With more and more people trying to improve their health these days, it can become confusing as to which diet or exercise regimen to follow. Many of us also miss the big picture when it comes to health maintenance. Health is about balance, and it involves addressing more than just the body. Read more about this in an article I contributed to with The Active Times at 7 Surprising Habits Your Health Routine Might be Missing.
Dear Dr. Aunna,
I have been dealing with low levels of energy for the past few years and it only seems to be getting worse. I have seen a few doctors for this but my blood work is normal except for a borderline high cholesterol. Everyone keeps attributing my symptoms to depression, but except for a little stress here and there I feel pretty happy. Coffee doesn’t work anymore and I can barely stay awake during the day. I am at my wits end and need your advice because I am falling behind in everything!
*AH, a coaching client of mine, like many others, struggles with low energy and fatigue. AH’s doctors did a thorough workup, checking every possible cause of fatigue from anemia to thyroid disease and even sleep apnea and narcolepsy. Most people fail to realize that their lifestyle habits greatly contribute to their fatigue, rather than a serious disease or “hormones.” Here is a snapshot of part of AH’s holistic health assessment:
Breakfast: Muffin or bagel, coffee with sugar and creamer
Alcohol: 3 glasses of wine at night
Exercise: Don’t have the time or energy
Sleep (duration and quality): 5-6 hours per night. Not good, toss and turn
AH may be considered healthy based on her labs and lack of any specific organic disease, but as you can see above, there are many other factors at play. In fact, there were many other emotional and social issues affecting AH not mentioned above. AH was convinced that she had a diagnosis that no one had discovered yet, but given the fact that she was willing to try anything, she implemented the simple solutions I suggested. She not only regained energy but her cholesterol level dropped and she lost weight. Here are some take away points from her case.
Problem: Lack of awareness. AH didn’t even realize how unhealthy her lifestyle was until she wrote things down. Many people are on the go and accustomed to certain habits, that they don’t even question them or realize how harmful these habits can be.
Problem: Excuses. Enough said.
Problem: Unhealthy diet. AH’s diet is filled with refined carbs, low fiber, sugar, and barely any fresh fruits or vegetables. Restaurant and frozen meals are often filled with unhealthy ingredients. Whenever we eat high glycemic index foods, our blood sugar spikes and so does insulin, leading to a crash and feeling drained. An unhealthy diet can also lead to obesity, diabetes and heart disease which will definitely cause fatigue.
Problem: Skipping meals. A drop in blood sugar can lead to feeling weak.
Problem: Dehydration. Dehydration not only leads to fatigue, but can also lead to feelings of hunger.
Problem: Caffeine overload. While caffeine can give you some energy, it can also cause insomnia and throw off your sleep. Caffeine also activates the sympathetic nervous system, so with your body on continuous adrenaline drive you are bound to get worn down. It can also cause or worsen anxiety adding to even more stress. AH was also likely so fatigued throughout the day and developed a tolerance for caffeine, which is why coffee no longer helped.
Problem: Alcohol. Alcohol may help you fall asleep but the quality of your sleep will be affected. The restful cycles during sleep shorten with alcohol use.
Problem: Lack of Sleep. Stress, caffeine and alcohol all disrupt sleep. TV, especially at night can be activating and interfere with sleep. What’s worse is that the less we sleep, the more we accumulate a sleep debt. Lack of sleep not only causes fatigue but also increases our risk for infection and can lead to depression.
Problem: Lack of physical activity. Exercise helps maintain a healthy weight, boosts energy and helps release stress.
Problem: Lack of coping mechanisms. If we don’t release stress we wear ourselves down and can lose sleep. Using alcohol and drugs to cope with stress has detrimental effects on our body.
If you struggle with fatigue, it’s important to consult with a healthcare professional as serious causes for fatigue always need to be ruled out first. Practicing healthy lifestyle habits will improve your quality of life regardless.
*Information from AH’s assessment was posted with permission. Names are changed to protect privacy.
As a family physician, I see patients of all ages and different medical backgrounds. Unfortunately, with obesity and chronic diseases like high blood pressure and diabetes on the rise, I do not see as many healthy patients seeking preventive care.
With people living longer these days, I also care for many patients who I like to call “less young.” Certain medical problems can also arise with age. Nevertheless, I have met many patients over the age of 80 who are healthy and hardly look their age. When I encounter these individuals, I always ask what their secret is, and each person has told me essentially the same thing:
“I never smoke or drank.”
“I grew up eating healthy food.”
“I always stayed active. I still exercise everyday.”
“I always try to make the best of everything.”
A patient with dementia once even told me “The Golden Rule.”
Most responses I have gotten revolve around the same theme: a wholesome diet, exercise, healthy lifestyle and a positive attitude. Not once has anyone said, “Well Doc, I just took all my pills like you told me to.”
The Real Secret to Health
When you dig deeper into these responses, you will find that there is a much more powerful force at play.
KARMA: Do good things for your body and mind, and in return you keep your body and mind healthy.
