None of the weight-loss drugs approved by the FDA even promise massive weight loss. In other words, you’re just taking the pills and hoping for the best.

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Problem #4: The purported solutions sometimes cause different problems than they address.
According to the FDA, the warning label for the newly approved drug will come with a warning that it might increase suicidal thoughts. Other possible side effects include increasing heart rate and blood pressure. Guess what? Obesity already increases heart rate and blood pressure; you don’t need a pill for that. Even worse, in the past some obesity drugs (remember fen-phen?) have been linked to serious heart problems and were pulled from the market.
By no means am I attempting to be flippant here. My concern is real. Consumers are prone to grab at whatever hope is offered, and a slickly marketed weight-loss pill is a great way to attract consumers, even at $200/month and when many insurers won’t cover the cost. Some of you will even swear by your pills. You can do much better for yourself by making a commitment to a lifestyle change that involves healthy eating, moderate exercise, stress reduction and all around better choice.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offer. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Straight, No Chaser: Toxin and Detoxification Series Summary

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I want to thank you for all the positive responses to the series of posts on toxins and detoxification. You have shared many personal stories and asked many great questions. I guess I’ll continue to accept your being shy (especially on these topics) about asking personal questions publicly, but keep contacting me here. To that end, I’ll summarize by sharing some of your thoughts and making a few final comments.
You can’t escape toxins, but you can pretty easily reduce your exposure to them. For the things you can control, “everything in moderation” is a pretty good rule of thumb for most, except for cigarette smoke into your lungs. That just needs to stop.
Your body does a great job of detoxification through the lungs, kidneys, liver, intestines and skin. This process is retarded by age and the effects of toxins on these systems.
There are a lot of fad diets and questionable methods of detoxifying. Most have risks that should make you cautious. None are more effective than tuning your body to do its best work. Furthermore, these methods are invariably more effective in the short-term than the long-term.
Now, to some of your questions.
1. So are you saying bowel movements are good enough to detox the intestines?
Until and unless your bad habits catch up with you, yes. Consider the ways the large intestines (the colon) handle toxins.

  • If healthy, the colon sheds old cells about every three days, preventing a buildup of harmful material. It regenerates new healthy cells in their place. It’s lining includes mucus membranes that can keep toxic substances from reentering the blood and tissues.
  • You have “natural” bacteria that reside in the colon. They actually detoxify food wastes for you. (One of the potential issues of colon cleansing is the removal of these bacteria.)
  • The liver’s main function is to neutralize toxins.
  • Your bowel movements remove waste and toxins from you. Although the number of bowel movements vary between individuals, your body (if healthy) is able to regulate when you defecate based on your needs.
  • Increasing the number of bowel movements doesn’t improve weight loss. That’s because the body absorbs most calories before they reach the large intestine.

Nothing in a colonic or juice fast will match this level of effectiveness. Spend your efforts keeping your body healthy. Increase your fiber, water, fruit and vegetable intake. Lower or eliminate the intake of red meat, cigarettes and alcohol. There’s your detox program all day long.
2. So what’s the verdict on the detox diets and colon cleansing?
Consult with your physician. I’d imagine that using the diets as a starting point for lifestyle changes would be endorsed. I’d doubt that any fad diet would be endorsed.
3. You said tap water is no longer good? Should I exclusively drink bottled water?
Actually filtered water is even better.
4. Are you suggesting I stop wearing makeup?
You’re beautiful just the way you are.
5. Have you ever had a colonic?
Yes, and it made me feel dirty. (Was that serious, or a joke?)
6. I’d never do that.
Actually, you will. (Well, almost.) Many men over 50 will have a colonoscopy to evaluate for the possibility of colon cancer at some point. If and when you get that, you’ll get your colon cleanse solution one to two days before the procedure and maybe an enema in addition. At least you’ll be under the care of a physician, and you’ll get a sedative first!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what  http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Straight, No Chaser: A Look at Detox Diets

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Everyone who talks to me about detox is motivated and sincere about making an improvement in his or her health.  Therefore, it’s important that they be shown respect and encouraged.  However, some of these same individuals exhibit a level of desperation that is counterproductive and leaves them subject to fads and scams that are doomed to long-term failure. The first question I ask is “Are you trying to improve your health or weight?” These are often separate considerations. Of course, I’m hoping they answer, “Both.”  Interestingly, that happens less often than you might think. Next, I’ll ask if they’re engaged in some basic, fundamental activity (click here), which is rarely the case. Once people discover the latest, greatest thing, they tend to lock in on it and just have to go for it.  So be it.

