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.
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.
Hello 2014! Are you still waiting until next week to start working on your resolutions? Well, why? Why have you waited for the past year? Last month I wrote in my post All Years Resolutions- Part 1 that we shouldn’t have to wait to make changes that benefit our lives. Of the 45% of Americans that make New Years Resolutions, only 8% are successful in achieving them. Chances are, many of our resolutions have been carried on from year to year. The following are some of the reasons that keep us from achieving our goals.
Unreasonable expectations: We as human beings are incredibly hard on ourselves and it does not help that we are constantly trying to be “better,” “fitter,” “richer,” etc. We constantly strive for this different version of ourselves and are never satisfied. How many of us finally reach our goal only to find something else to try to “fix?” Many of us are also striving for perfection, which is unattainable; so when we don’t achieve this we feel disappointment. (For those of you struggling with your body image, I suggest you watch this video on airbrushing in advertising). There is nothing wrong with having high standards, but make sure it is an attainable goal. I also encourage you to look at your goals from the perspective of improving meaningful attributes of your life. Instead of wanting to be a certain size or shape, think about wanting to be healthy. If you approach it this way you will achieve your goals in ways that are directed at self-respect rather than at superficial ideals. For example, wanting to be healthy rather than “hot” will help you make the choices that will eventually lead to a healthy looking body.
Wanting instant results: Certain issues did not happen overnight. We are creatures of habit so changing habits takes some time (they say it takes 21 days…) Healthy life changes should be part of a daily regimen, not to be packed into 2 months of the beginning of the year. Remember, delayed gratification is important. Let’s take weight loss, for example. While a weight loss pill may take the weight off in a short period of time, you still have not made the changes to your diet and lifestyle that will lead you to gain the weight back once you have stopped the pill.
Trying to do too much too fast: New Years Resolutions are exciting. It gives us something to talk about and something to look forward to starting off the new year. Sometimes, however, the excitement drives us to do everything at once and this can be overwhelming. This can lead to not being able to balance everything else in our lives and eventually to burn-out. This in turn leads to frustration and may prevent us from taking any more steps to making changes or moving toward our goals. Instead, focus on what you are capable of fitting into your schedule and prioritize. Cleaning the attic can probably wait. Make a daily commitment to yourself and set short term goals. Let’s take a look at some common resolutions and some examples of how to make daily changes related to each:
– Weight Loss: It’ s probably not a good idea to start P90X if you haven’t been physically active for awhile. You may either injure yourself, or feel ill afterward and hate the thought of any exercise in the future. A better option would be to start off slow with walking or light exercise to build up both endurance and strength and then gradually increase the intensity of your workout. Also get in the habit of exercising when you get home on certain days of the week. Don’t forget to choose the healthy food options on your lunch break.
– Organization issues: Everyday throw away a few things you don’t need. Get in the habit of putting things away right after you use them. Clean up any messes before going to bed so that you can wake up to a fresh start!
– Debt issues: Cancel a subscription to that magazine you never read. Cook instead of eating out (this will also help with weight loss!)… who knows, with the money you save you may be able to take that dream vacation on your list after all!
These are only a few examples of little things you can do, and these changes will add up in the long term. Remember, change takes time and if we do not achieve all of our goals in one month we still have a whole year and a whole life to do so. (This does not mean putting things off however!)
Excuses: Anyone can make time for what they prioritize. TALK is cheap. The time you spend talking can be time spent doing. Avoid procrastination. Get started on your goals now. If you don’t start your exercise regimen today, when will you?
Focusing only on the outcome: Remember, it’s about the journey, not the destination. It’s important to have your goal in mind but the way there may not pan out how you expect. And if you do achieve your goal, how much satisfaction will you have if the process was tedious and stressful? Let it flow. Make it fun. Want to eat healthy? Find fun recipes or make cooking an enjoyable family affair. Are you dreading the gym? Why not join a dance fitness class or walk outside and enjoy the scenery?
The next post is about the mental and emotional obstacles that prevent us from achieving our goals. Until then I ask you, what has kept you from accomplishing your goals?
Aunna Pourang, MD is a board certified family physician who lives in Jacksonville, FL. It is her journey to wholeness that she learned the importance of healing the mind, body and spirit to bring true happiness and health to her life. It is through this blog she wishes to help others do the same.