It seems so glaringly obvious, yet there are many people out there who don’t realize that their health issues are primarily caused by the choices they (knowingly or unknowingly) make. They then take pills for these self-created issues, and often in addition to not feeling better, end up experiencing more problems related to side effects from these pills.
Health is a Choice
The leading cause of death in the USA is heart disease, which continues to rise, due to an an increase in poor lifestyle choices. These lifestyle habits include smoking and alcohol use, as well as an unhealthy diet and lack of exercise, both which lead to obesity, diabetes and high cholesterol. What’s interesting is that heart disease can be reversed by adopting healthier lifestyle habits, as demonstrated by this study. In fact, according to the CDC, the most common diseases are not only the most costly, but can be prevented just by eating a healthier diet, being more physically active, moderate alcohol use and not using tobacco.
What about a positive attitude? I truly believe that happiness creates health, and that emotional health is just as important as physical health. Positivity is highly underestimated in its role in health. This great article explains the power of the mind in healing.
Regardless of what health issue(s) you are dealing with, it’s important to be aware of how you may be contributing and why? Until the root cause of illness is identified, no amount of pills or doctors is going to make you healthy.
Old Wive’s Tales
I have taken the advice of my healthy and happy older patients, and guess what? I am healthy and happy, and you can be too. It’s simple, doesn’t come in a pill bottle, and it ultimately starts with you. Remember, do to yourself as you would want done to you.
Share your secrets for health or what you have done to become healthy again in the comments below.
No, I’m not talking about the pop culture oxymoron that describes thin yet flabby physiques. I’m talking about something more serious. Which brings me to my next point: SKINNY DOES NOT MEAN HEALTHY!
I REPEAT, SKINNY DOES NOT MEAN HEALTHY!
While some people may look deceivingly well in clothes, there may be something even more dangerous going on underneath the skin.
Why You Can be Skinny but also Fat
There is actually a scientific word for skinny-fat people: Metabolically Obese- Normal Weight (MONW). A thin person with a normal weight may actually be obese based on the amount of fat contained in his or her body. In fact, studies have found many people with normal weight to have a high percentage of body fat. So the number of obese people in the USA may actually be a lot higher than what is known now just based off the BMI values in our population.
In 2013, of US adults over 20 years of age, 35.1% were found to be obese and 69% were found to be overweight (including the number of obese people). Think about that, more than half of US adults are overweight, and what’s even more sad is that this number continues to grow. Along with obesity comes the growing number of obesity-related diseases like high blood pressure, high cholesterol, diabetes, stroke, heart attacks and even certain cancers, eventually leading to early death.
Overweight vs Obese
Being obese means having excessive body fat, whereas being overweight means weighing too much. The statistics mentioned above are based off of the body mass index or BMI of an individual. A BMI is a measurement of relative weight based on someone’s mass and height (weight in kilograms divided by height in meters squared).
BMI greater than 25= overweight
BMI greater than 30= obese
The higher the BMI is, the higher your potential risk for developing debilitating diseases and even death. The problem, however, is that the BMI does not actually measure body fat. Muscles and body water are just a few other things that influence a person’s weight. A healthy and fit male who weighs 200 lb at 6 feet tall would be considered overweight based on his BMI of 27.
Why Being Skinny-Fat is So Dangerous
MONW individuals, as compared to people with normal weight and healthy fat levels, have been shown to have an increased risk for pre-diabetes, high blood pressure, high cholesterol and risk of dying due to cardiovascular disease. It is thought that these individuals also contribute to the high prevalence of these diseases in our country.
So we have determined that it is not so much about how much you weigh, as it is about how much fat you have. So where is all the fat hiding? It turns out what’s more important is where the fat is located in your body. There are many different types of fat in the body. While subcutaneous fat (the fat you can pinch) may not be aesthetically pleasing, it’s the visceral fat, or the fat that surrounds the organs that is detrimental to our health. It’s this visceral fat that is associated more with the diseases I mentioned above. It’s true that people who are overweight are more likely to have a higher visceral fat content, as well as a larger abdominal circumference, which is also associated with obesity-related diseases. MONW individuals with smaller waists however also have a high content of this visceral fat as well.
It’s very important to note that this does not mean that it’s ok to be overweight either. People with excess body weight can also run into issues with severe arthritis, physical deconditioning, difficulty walking, difficulty breathing, sleep apnea, chronic pain and overall poor quality of life.
Are you a Skinny-Fat or MONW Person?
The best way to determine fat distribution is with radiologic imaging such as a CT scan, DEXA scan or MRI. These tests, however, are expensive and not covered by insurance for this diagnosis. An easy estimate of total body fat can be made by skin fold analysis which can be done by a personal trainer or healthcare professional.
How NOT to be Skinny Fat… or Fat at all
So far it’s pretty obvious that it is not all about being thin, rather about being fit and healthy. Regardless of how much you weigh, if you feel you have excess body fat and are not fit, there is an answer. Research has shown time and time again that an unhealthy diet and lack of exercise are the main causes for obesity, and that a healthy diet with routine exercise not only decreases the amount of body fat (both under the skin and around the organs) but that it can reverse diabetes, heart disease, high cholesterol and decrease your risk for stroke and heart attacks.