So… today and tomorrow, I’m going to discuss two very common “quick-fix” approaches to detoxification. Let’s start with the “detox diet.”  For the purposes of this discussion, all detox diets are variations of the same theme. I hope this doesn’t disappoint you or come off as dismissive, but the point of the matter is that from a medical standpoint, these actions are reducible to a set of physiologic actions that either produce biological effects or don’t.  Giving a car a new coat of paint doesn’t make it an airplane.  Similarly, taking a quick detox diet doesn’t make you healthy if you return to the same conditions that produced your pathology in the first place.  Folks, it really should occur to you that given the rates of obesity and disease that exist, if these diets really worked, the pharmaceutical and medical communities would be all over them because of their potential for profit (and of course the potential for good…).  Here’s what detox diets do and don’t accomplish.

The Premise: Going on a diet for a few weeks can clear your body of toxins, which will improve your health.
The Short Term Effects: Proponents of detox diets often claim or note the following during the diet:

  • Weight loss
  • More energy
  • Better mental focus

The Long Term Effects: Proponents of detox diets often make the following claims about the benefits of the diets:

  • Health promotion
  • Prevention of new diseases
  • Cure of chronic diseases

What’s Really Happening: Have you ever heard that correlation is not causation?  If you engage in any activity involving backing away from fats, drinking more water, taking in less sugar and processed food, eliminating alcohol and caffeine, and taking in more fruits and vegetables, you’ll feel better!  In fact, I’m all for it.  Refer to this blog post where I give you details on how to naturally, healthily and sustainably do this.
Now, here’s the question. Is your detox diet just a two to four-week “challenge,” or is it the launching pad for a set of lifestyle changes? The problem is that people use these diets with their better principles, but they usually don’t sustain them.  In fact, the diets themselves generally are not sustainable because they’re too restrictive. If you tried sustaining some of these diets, you’d end up hospitalized.  You’re much better off applying fundamental principles that will slowly and steadily improve your health and also help you lose weight. By the way, those long-term claims have been roundly and routinely debunked by the medical community, which has every incentive to want to discover new ways to treat disease.
Precautions and Risks

  • Before starting any diet, you need to discuss what you’re trying to accomplish with your physician. I’d venture a bet that most would not approve one of these diets, especially if you suffer from any chronic illness, especially diabetes, mental illness, moderate to severe (and poorly controlled) high blood pressure or cardiac disease. They also won’t approve it if you’re pregnant or at the extremes of age.
  • Based on the components of these diets, you are introducing certain specific risks.  These include vomiting, diarrhea and dehydration, electrolyte loss and imbalance and disruption of the function of your digestive system.

Let’s finish with two pointed questions and answers.
1.  Should I go on a detox diet?  I encourage almost any activity that motivates you to improve your health and has been shown to improve your health. If you want to naturally detox, apply these principals as the basis for a lifestyle change. As your body recovers, your natural detoxification system will take over and do just fine (assuming you are otherwise healthy).
2. I quick-flush my system with a diet every few months. Is this healthy?  It depends on what you’re doing as a “quick-flush” and even more so, what you’re doing in-between. Focus on enhancing your natural detoxification system. I can’t say that a one-time or intermittent initiative to kick things off would be a terrible thing — if you stay with the program. In the best case scenario, it’s like going to get a dental cleaning every six months. You’ll still have decaying teeth and disease if that’s the only thing you’re doing. On the other hand, if you’re brushing and flossing every day, then the six-month check up is quick (and in this case, maybe superfluous).  I’m much more concerned with you sustaining a healthy approach toward the desired goal.
Next up, and the last in this series on detoxification will be a look at colonics.  Until then, bottoms up!
Call us at 1-844-SMA-TALK or login at www.SterlingMedicalAdvice.com to chat more.
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Straight, No Chaser: Quick Tips to Detoxify Yourself Naturally

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Here are 3-4 Quick Tips for each of the organs involved in naturally detoxifying you; I’ve limited what I’m giving you to do in the effort to make this manageable for you. I don’t think you’ll find anything here beyond your ability to implement into your routine. If you incorporate the items listed below, you’ll be well on your way to a healthier life.
Quick tips to naturally detox your skin:

  1. Diet: think fruits and vegetables, and cut back on refined sugar.
  2. Sweat: You know I prefer you exercise, but if you’re healthy enough, the sauna works too. Or you can just move to Texas in the summer.
  3. Exfoliation is a beautiful thing. There are dozens of ways to do it. Find one that works for you.
  4. Hydrate and moisturize. You spend too much time in the sun and lose too much water from your skin not to replenish (You get a bonus tip because your skin is such an important detox organ.).

