Wednesday, April 23, 2014

Health Coaches - Bridging the Primary Care Gap

As I set foot into medical residency in July, one of my biggest concerns is the amount of time that I'll have to discuss diet, exercise, sleep, and stress with my patients.  My frustrations in medical school were the driving motivator to establish Sweat and Butter.  A physician is neither trained nor incentivized to promote lifestyle change in their patients.  Health coaches, on the other hand, have the training that the healthcare system currently lacks in preventing the nation's most expensive diseases.  Normally, I write lengthy pieces focusing on the science behind lifestyle change, but this time around I'm going to keep my post short and sweet. 

When Sweat and Butter speaks to groups of health care professionals (e.g. physicians, nurses, nurse practitioners, and physician assistants), the idea of a "quick fix" is the first thing that we feel compelled to dispel.  If you have ever tried to lose weight yourself, you know that it's more complicated than following a simple "eat this, not that" list.  Physicians and patients alike continue to exhibit silver bullet syndrome in their search for easy solutions to complicated, ingrained problems. 

The tendency to seek a quick fix is a big problem.  The willingness of health care professionals to treat symptoms pharmaceutically without simultaneously treating the underlying causes for their unhealthy lifestyle is a Gordian knot.  In many rheumatology clinics, for example, patients would prefer to continue to take strong, expensive medications for their joint pain and skin flare-ups as opposed to transition to a gluten-free diet in an effort to curb their symptoms. On the other hand, some conversation with patients around the barriers that they experience regarding cutting bread and pasta out of their diets might make this a less daunting task.  Pharmaceutical companies and health insurers have catered to an increasingly impatient population of sick people who have now come to expect a quick solution to their multi-faceted problems.  This is a positive feedback cycle with no end in sight, and, as the cost of treating obesity-related disease eclipses $200 billion annually in the coming years, we need to reassess our approach.

Sweat and Butter's approach to helping clients lose weight has several advantages over the typical support provided in an outpatient clinical setting.  

First of all, health care professionals don't have sufficient time with patients to fully elucidate a particular patient's obstacles to developing lasting, healthy habits.  On the other hand, our health coaches spend sixty minutes on average during their first session with a client. During this session, which we call a "health history", we direct our questions to unveil the client's fears and their preconceptions about what it means to live a healthy lifestyle.  We get to know every detail of the client's life as it pertains to their lifestyle goals. In the clinic, you simply don't have the time required to understand these barriers.  

Second, you can't bill insurers for the effort required to build deep relationships with patients. Currently, a few major health insurers cover health coaching, but the programs are usually insufficient.  At Sweat and Butter, several of our clients have come to us skeptical of health coaching because the coaching service provided through their health insurer was less than adequate.  It isn't the advice that is lacking; it's the approach.  An occasional, impersonal phone call isn't going to build trust or keep patients accountable.  Our coaches meet with clients in person or on an internet service like Skype every two weeks, enabling us to gradually develop a trusting relationship.  It is important to recognize relationship-building as an important aspect of behavioral change for your patients.  Once we have proven that personal health coaching is a potential means of reversing preventable disease, health insurers may improve compensation.  

Third, in the short time allotted to counseling patients, health care professionals are probably giving incomplete advice.  In preparing his presentation for the 2014 PaleoFX conference, a friend asked me to browse my entire medical school curriculum to gauge the amount of training that I had received on counseling patients in lifestyle change.  My search revealed a paltry three lectures, and they were outdated, focusing on BMR and "calories in, calories out" as opposed to the science behind behavioral change.  When health care professionals do manage to squeeze in some advice in the outpatient setting, it's hasty and generalized.  For various reasons, patients have begun to tune physicians and other health professionals out. Furthermore, because it is reserved as an after-thought in the outpatient setting, weight loss and dietary advice is met with defensiveness.  Is it any surprise that your patients return six or twelve months later without having lost weight or without having made any lasting changes to their diet?  It shouldn't be.  If an engineer fails to complete a task with a specific type of valve, for instance, the failure doesn't trigger her to think, "Oh!  Maybe I should just use two of these valves."  She is more likely thinking, "I guess that won't work.  Time to try something new."   Likewise, in an effort to motivate patients to change their lifestyle, you are using an approach that has failed time and time again.  Instead of continuing to blame your patients for their failure to practice a healthy lifestyle, let's change things up.

As health care professionals, it's time to admit that you need help in the area of lifestyle modification.  As medical school curricula attempt to accommodate the rapidly expanding field of medicine, the study of behavioral change is being crowded out.  Health coaches are a special breed that can connect with your patients in ways for which you have neither the time nor training.  At Sweat and Butter, we are collecting testimonials and data that lasting lifestyle modification is possible for even the most difficult patients.  

The advice that we provide our clients is similar to the advice that you are hopefully providing in your office, but getting patients to change their ways will likely require much more than that. Your patients need to be heard, and you need to respect the complicated nature of behavioral change.  Some of the obstacles that we reveal in our clients have nothing to do with diet and exercise.  In our practice, we work with clients on five factors: sleep, stress, movement, diet, and relationships.  Some clients seek weight loss; others are chronically stressed out and sick because of it.  Regardless of their goals, they need help in prioritizing their lifestyle to feel better.  