What are your New Year’s Resolutions? The Top 10 New Years Resolutions for 2015 (Updated for 2015) revolved around, yes, you guessed it: health and happiness! During many of my patient encounters, I go over the same things about healthy diet, quitting smoking, starting an exercise regimen, etc. I hear many excuses, but for some reason, it’s during this time of the year when people start making more efforts to try to make changes. Did you know that according to the University of Scranton Journal of Psychology, in 2012, of the 45% of Americans that made New Years Resolutions, only 8% were successful in achieving them? While I do see many people making an effort at the beginning of the year, I would say that by March many people go back to their old routines.
So why does this happen? There is nothing really different about the New Year except for a change in the date. So when my patients tell me they are going to start eating healthy and exercising after the holidays, I ask them, “Why not today?” Naturally the thought of a new year causes many of us to evaluate the past year and think of what we want in our lives for the next. Still, why wait and procrastinate on making changes that benefit our lives?
The following are some tips meant to help ensure your success in achieving your goals.
First: Make a list of EVERYTHING you would like to work on, change, have, etc.
Second: Make a new list from the first, prioritizing the most important to the least important in terms of what you would benefit from changing sooner rather than later. Health and financial/legal issues would probably be better listed before “buy brand new car.” Also, is there anything you want to change that is ok the way it is? If so, your efforts would be better spent working on something that you would benefit from improving.
Take out another piece of paper and write down everything you are grateful for and proud of over the past year. It may be hard to think of things at first because we tend to focus on the negative (Read more on gratitude here). If we try hard enough, however, we will find that there is also a lot to be happy about. The “little” things such as being alive, having our family around us, having basic survival needs are important too.
Compare your lists. How do you feel when you read each list? The “resolutions” list may bring on strong emotions. There is no reason for negative emotions to be dominant over the positive ones, except for what you are focusing on. So even if this time of reflection may bring on negative feelings, make sure to think about all the great things going on as well.
It is important to be honest with yourself during this step. Review the first list and ask yourself, “Why do I want this? What benefit will it bring to my life?” and write the answer next to each item.
If there is anything on your list to try to prove something to someone else or make someone else happy, consider whether or not this is actually important to you. For example, if you want to quit smoking because everyone is telling you to do so, you will not likely be successful. I will be the first person to encourage someone to quit smoking, but I also know that most people who quit successfully do so when they are ready. They also often quit cold turkey without any medication or nicotine supplements. Unfortunately it usually takes some type of health crisis to wake some people up; nonetheless, it has to come from within. You will not feel satisfaction in achieving a goal when it is meant to seek approval from others or to make others happy. If the other parties don’t react the way you want, then you will have spent all your time doing something for someone else and left with regrets and resentment. In the end you will not have done anything to make yourself happy.
Tune in for the rest of the related articles on ways we prevent ourselves from achieving our goals.
Share what your New Years Resolutions are in the comments below!
How often do we all face “obstacles” in our lives that we would like to overcome, but feel some resistance to them? For example, if we are dealing with being overweight, we likely know that we would benefit from a healthy diet and exercise. It’s obvious that taking care of ourselves would eliminate many of our health issues. So then why do we sometimes find ourselves not doing just this? I’ve heard many excuses from people, such as “I’m too tired after work to exercise,” or “I just can’t.”
Why is it that we are so much more willing to take care of others? I personally think it is because of the deep love we have for the ones we care about. Well, what about the love for ourselves? I am not talking about a vain, egotistical type of love, but a true appreciation for ourselves and our well-being.
What is holding us back from taking care of ourselves? When I ask this question to people, the response is often, “I don’t know.” If you are facing health challenges, consider reflecting upon that question. Could it be that you have a deep- seated subconscious belief that you are not worthy of good things in your life, such as optimal health and wellness? I think if you truly appreciated yourself, you would make time for a 15 minute walk even when you are a little tired. Just like you would make the time to take your child to a sports practice or to meet up with a friend.
I also encourage you to take the time to change your perspective. Think of all the time you have spent thinking, “I can’t,” and look at what has happened: you couldn’t… because you didn’t. Have you ever thought, “I can!” or “I’m worthy of being healthy and feeling good about myself.” Have you ever thought that the “obstacles” may actually be opportunities to grow?
Just as you are so willing to be selfless for others, doing things that benefit your life will keep you around longer to enjoy time with the ones you love. Give it a try, you are worthy.