Quick tips to naturally detox your lungs:

  1. Avoid inhaling cigarette and cigar smoke. Duh.
  2. Exercise makes your respiratory machinery more effective and efficient. Go for it.
  3. Learn to deep breathe. Take it in from your belly. Learn to breathe slowly and deeply. Yoga is a great complement to this.

Quick tips to naturally detox your kidneys:

  1. It’s all about fluids. Remember that your body is over 60% water, and you have to stay hydrated and keep flushing. I’ve discussed this previously but remember to get in at least 64 ounces of fluids a day.
  2. Learn about cranberries. Many of those urinary tract infections are successfully addressed by drinking cranberry juice.
  3. Remember that diabetes and high blood pressure are the most common causes of kidney disease. You want to detox your kidneys? Control your blood pressure and avoid/control diabetes.

Quick Tips to naturally detox your liver and intestines:

  1. Increase your water intake. Water makes your entire body function better but also softens your stools, facilitating transport.
  2. Increase your fiber intake. Fiber bulks your stools and makes it easier to expel.
  3. Decrease your alcohol intake. As everyone knows, alcohol will sufficiently damage your kidneys to the point where your body will be unable to eliminate many toxins. Liver disease is a very unpleasant experience and way to die.

It bears repeating: if all of this sound fundamental, it’s because it is. You have the ability to help yourself if you consistently apply basic health and wellness principles. You can do this.
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From the Health Library of SterlingMedicalAdvice.com: "Will eating once a day help me lose weight faster?"

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Is starving yourself the goal? One meal a day is not enough to keep you healthy. Doing this will prompt the body to go into starvation mode and to hold on to body fat. Your metabolism will slow and your lean muscle will be consumed. Honestly, the best way to lose weight is to eat portions that are the size of the palm of your hand, which is the size of your stomach. This is the portion size you should be eating. Also, eat a lot of fruits, as it has fibers that break down fatty acids. Drink six to eight (6–8) glasses of water but not much more then eight (8), as you can actually poison yourself from water. In addition, remember to eat proteins, as it also helps break down fat.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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From the Health Library of SterlingMedicalAdvice.com: “Is there really a way to eat what you want and still lose weight?”

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In all honesty, if you are staying within the daily calorie intake range, then yes, it’s possible. That said, foods that are bad for weight loss cause your blood sugar levels to rise and drop quickly, making you hungry. Of course, if you are craving more food, you are going to take in excessive calories and gain weight. That’s why eating nutritious foods will help you lose the weight and keep it off.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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From the Health Library of SterlingMedicalAdvice.com: "Why Is It So Hard to Lose This 'Last' 5-10 Pounds?"

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It may be that your body has reached its ‘desired’ weight – its effective, genetic set point.  Reaching this level is relatively less painful than getting past it, but your body’s idea of an ‘effective’ weight won’t necessarily correspond to your personally desired level of leanness. Women in particular tend to achieve healthy homeostasis at higher body fat levels. Breaking through plateaus can be hard enough, but plateaus ordained by the body can seem to be impossible. It’s probably going to take some serious tinkering with carbs, calories, activity levels, sleep and stress. If everything else is on point and accounted for, you may be looking at healthy homeostasis (a biological balance). Then the question becomes “Do you want to mess with a good thing”. If so, stay the course; just don’t expect results as rapidly.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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Straight, No Chaser: Life Begins (To End) at 40 (Unless It Doesn’t) – The Musculoskeletal System