A cookie-cutter approach isn't going to work.  Health coaching is a resource that needs to be tapped into as a bridge between patients and their primary care clinicians.  At Sweat and Butter, we have an approach that has been proven through experience to meet your patients' needs between office visits.  We help to foster lasting, healthy habits by challenging clients to make small, realistic adjustments, one baby step at a time, which allows for sufficient reflection on successes and failures.  This is the missing piece in your efforts to motivate patients to live a healthier lifestyle.  If we collaborate, you will gain time, insurers will save money, and your patients may achieve lasting well-being.   

Nathan Riley is a 2014 MD candidate at Temple University School of Medicine.  He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD.  He can be reached at  You can also connect with him on Google+. 

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Wednesday, April 9, 2014

A Mud Race: Your New Goal For the Summer

My legs were feeling stiff from the mud that was caking on my skin, making it uncomfortable to bend at the knee as I ran.  I knew what whatever lied ahead was going to test my strength, but I was determined to press on.  While on the trail I was able to assess my condition, and I realized that my bruised legs would be horrifyingly black and blue for days to come and the scratches that I had accrued were starting to sting.

I laughed a little under my breath as I jogged on: "Why I am doing this to myself?" I was surprised that my response was an instant and resounding, "Because it's not often that we get to play like this!"  It's true!  No matter how crazy some of the obstacles were throughout the Tough Mudder, I was loving life at every step.  Being outdoors, challenging myself mentally and physically, surrounded by friends and helpful strangers was a breath of fresh air.

I have never been an athletic person and even less of a competitive opponent.  My first Tough Mudder was an intimidating venture, because I thought that I was going to be the weakest link in the team, and I feared the embarrassment of failure.  It is important to physically prepare for these events so that you minimize the risk of injury.  At that time, I  maintained a relatively relaxed workout routine, though I by no means trained diligently for the race.  From the beginning I was supported by friends that assured me that it was going to be a day dedicated to team work and fun.  
Turkey leg, no manners and no cares

If you have ever considered the challenge of an obstacle course race, I highly recommend it! There are people of all different shapes and sizes that take the challenge, and the entire day is loaded with a palpable positive energy.  I was pleasantly surprised to realize that no matter what physical condition you may be in there are obstacles that can hit everyone's strengths and weaknesses.

I found it endearing when I came across a large beast of a man who was hesitant to start one of the obstacles.  The burly guy was nervous about crawling through an underground tunnel that was pitch black once you were inside.  I coaxed him in by telling him that I would follow closely behind him for support.  We both made it out on the other side and he gave me huge bear hug because I had helped him through his fear of confined spaces.  Thankfully we kept bumping into one another at other obstacles, and he was able to hoist me over huge walls that I could not do on my own.

I have a few of these under my belt now.  Without fail, I cry at the end of each race.  To be honest, I'm not exactly sure why I get so emotionally overwhelmed, but I do know that the entire day of activities exhausts me.  After a good 20 seconds of emotional release, happiness overrides and hunger proceeds!  It is important to fuel up after such rigorous activity, and let me tell you that the first meal after the event is a glorious, well-earned experience.  

My favorite parts of these kinds of events are as follows:

"Let's get weird"
* The only one you are competing with is yourself! - The challenges are fun and unique to test your abilities.  If you are unable or unwilling to do one of the obstacles you are free to walk around and skip it.  I loved feeling free  to laugh at myself during my failed attempts, and I relished  the feeling of success when I completed an obstacle.  I finally completed the monkey bars on my 3rd Tough Mudder, and I couldn't have been happier.  High-fives never felt so good! 

* You get to move your body like a kid again - I never realized how liberating it was to run, jump, crawl, swim, reach and stretch!  I was brought back to the feeling of recess where everyone just let loose and had fun.  I definitely had to push myself to complete the race, but I enjoyed the opportunity to move my body in ways that I do not do on a daily basis. 

* Camaraderie - The whole day is full of those connections that Sweat and Butter tells you to seek out. We explain the importance of being present and mindful with yourself and others. They are not necessarily life-changing interactions but having a the same goal as everyone else, people cheering you on and even simply acknowledging the people around you makes for a special environment.  

* The challenge - I cannot tell you enough how much self doubt I discovered during these events.  Knowing that I had all day to complete the course gave me some solace, but I had to counsel myself just to keep going. The course allowed me to take physical obstacles head on even when I knew that failure was almost a guarantee.  It was clear to me that, whether obstacles were physical or mental. overcoming that self doubt requires a first big step.  I have been able to translate that experience into many life experiences such as avoiding a big project that needs to be done at work where the pressure was too daunting to even get started.  This fueled many ah-ha moments for me throughout the day.  I enjoyed proving myself wrong over and over again by saying, "See you can do it!" 