So the next time you get on the scale or look at yourself in the mirror, focus on whether or not you are healthy, rather than skinny. Your life literally depends on it.
Let me know what you think in the comments below. Also a few questions to ponder:
Could you be a skinny-fat or MONW person?
Could you benefit from eating a healthier diet or exercising more?
1. CDC. 2014, May 14. Obesity and Overweight FastStats. Retrieved from http://www.cdc.gov/nchs/fastats/overwt.
2. Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol 2010; 115: 982–88.
3. Romero-Corral A, Somers VK, Sierra-Johnson J, Korenfeld, Y, Boarin S, Korinek J, Jensen MD, Parati G, Lopez-Jimenez F. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2010 Mar;31(6):737-46.
I’m talking about FITNESS. Obesity is at an all time high and unfortunately on the rise. With more and more people trying to get healthy these days, there seem to be new workout programs and videos everywhere you turn. But let’s get back to the basics. Exercise is one of the best things you can do for your body. In addition to looking and feeling great there are many other added health benefits of exercise.
All it takes is 150 minutes of exercise per week… only 30 minutes, 5 days per week, to benefit
Benefits of exercise include (but are not limited to):
– Reduces the risk of cardiovascular disease, type 2 diabetes, and even breast and colon cancer!
– Promotes weight loss and weight maintenance (with a healthy diet of course)
– Strengthens muscles and bones
– Improves mood and sleep
– Increases lifespan
– Improves balance and reduces the risk of falls (Important for the “less young”)
How much exercise is enough?
All it takes is 150 minutes of aerobic exercise per week (an average of 30 minutes per day, 5 days per week) to benefit. You will benefit the most from moderate intensity exercise which means you can talk comfortably for the duration of exercise and/or 50-70% of your maximum heart rate related to age.
How to Calculate Maximum Heart Rate
50% (220- Your age) x 0.5=
70% (220-your age) x 0.7=
There are many great heart rate monitors available for tracking your progress. Even if you can’t initially achieve this goal, just being up and moving about is better for your health than being sedentary.
What kind of exercise is best?
There are many different types of physical activities to choose from. The most benefit comes from a regimen that includes both aerobic exercise (what you would typically think of as “cardio” such as running, elliptical machine, biking, etc) and strength training such as weight lifting, squats, crunches, resistance band exercises, Pilates and so on. If you are not sure where to start, there are many great gyms that have personal trainers that can help you choose a fitness plan that is right for you. They can also ensure that you are doing the exercises correctly and safely.
Work Out Smart, Not Hard
Some of you may think that exercising harder and longer is better. In fact, running long distances or spending hours on the treadmill can lead to muscle loss. If you are looking to burn calories it’s actually more efficient to do high intensity interval training exercises, where you mix high intensity exercises to increase your heart rate with low intensity exercises for recovery. Overexercising can lead to fatigue and injuries and can increase your susceptibility to infections, so take it easy on your body.
Don’t Forget to Stretch!
Always stretch after exercise. Stretching helps with flexibility and helps prevent muscle injury after exercise. Yoga is a great way to improve flexibility and relieve stress.
Excuses for Not Exercising, and How to Overcome Them
Not having enough time
– We make time for what we prioritize. Case and point!
Not wanting to go to the gym
– Who said you had to be a gym member? You can exercise in your home or outside. A little fresh air is even great for stress relief!
Thinking exercise means vigorous intensity
– Remember, as long as you can talk comfortably while exercising, you are benefitting.
Working out intensely and feeling sick or getting injured
– It’s great to have the motivation to exercise, but if you have not been physically active for awhile, start off slow and gradually build up endurance and strength and before you know it you will be exercising at increasing intensity with more ease!
– Whenever we feel like others are judging us, it’s mostly because we are judging ourselves. Other people are not living our lives for us. If anyone has anything negative to say, that’s on their terms and we have the power to not let it affect us. You have nothing to prove to anyone but do have the responsibility to do what is necessary to keep yourself healthy.
Exercise can be enjoyable if you change your perspective and make it fun. In addition to exercise, don’t forget to incorporate a healthy diet and adequate sleep as a part of your daily routine. As always, you are worthy of being healthy and strong!
Let me know what you think in the comment section below:
– When could you fit in 30 minutes per day, 5 days a week minimum for exercise?
– What have your excuses been in the past for not exercising?
– What are your favorite fitness activities?
Always consult with your healthcare provider before starting any exercise regimen.
1. 2011, Feb 16. Physical Activity and Health. Retrieved from http://www.cdc.gov/physicalactivity/everyone/health.
2. Garber, C, Blissmer, B, Deschenes, MR, Franklin, BA, Lamonte, MJ, Lee, IM, Nieman, DC, Swain, DP. 2011. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Medicine & Science in Sports & Exercise. 43 (7): 1334-1359.
3. Klika, BC. Jordan, C. 2013. High Intensity Circuit Training Using Body Weight: Maximum Results with Minimal Investment. ACSM’S Health & Fitness Journal. 13 (3): 8-13.