Physical Therapist Working with Patient
The second part of this series is about your muscles. This section combined with the previous skin section explains why you wrinkle. As before, I’m going to go through system – changes – challenges – solutions. If you’re keeping score, especially focus on the take home messages within solutions. I welcome any questions or comments.
Changes: Did you know that muscle cells are unable to replace themselves once they are formed? Therefore, muscle cell loss is permanent. Plus, muscular response gradually slows with age. That said, the loss of muscular capabilities over time is by far the result of cell loss due to inactivity. As muscle cells are lost, weakness and slowness increase. Plus, some of you don’t exercise at all, or as much/vigorously as you used to, so you’re not building up anything new.
Challenges: The effects of these changes on our health status are mostly due to the fact that the muscles are the main tools for effecting strong circulation throughout the body (i.e. muscular contraction pushes blood around). As the muscles become smaller, including the muscles in the face, and as fat tissue accumulates, including in the face, the entire appearance changes to that of an older person, with all the ramifications described in the post on the description of skin changes with aging. In addition, as muscle fibers decrease, weaken, and slow, it becomes increasingly difficult to keep up with younger people, who may make allowances, but who may also become avoidant. Your recognition of this creates a vicious cycle, and you eventually settle into ‘being old’.
Solutions: In two words – exercise & activity. A well designed, consistently followed exercise program addressing both strength and response is indispensable for the maintenance of muscle cells, and of good health over time. A personal trainer is a pretty good idea after a certain age. You neither need to under nor overdo your weight lifting regimen. In any event, move those muscles as much as you can, whether via walking, yoga, running or sex. Being a couch potato is never a good thing.
Post-scripts:

  • Another thing that very few of us do is stretch. Those old muscles are tight, and the tendons/ligaments are short and ready to pop. You really must stretch before your weekend warrior events or most any big exertional activity. That’s a big part of why yoga promotes longevity.
  • Fortunately, the main muscles of the heart and the diaphragm (your breathing muscle) do not lose muscle fibers with age because they are continually active. Yet, your heart and lungs have their own problems besides the muscles. That topic is forthcoming. All that said, be mindful that through ongoing exercise and training, you can stem the tide on these changes.

Young is as young does.

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Straight, No Chaser: Quick Tips on Boosting Your Metabolism

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It would be improper for me to have dragged you through the mud for three days and depressed you into thinking you can’t improve your situation. Hopefully, you’re not feeling that way. You should now have a better understanding of how the body works, how to count calories and how to compare yourself to a baseline for health. What left is giving your body a leg up on your efforts. Yep, I’m talking about boosting your metabolism. Any of you that have been with me for a while know that means I’m not promoting something you’ll find in a bottle, although there are many good supplements that can assist in that effort. I’ll refer you to your (or my) favorite personal trainer for those considerations. As always, I want to offer you the tools to be self-empowered. To that end, here’s five Quick Tips to boost your metabolism. Why five? Because five is easier to implement than six. Once you get these five down, let me know, and we can get a bit more intricate.
1. Eat smaller meals, and eat more frequently. It’s true. More meals more often is better, but only if they’re smaller. Calorie counting is still a major part of the equation. The point of more frequent meals is preventing the body from going into starvation mode, which slows your metabolism as the body attempts to conserve energy. If you do this, you’ll discover those meals are smaller and you will get closer to eat more appropriate portions than we typically do. Also, make those in-between meals healthy choices like a handful of fruits or nuts.
2. Prime your pump. Remember, it’s all about your heart’s ability to efficiently move blood around the body anyway. The healthier your heart is, the better your metabolism will be. You need aerobic exercise that increases your heart rate for 20-30 minutes at a time. Learn your target heart rate for your age, and exercise to get into that range. Your metabolism will better approximate that of a fine tuned machine rather than a sputtering old car.
3. Weight train. This is very simple. The more muscular you are, the more calories you will burn, especially relative to someone of the same weight who is obese. Not only will you become a finer calorie-burning machine, in this case you actually will look better! Add weight training to your exercise regimen.
4. Choose the fish (and not the fried variety). Fish oil contains substances called omega-3 fatty acids (EPA, DHA) which increases levels of fat-burning enzymes and decreases levels of fat storing enzymes. Daily ingestion has been shown to help by approximately 400 calories a day.
5. Enlist a personal trainer. Everyone needs help and motivation. Some of us need a lot of help and a lot of motivation. We also need expertise. There’s nothing more frustrating than working hard yet not seeing any results because you’re working incorrectly. A good trainer can put you on the path, supervise your regimen, and hold your hand through the process. The minutia of age, sex and body habitus considerations that also play a role in this can be managed by a good trainer. Your ideal trainer will have knowledge of nutrition, wellness and supplements that are tailored to your specific considerations. This will get your metabolism revved up!
By the way, if you’re into green tea, caffeine or spicy/hot peppers, enjoy them for their other benefits, but don’t expect them to contribute significantly to your efforts to improve your metabolism. At least that’s what the consensus in the medical literature points out.
Finally: yes, it’s true that metabolism naturally slows with age (starting as early as age 25); everyone has heard that fact. However, here’s what you don’t usually hear: that’s not inevitable and is more a result of your becoming less physically active than just aging. That demonstrates the need for you to be even more diligent in your efforts. Good luck, and I welcome your questions and comments.
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Straight, No Chaser: Healthy, Sustainable Weight Loss – Let's Get Started