If you have been curious about doing one of these events I suggest that you leave your reservations at the door and sign up!  Get a group of friends together and make it a bonding day for everyone.  You can dress up around a specific theme or just go in with the ultimate goal of pushing yourself past your comfort zone.  If you have been needing some extra encouragement, having a goal like an obstacle race is also a great motivator to get active and stay healthy throughout the process before the big day.

Curious? Get pumped!

**Disclosure: I am not writing on behalf of or for the Tough Mudder or any other obstacle races.  All opinions are my own, and these are personal stories of my experience with races. 

Stephanie Telep is a co-owner and health coach at Sweat and Butter.  She received her training at the Institute for Integrative Nutrition and holds a bachelor’s degree in Psychology from Duquesne University.  She hopes to help others make necessary changes in their lives while fostering a positive and healthy attitude.  She can be reached at

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Wednesday, March 26, 2014

A Story About Inflammation: Oils and Your Health

Here at the Sweat and Butter Journal, I write on topics about which I'm asked most commonly by our health coaching clients and workshop attendees, and oils top the list.  Understanding the nature of oils as they pertain to human health requires an understanding of "inflammation", a buzz word that can take on a wide range of meaning.  For our purposes, I will review the dangers of inflammation when it persists in the body as well as how selection of cooking oils/fats can exacerbate it.  

This article is rather dense.  If you are the type who found yourself spacing out in science class, here are the take home points:
  • The primary problem with oil consumption in our nation is that we consume too much omega-6-rich fat and too little omega-3-rich fat.  Both types of fatty acids are important to your health, but neither should be consumed in great abundance.  The idea ratio of omega-6-to-omega-3 is 2:1, but the actual ratio in the typical Western diet is 20:1.  This ratio promotes low-grade, chronic inflammation.
  • Seed and vegetable oils such as canola, safflower, and sunflower are rich in omega-6 fatty acids.  Wild-caught fish, walnuts, seaweed, and grass-fed beef are rich in omega-3 fatty acids.
  • Extra virgin olive oil will easily burn even under low heat, thus becoming oxidized and potentially damaging to your health.  It's best to drizzle olive oil on food that is already cooked.  Keep your olive oil refrigerated in an air-tight container.
  • Cook with unrefined coconut oil, palm oil, or butter or lard produced from grass-fed animals.
  • It's better to eat fish a few times per week than to supplement with high doses of fish oil.  If you don't eat fish, I recommend supplementing with a fermented cod liver oil/butter oil blend.  Keep this oil in the fridge and in an air-tight container.
Let's start with a little cell biology and biochemistry...
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This story begins at the level of the cell.  Each cell in your body is comprised of phospholipids.  The structure of a phospholipid permits a bilayer of these compounds to arrange themselves such that the internal environment of the cell remains tightly regulated.  
If you look closely at this image, you will see the fatty acyl ("acid") tails of the phospholipids labeled at the bottom right corner.  Here is an enlarged schematic of the structure of phospholipids: 
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These fatty acid tails (blue squiggly lines in the image to the left) help the cell membrane to keep certain things in and other things out.  As I mentioned before, the phospholipid bilayer is the gatekeeper.  Because your body tissues are regularly under physical stress, it's important that your cells are compressible and flexible.  A fragile cell will easily break open, which renders it useless. Fatty acid chains stack neatly together allowing phospholipids to sit very closely together in order to fully enclose the cell, but this neat stacking also tends to make the cell membrane rigid.  A rigid cell membrane is fragile, so this is not favorable.  Fortunately low-density lipoprotein (LDL) is constantly delivering cholesterol to the cell membranes of every tissue in your body, wedging it between the otherwise perfectly arranged phospholipids.  Though it may seem counter-intuitive, cholesterol helps promote fluidity in the cell membrane phospholipid bilayer, and this is important for the health of your cells.  

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Phospholipids are clearly important, but the nature of their structure can also lead to problems.  Their fatty acid chains are polyunsaturated fatty acids (PUFAs).  This type off fatty acid is great for use in the phospholipid bilayer because, as I've already mentioned, they can stack neatly beside one another, but this structure is also easily oxidized.   Oxidation is a chemical reaction whereby the multiple double bonds of PUFAs are broken and rearranged when exposed to oxygen, and these rearranged bonds are at an increased risk of forming free radicals.  
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Free radicals aren't necessarily a big problem in small doses, because our cell membranes are equipped with special enzymes and antioxidants such as Vitamin E to repair damaged ("rearranged") fatty acid chains.  If they aren't repaired, free radicals will greedily steal electrons from nearby structures - i.e. DNA, organelles, other phospholipids, proteins, etc. - in order to stabilize themselves, but this theft is damaging.

OK.  Now, you're probably thinking, how do cooking oils fit into this picture?  Moving on.

Not All Cooking Oils Are Made the Same
The next chapter in this story will be a little more useful in the kitchen.  Every cooking oil that you see in the grocery store has a slightly different fatty acid profile.  The two major types of fatty acids that we must cover are omega-3 and omega-6 PUFAs. 