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How to Lose Weight, and What is Healthy Weight Loss (AKA, How Much, How Soon and How)?
Let’s start with the How. Commercial voice: “You should contact your physician before starting any weight loss routine”. We ended things on the last post talking about the caloric balance equation, which (simplified) means you need to get off your derriere, and close your mouth. Without getting too technical, to lose weight, 1 pound equals 3,500 calories, so your net caloric intake must be cut by at least 500 calories per day to lose a pound a week. Here are some Quick Tips to cut calories (and I will not be discussing any of the popular diets or medical remedies (with one exception in the next post); you can see your physician or nutritionist about those. Besides, guess what? Most of you don’t need a fad diet. Keep it simple. And…more importantly, you should be more concerned with healthy regimens that help you keep the weight off, not drastic efforts that have proven to have quick short-term but unsustainable long-term outcomes).
1) Work out: If you can sprint, do so. If you can’t, jog. If you can’t jog, walk. I like working out while watching sports, because my heart’s pumping anyway. Weight training at the same time is even better. Once you hit a good exercise regimen, your metabolism will improve, making weight loss that much easier.  By the way, the next post is on metabolism; stay tuned.
2) Hungry?  Start counting calories.  Use this standard to determine what your daily calorie intake should be.  Meal plan so you don’t exceed that level.  Remember the caloric equation to lose weight: Amount expended minus the amount eaten should be 500 calories a day.  In the next post, I’ll give you a Quick Tip for an extra 400 calories a day you can lose.
3) Still hungry? Try brushing your teeth. Don’t laugh. It actually works. And it gives you nice teeth. Otherwise try drinking water or chewing calorie-free gum. All these are nice, simple inexpensive appetite suppressants.
How Soon? It’s natural for anyone trying to lose weight to want to lose it very quickly. But evidence shows that people who lose weight gradually and steadily (about 1-2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just about a “diet” or “program”. It’s about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits. Think health instead of weight, and the weight will improve.
How Much? If you were my patient (but you’re not!), I’d tell you to forget about ideal body weight and BMI – for now. Focus on a modest weight loss, like 5-10% of your current weight. Even this success will improve your blood pressure, cholesterol and blood sugar levels. Once you accomplish that goal, do it again. So even if the overall goal seems large, see it as a journey rather than just a final destination. Seek to learn new eating and physical activity habits that will help you live a healthier lifestyle. These habits may help you maintain your weight loss over time. To that end, I love healthy challenges. Try a 30-day water instead of pop (soda)/coffee, etc. challenge, or even better, give yourself a 30-day ‘fruit for dessert challenge’ or ‘salad of your choice for lunch’ challenge. When that’s done, immediately do it again.  Learn to integrate healthy habits into your quest to lose weight, and you’ll increase the odds of having sustainable weight lost. At the end of the day, it’s been well established that those who maintained a significant weight loss report improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence. Good luck, and check back for the next post on how to fine-tune your metabolism!
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Straight, No Chaser: The Adverse Health Effects of Obesity and Why You Gain Weight