All of the omega-3s are derived from alpha-linoleic acid (ALA), whereas the omega-6s are derived from linoleic acid.  Several enzymes are required to convert these precursors to the the various omega-3s, such as EPA and DHA, and omega-6s.  The details of these conversions from precursors to useful fatty acids are found in the image below:
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(Isn't it interestingthat the same enzymes are used in both pathways?!  This means that whichever 
pathway is supplied with more precursors will procede preferentially over the other.  Neat.)

Omega-3s are generally said to be "anti-inflammatory" and omega-6s are generally regarded as "pro-inflammatory".  The reason for this takes us back into the biology of the cell membrane.  As you can see in the image above, EPA and DHA are intermediates in the omega-3 synthesis pathway.  Both of these compounds are readily converted into anti-inflammatory substances.  On the other side of the image, arachidonic acid (AA) is an intermediate in the omega-6 synthesis pathway.  AA is readily converted into pro-inflammatory compounds.  The balance between EPA/DHA versus AA production is the fundamental root of inflammation in the body.  If you are producing AA at a higher rate than EPA/DHA, you are inflamed.  But what does it mean to be inflamed?  We'll get to that a little bit later.  For now, just understand that it's no bueno.  

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Until we can talk about inflammation, there are still a few important things to discuss about cooking oils.  Depending on its source, an oil will contain different proportions of PUFAs.  When you eat omega-6 PUFAs, they are incorporated into the phospholipids that comprise the cell membranes.  As you may have already guessed, if you are consuming more omega-6 PUFAs in your diet, you'll be producing more pro-inflammatory compounds via a higher proportion of AA versus EPA/DHA, as your omega-6-rich diet will provide a steady supply of precursors to feed the omega-6 synthesis pathway shown in the image above.  When the cell membrane is injured due to free radical damage or trauma, AA is produced and converted into the pro-inflammatory compounds mentioned before, namely LTC4PGI2PGE2, and PGF2.  
Below you'll find a list of common cooking substances and their relative proportions of anti-inflammatory omega-3s and omega-6s.  A low-inflammatory diet will have a relatively low proportion of omega-6s. Unfortunately, vegetable oils have been produced cheaply and abundantly since the 1960s, which marked the beginning of the demonization of saturated fats.  These oils - canola oil, safflower oil, sunflower oil, soybean oil, and corn oil, as seen in the chart below - are rich in linoleic acid (blue).  If you read the labels of most processed foods, you'll see that one or more of these oils have been slipped into the product.  Likewise, restaurants use these oils in the majority of their meals because they are so cheap.  This has meant bad news for consumers of the Western diet.  As I mentioned before, both omega-6s and omega-3s are important for the construction of healthy cell membranes, but the ideal relative proportion is 2:1, omega-6-to-omega3.  For the reasons noted, the typical Western dieter is likely consuming a ratio closer to 14:1 or 20:1! This means a greater opportunity for the production of AA and thus pro-inflammatory compounds. 

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I recommend that you minimize use of omega-6-rich oils at the top of the list in favor of butter, ghee, lard, palm oil, and coconut oil

Before we shift the discussion to the dangers of inflammation, I want to make a few comments about extra virgin olive oil (EVOO).  This oil has been touted as a superfood for years, as it is consumed in high quantities by healthy populations that live in the vicinity of the Mediterranean Sea.  On the chart above, you'll see that olive oil is comparable to safflower oil in fatty acid composition, but extra virgin olive oil tends to be lower in omega-6s than more refined varieties.  Having said this, the omega-6 content of EVOO is still higher than the healthier options I mentioned before such as butter or coconut oil, so use it sparingly. Furthermore, EVOO burns easily even at low temperatures, which expedites the oxidation process.  As you'll recall from our discussion at the beginning of this article, oxidation is our enemy because it leads to free radical production in the phospholipids of our cell membranes. This free radical formation can trigger the conversion of phospholipid fatty acid tails to AA, which, as you know, easily converts to pro-inflammatory compounds.

The Final Chapter: Inflammation
It's time to come full circle.  We know that a diet rich in omega-6s may lead to inflammation, but what exactly is inflammation?

When we hear the word inflammation, we normally think of sore joints .  After running a marathon, your knees or hips may be sore and inflamed for weeks.  This is an example of acute inflammation, which occurs in response to injury.  It's easy to know that your knees are inflamed because they hurt and this may limit your mobility.  On the other hand, chronic inflammation is probably far less noticeable, which is why it's routinely referred to as "low-grade" inflammation.  This is dangerous because, unlike in response to acute inflammation, we don't always address chronic inflammation since it can often burn in the background without producing any dramatic symptoms.  After all, if you aren't experiencing any severe pain at the moment, how will you know you need to change your ways?  A little stress once in a while can set into motion cellular mechanisms that will make you stronger through a process called "hormesis", but a relentless bombardment of stressors can be destructive.  Chronic inflammation can persist for years, and serious disease processes are normally well under way before you change your ways through lifestyle modification. 

The pro-inflammatory compounds produced from AA in response to free radicals or other damaging trauma to a cell membrane set into motion physiologic mechanisms that help to repair the damage.  Evolution at its finest!  Prostaglandins and prostacyclins work to dilate blood vessels, allowing blood carrying immune cells to rush to the site of injury.  Leukotrienes raise a red flag to mark the site of injury in order to direct the immune cells that are brought to the site by the increase in blood flow.  These immune cells, namely neutrophils, go to work on the damaged tissue at the site of injury.  If they hang around for along enough, they also start to eat away at healthy tissue, disrupting the physiologic processes that keep us healthy, which is why chronic inflammation has been linked to so many chronic diseases, including cancer, heart disease, diabetes, obesity, and Alzheimer's dementia.  

To mitigate the inflammatory effects of an omega6-rich diet, you must aim to restore your omega-6-to-omega-3 ratio to 2:1.  First of all, reduce your omega-6 consumption by cutting out vegetable oils altogether.  Cooking with butter, lard, palm oil, and coconut oil tastes better and is better for you.  Likewise, you should increase your consumption of anti-inflammatory, omega-3-rich foods like fatty fish, walnuts, and seaweed.  Certain fish are richer in omega-3s than others.  Check out the graphic below.

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Please keep in mind that PUFAs are naturally produced in chloroplasts in the leaves of plants! Fish that feed on algae (or fish that feed on fish that feed on algae) are rich in omega-3s because they feast on wild marine plant-life.  Farmed fish, on the other hand, are fattened up with soy products, which are rich in omega-6s. Take care to purchase wild-caught fish. Likewise, cows that spend their lives grazing on healthy, lush grass as nature intended will provide you with a healthier fatty acid composition when compared to cows that are marbled up at a feedlot.  Vegetarians and vegans argue that they can consume sufficient omega-3s on their diets.  Of course you can obtain a lot of ALA by eating flax seeds and other leafy plants, but our bodies aren't great at converting ALA to EPA and, in particular, DHA.  Our herbivorous critter friends help us out by munching plants rich in ALA, converting it into EPA and DHA, then stashing it away in their meaty flesh to the benefit of predators - us.
Modern feedlot
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One note about fish oil supplementation.  Fish oil is often touted for its anti-inflammatory effects, but all PUFAs - both omega-3s and omega-6s - are at risk of oxidation and thus free radical formation, so consuming large quantities of even "healthy" omega-3-laden fish oil predisposes you to harm. Of all the fats you consume in a day, it's best to keep your PUFA consumption to around 1-3% of your daily caloric intake.  If you absolutely won't eat fish, taking just 1000mg (1g) of fish oil daily is sufficient to reap the benefits (although the clinical evidence on the beneficence of fish oil supplementation is a mixed bag).  It's thought that Vitamin E will prevent the oxidation of this high-dose PUFA supplementation, though this is also debatable.  Better yet, I recommend fermented cod liver oil/butter oil in capsule or liquid form.  This formulation provides ample Vitamin D, Vitamin K, Vitamin E, and Vitamin A in addition to sufficient omega-3s.  Keep your fish oil refrigerated in an air-tight container, as oxygen exposure increases the likelihood of oxidation. 

I hope this article helps you to understand the importance of selecting healthy, nourishing oils and fats for use in the kitchen.  This guide is incomplete in a lot of ways, but I didn't want to burden you with too many details.  I'll leave that to the guys getting their hands dirty in the lab. I'm only the messenger, and, as the messenger, I would be happy to answer any questions you have about the information presented here or to start a discussion if you want to delve even deeper.  

Nathan Riley is a 2014 MD candidate at Temple University School of Medicine.  He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD.  He can be reached at  You can also connect with him on Google+. 

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Wednesday, March 5, 2014

Recess For Your Brain're stressed and overworked.  This is a common feeling for most people, and we all have our go-to resources to de-stress.  Let's take a step back to examine how we may constantly perpetuate an endless cycle of stress without even knowing it.  By tweaking our daily routines we can see how bombarded we really are by our surroundings.  Once we've considered the reasons for which it's so difficult to find calm in the world, I'll provide a few relaxation methods that you can put into practice starting right now.  Let me take your brain to recess...

We are currently over-stimulated by an unrelenting stream of distraction to the point where we have been conditioned to crave it.  We are addicted to self-induced stress, like constantly checking our phones, emails, and social media.  Often times, this method allows us to disappear for a moment and take ourselves away from an uncomfortable silence or re-center ourselves during a tedious task.  This perpetual obsession with smart phones is likely contributing to a low-grade anxiety that many of us experience without even realizing it.  
Imagine this scenario:  You decide to leave your phone in the car on your way into your favorite bar for a quick bite to eat.  Anticipating some solo time, crossing the street seems strangely liberating because you are completely alert and aware of your surroundings now that your nose is no longer pasted to a small screen.  Unfortunately, within a matter of minutes, you are already searching your pockets for the phone that you had just moments before decided to leave in the car.   You sit down at the bar and remember the Sweat and Butter workshop you attended about eating for energy, so you order a side salad with olive oil and vinegar to accompany your steak and sautéed veggies for dinner.  Finally, you start to settle in for a mindful meal.  Things are starting off pretty pretty well, this evening!  Then you realize that the room in which you had been seeking peace of mind is filled with jams from the nineties, an incessant flashing jukebox, five TVs broadcasting a silent report on the latest sports scores, and the low hum of multiple conversations.  This is life as we know it.