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Earlier, we identified the differences between a ‘normal’ weight and being overweight and/or obese. Today’s goal is to help you understand specific risks of carrying extra weight.  We’ll also set the table for losing weight by discussing why weight gain occurs.  It bears repeating that none of this has anything to do with the perception of one’s physical attractiveness.
Let’s focus on three considerations.
1. What are the health risks?
As body weight increases, so does the risk for several different medical conditions and illnesses, including the following:
• Arthritis
• Cancers (breast, endometrial, and colon)
• Diabetes
• Gynecological problems (abnormal periods, infertility)
• Heart disease (heart attacks, heart failure, hardening of the arteries)
• High cholesterol
• Liver and gallbladder disease (gallstones)
• Sleep apnea and other respiratory problems
• Stroke
In the event that these risks are just words on a page, learning a little bit about some of them might provide the motivation needed to avoid them.
2. What is a realistic goal for weight loss?  What’s the balance between family predisposition and the foods I eat?
No matter what I tell you today, it’s unlikely to turn you into a supermodel. The goal (independent of your consultation with your own health care provider) is to get you to optimize your situation based on the things you can control. Yes, genetic factors do play a role in obesity, but beyond that you are more than able to close your mouth and get off your…couch. You are able to limit your fat and caloric intake and put down the salt shaker. Yes, genetics count, but behavior and environmental (culture, socioeconomic status) consideration play at least as much of a role. These latter considerations can even jumpstart your metabolism beyond your genetic predisposition.
3. Why do I gain weight if I’m still active?
The most simple way to answer this is that weight gain occurs from an energy imbalance.  You’re taking in too many calories, and/or you’re not engaging in enough physical activity. It’s an equation, and the weight gain occurs when you’re on the wrong side of the equation. It’s not much more complicated than this. Either do less of the eating, more of the activity, or both.  I mentioned in a previous post on caloric counts that you must have an excess of 500 more calories expended than you ingest daily every day for a week just to lose one pound.  It takes work.  This is the simple answer as to why fad diets don’t work long-term.  You can’t cheat the equation.  The moment you stop being diligent, you’re headed in the wrong direction.  Your weight loss plan must include lifestyle changes for the long-term.
In the next post, we’ll identify some very simple methods to combat obesity based on the information provided to this point. Feel free to ask any questions or submit any comments you have.
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Straight, No Chaser: How Many Calories Do You Need a Day?

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Let’s put this post (at least the end of it) under the category of things you do but really don’t think about.
How many calories should you take in per day to function (meaning produce the energy you need for your activities of daily living)?  It actually depends on your gender, your age and your level of activity.  Let me start by defining the types of lifestyles, according to the Institute of Medicine.  If you are in the third category (active), I doubt that you’re worried.
Sedentary means a lifestyle that includes only the light physical activity associated with day-to-day living.
Moderately active means a level of physical activity equivalent to walking about 1.5-3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
Active means a level of physical equivalent to walking more than 3 miles per day at 3-4 miles per hour in addition to the activities of daily living.
That breaks down as follows:

  • For women between 14-50, the number is right about 2000 kcal/day (calories) if you’re moderately active and 1800 if you’re sedentary.
  • For men between 14-50, there’s some greater variance, but the 2500 kcal/day works if you’re moderately active and 2200 if you’re sedentary.

In short, that averages to about 600-800 calories per meal, with the low end being for sedentary females and the high end being for moderately active males.
Now consider, 16% of the calories in the average American diet come from refined sugars.  Fully 50% of that total comes from beverages with added sugar.

Every 12 ounces of non-diet of pop/soda you drink contains about 150 calories.  

Your average dessert ranges from 300-500 calories.  

The most popular one, only one cup of ice cream, contains 270 calories.

I’ll let you take the math forward from there.  However, the take home point is obvious.  Suffice it to say, the link between pop, deserts and obesity has been well established.  Here’s three Quick Tips for you.

  • Try finding a drink with fewer calories if you want to lose calories (and weight).  It’s water, not Coke, that adds life.
  • Try eating your favorite fruits as dessert.
  • Also, consider just walking 3-4 miles a day.  It’s not that hard, if you just do it.

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Straight, No Chaser: Back Pain to The Future

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Over 40 million Americans suffer from various forms of chronic low back pain. We must work really hard.
Lower back pain is a tricky subject for an emergency physician. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

  • Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
  • Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:

  • Direct blow to your back
  • Fever and new onset back pain
  • Loss of control of your bowel movements or bladder function
  • New onset back pain after age 65
  • Numbness and tingling in both of your legs
  • Nighttime back pain
  • Sudden sexual dysfunction
  • Weakness and/or loss of motion or sensation in your legs
  • Weight loss and new onset back pain
  • Work related back injuries

What can you do to prevent or reduce the pain at home?

  • Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

CaptainMorgan

  • Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
  • Wear low-heeled shoes whenever you can, ladies!
  • Learn how to stretch your back.

LBP exercises

  • Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
  • Sleep on your side. Try a pillow between your knees.
  • Walk. Did you know walking is the best (and easiest) exercise for your back?

I’ll be back later (no pun intended) with your questions and more.

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