Is it possible to find truly relaxing space anymore?  Think about grab a banana as you rush out the door in the morning.  You shovel your lunch into your mouth in between checking emails and finishing paperwork.  Then, you plop down on the couch after a long day and mindlessly eat your takeout in front of a glass screen that recreates a world in front of you in which you are not forced to interact.  Because life keeps you constantly on the go, you are forced to find solace in "relaxing" activities, many of which aren't relaxing in the slightest. Crappy TV isn't rejuvenating; it just adds to the stress.    

Have you ever seen such plush terrycloth in your life?!
There needs to be a disconnect, but sometimes this can seem like a chore.  "I want peace and if this isn't working then nothing will!" The reality is that creating and maintaing healthy, stress management strategies takes time, practice and patience.  
For those of you who have tried to implement relaxation tactics, you may find yourself confused by guidance you have received in the past.  If a yoga guru tells you: “Chill out! Just meditate, man!”, it's natural to have an insatiable urge to throat-punch them with your hand bone.  This is likely due to the insecurity that you feel when it seems like you are the only one missing out on the zen.

Magazines depict an unachievable ideal for us.  Simply climb an incredibly high mountain far from any civilization, and then hold a striking yoga pose effortlessly in order to be one with the universe.  Another example would be this cat picture. (above)  This picture says: "Allow your mind to evaporate any thoughts and calmly relax into serenity with the aromatherapy of freshly cut cucumbers."  Ahhhh...smells like fresh bullsh$t to me!

These cliches are everywhere.  It's as though we are expected to have some innate state of enlightenment that we simply need to tap into.  "Yes, of simple!"  If you have ever unsuccessfully attempted meditation, you may know the feeling of trying to connect to that quiet space only to find yourself running through a grocery list in your head before suddenly switching channels to consider the types of nuts that North American squirrels prefer.  This cycle can be maddening and discouraging.

Didju move my bongos, bro?
I realized the importance of space and calm recently when I was on the bus.  Every day I get onto the bus early enough to grab a seat as the rest of the stops start to pack in like sardines.  Most of the time I'm sleepy enough to enjoy the rumble of the engine and the warmth of the cabin, protected from the winter cold.  I never feel the need for a book,  because my brain isn't ready just yet.  Nor am I compelled to put on headphones since the bus is quiet with everyone mentally preparing for their day.  On this particular morning, I found myself unusually jarred by something new on the bus.  One of the stops now has an automatic ad over the speakers that announces the unbeatable prices that Megabus offers.  The voice narration of the ad jarred me.  I became irritated because it was ripping me out of my quiet moment. I quickly realized that this was my only quiet space, that time on the bus was sacred!  The ad made me realize that I needed to schedule more down time for my brain on a daily basis, because each and every moment seems to be saturated with information to process. 

I have since started incorporating three simple things into my daily routine: 

1. 5-5-5 breathing.  Breathe in for 5 seconds, hold it for 5 seconds, breathe out for 5 seconds, then repeat this four more times.  Better yet, make your goal to do this 5 times a day.  Focus on every breath.  This is easy to do, and once you find your groove you can use this as a reset switch to sooth your information-overloaded brain. 

2. Go for a walk.  You know all of those strange thoughts that streamline into our consciousness somewhat randomly throughout the day?  No matter how insignificant they may seem they must be coming from somewhere.  Get up and move around once in a while. Aside from the physical benefits of breaking up a long day in front of a computer screen with regular bouts of movement, the change of scenery will benefit your psychological health.

3. Practice mindfulness.  Try to be present at every moment, even if you're alone.  Put the phone away and enjoy your meal at the table.  Eat and converse with your family instead of gluing yourself to yet another screen: the TV.  Enjoy your food.  Look at the colors.  Think of how it nourishes you.  Allow your mind to wander in order to release any clogged areas of the mind.  This quiet space will allow your thoughts to run free.  It’s like recess for the brain

It can be an overwhelming task to find peace in your busy world.  Finding that calm, quiet space of mind takes patience and practice. These three steps will help you crowd out old habits and make you more aware of where your serenity actually lies. 

Stephanie Telep is a co-owner and health coach at Sweat and Butter.  She received her training at the Institute for Integrative Nutrition and holds a bachelor’s degree in Psychology from Duquesne University.  She hopes to help others make necessary changes in their lives while fostering a positive and healthy attitude.  She can be reached at 

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Wednesday, February 26, 2014

An Open Letter to My iPhone

Dear iPhone,

I have some good news and some bad.  

Let's start with the good news.  When I first bought you, I was just beginning medical school, and you were a savior in many ways.  I was struggling through a tough break-up, and I struggled to keep my mind off of my ex-girlfriend.  I became anxious, and I began biting my nails and nibbling on my knuckles far more than usual.  You gave me 24/7 access to a world of information and multi-media incomparable to any piece of technology that I've ever fully incorporated into my life, and this access served as a wonderful distraction from the pain.  

Your functionality also enabled me to become more productive than I ever thought possible.  In college, I managed a 19-credit course load, triathlon training, and a non-profit that I had started in Malawi. Would you believe that I did this using just a flip phone?!  I managed to get a lot done back then, but you, iPhone, have helped me pack even MORE into my day.  I didn't think it was possible, but your push notifications ensured that every waking moment of my life in medical school was an opportunity to do something productive.  

For this, I will always be grateful, iPhone.  Medical school demanded a lot of busy work, and you kept me on track.  As a medical student, neurology rounds with the stroke team were extremely boring and long - sometimes up to six hours -, but I could always rely on you when my attention started to drift.  Likewise, while studying for boards, I fared quite well because you enabled me to review practice questions anywhere at any time.  Seriously - lifesaver status with that one!   

But your virtues are also implicit in the bad news.  While out for beers with friends, I would periodically check my inbox for email updates.  While waiting at a stoplight, I was preoccupied with checking to see if anybody "Liked" my most recent photo upload to Facebook.  On the rare occasion that I was at home with my parents, I felt compelled to check to see if I had any new Twitter followers.  Why not simply enjoy the company of my parents?  After all, they won't be around forever.  The problem is that whenever you're in reach I simply can't help myself, iPhone.  With you, I've developed the need for instant information.

Since I've trained my eyes and thumbs to communicate efficiently through your touch pad, you have become a perpetual source of distraction.  It's so easy to text, so why would I call my friends?  Bored by someone's story?  I bet there's something funny posted on Facebook. That awkward moment in an elevator with strangers?  iPhone to the rescue!  Even among co-workers or family members, I have felt compelled to turn to you, my mistress, to surf the web or respond to emails rather than talk to other human beings.  Even while I'm meditating, I think to myself..."by the time that that timer goes off, I'll probably have another email in my inbox!"  
Don't take this personally.  There are many fish in the sea, iPhone. There are dozens of cell phone users out there that are capable of defining parameters for their phone use.  Many people find it easy to leave their phones in the car when they go out to dinner with their significant other.  They can turn it off during their kid's soccer game.  They don't feel compelled to spend an extra 15 minutes on the toilet in order that they might glaze over a few more cat pictures on Instagram.  But I'm not one of those people.  You have a hold on me, and I need to break free.  I crave a return to sanity.  I want to appreciate quiet again.  I don't want to feel compelled to reach for you every time there is a lull in activity.  It's not you; it's me.  

The truth is, having access to information isn't enriching my life in ways that I had hoped.  It's making me anxious and distracting me from the important things in my life: sunshine, friends, and the taste of fresh ingredients at the dinner table.  I've become an egomaniac, allowing my attention to be driven by digital notifications.  It's as if the world revolves around me.  "Like" my photo! Comment on my post!  Yes, I'll accept your friend request, xAppleJacks43x!  I'm a slave to your screen, iPhone.

I might occasionally still need you to help me navigate difficult city streets, take high definition photos, or stream music while I'm writing or driving, but I need to limit our interactions to these occasional activities.  Would you believe that sometimes I have even imagined that I felt you vibrating in my pocket when, in fact, you had been silent?  Doctors tell me that I have "phantom vibration syndrome."  I'll google it for you., I shouldn't. me, I think we both need this.  I've noticed your battery has been overheating recently.  We clearly rely too much on one another.  

Oh, one more thing...I'm afraid to say that there's someone else.  Yes, she's a flip phone. She's perfect for me.  No bells and whistles...just basic phone programming.  Heck, she can't even send photos.   I know, I know...Evernote is nice, but I can just use a notepad and pen if I need to make a note of something.  I'm willing to put up with T9 texting and occasional poor reception in order to reprioritize my attention.   

I hope we can still be friends. 



Nathan Riley is a 2014 MD candidate at Temple University School of Medicine.  He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD.  He can be reached at  You can also connect with him on Google+. 

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Wednesday, February 19, 2014

Tried Everything To Lose Weight? Think Again...

"I've tried everything...It's not happening."

This has become the anthem of dieters world-wide.  As I write this, I'm sitting in an outpatient clinic where the majority of patients are obese, diabetic, and sick.  Weight loss recommendations are often made in the form of a fleeting suggestion, "Have you thought about losing weight?"

"I've tried everything...It's not happening," so says the patient.

Obesity is highly prevalent and very costly for our nation, which is why physicians routinely address it during office visits.  According to the CDC, 37% of the U.S. population is obese (defined as BMI equal to or greater than 30).  Treatment of obesity-related disease is estimated to upwards of $210 billion annually.  Our health coaching clients often walk away with much more to brag about than a slimmer waist line, but their driving motivation is their image in the mirror.  Unfortunately, addressing obesity in the physician office visit is coming up short in the battle to curb obesity.

There are many known health benefits that come with weight loss, including:
You don't need a snappy dresser to tell you that these disease processes can lead to an early death and poor quality of life, so why haven't we seen improvement in our nation's collective waistline?

In my experience, most individuals pursuing weight loss do it for aesthetic appeal.
Gordian knot: contemporary
metaphor for the impossible
Sometimes this is even a stronger motivator than avoiding the long-term consequences of high blood pressure or diabetes.  At this point, I'm certain that, in most cases, the "why" is understood.  The "how", on the other hand, is a gordian knot.  

I have watched family members struggle with weight loss for years.  Those who persevere eventually break through.  A healthy, lasting weight management program will address underlying emotional stressors and tendencies to overeat.  It might require readjustments to your sleep patterns or a little bit of muscle pain once in a while from a tough workout.  But a break through is possible.

When I talk about my history as a triathlete, many people react immediately with something like, "Oh...I've thought about doing that, but I don't know how to swim."  Guess what?  When I took up the sport, I couldn't swim.  I registered for an Ironman-distance triathlon (2.4 miles open water swim before biking 112 miles then running a full marathon) without knowing how to swim.  The registration fee was $500 that I barely managed to scrap together.  My first day at the pool, I had all of my gear in tow: goggles, skin tight booty shorts, and a swim cap.  I jumped in and found that my form sucked so badly that I was winded after 50 meters.  I struggled through numerous workouts, and I competed in a sprint distance triathlon to test my fitness.  I finished dead last and was forced to complete the majority of the swim using a doggie paddle.  Needless to say, I was incredibly discouraged.

Instead of resigning to never becoming an Ironman, I signed up for lessons at the YMCA. There were little kids swimming in the lane next to embarrassing.  When that strategy didn't work, I contacted collegiate swim coaches around my city to ask if I could join them for swim workouts.  This required me to get up at 4:00am, ride a train for 45 minutes into the city, try not to drown for an hour, return home, shower, get ready for work.  When that didn't work, I bought several books and DVDs.  On one occasion, I was trying to float in the shallow end, and, out of frustration, chucked my goggles in disgust.  Throughout this whole process, I was working a full-time job.  The final two months of my training took place at the very beginning of medical school, meaning I had to wake up a few hours earlier than my peers to run, bike, swim, or lift in order to meet my goals.  I persevered for nine months, and now I'm an Ironman.  And I'm also a very strong swimmer.
You are, indeed, unique and beautiful,
but your excuses are old news

My point is that if you want something badly enough, you need to keep trying.  Very few people have a genetic predisposition to obesity.  If you haven't accomplished your weight loss goals, it's likely because you simply haven't found the best method for you.  

If you have been living a life comparable to that of most Americans, you are overweight, inflamed, and perpetually fatigued.  To correct the metabolic derangement that has led you on your weary way, you may have to make some sacrifices.  You might have to try some new things.  You might even have to wander gradually from your comfort zone. But something will work, and, if you want it badly enough, you will keep at it.  Half of the battle is motivation.  How badly do you want it?

Nowadays before and after pictures have become common place.  The typical story reads something like this: "I struggled with my weight for years, but I didn't see great results until I tried ______ !"  Fill in this blank with HCG injections, Crossfit, P90X, jogging, juice fasts, coffee enemas, durian fruit, Atkins, or the paleo diet.  The impression conveyed by these media stunts is that "scientists" have finally found a miracle cure for your weight loss.  What these before-and-after pictures leave out is all of the perspiration, pain, tears, and determination that led the charge.  Maybe the scheduled, repetitive nature of P90X workouts is the key to getting you off the couch, but simply ordering their product isn't going to help you lose weight unless you put in the time.  Furthermore, if you want lasting, healthy weight loss, there is no magic bullet.  There are tools like home exercise DVDs, diet plans, and health coaching to help alleviate the burden of planning, but the rest is up to you.
Before and After.  
But what happens in between? 
Your lifestyle is what got you here in the first place.  You'll have to work really hard, and make some uncomfortable changes to your lifestyle, but it will pay off in the end.  You need to be honest with yourself.  Until you've truly changed your lifestyle, you haven't tried everything.

At the clinic yesterday, one of the nurses sat down at the table in the break room as we were all unpacking our lunches.  She deftly swooped a hand across her mouth followed with a big swig of water.  She caught me watching her, and she said, "Just took my fat pills."  I pried deeper. "My doctor says I have to lose 30 pounds, and nothing else works for me."  I asked, "Have you tried health coaching?"  "Oh, honey, I've tried everything...It's not happening."

Tried everything?  Perfect...that's our specialty.

Nathan Riley is a 2014 MD candidate at Temple University School of Medicine.  He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD.  He can be reached at  You can also connect with him on Google+. 

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Follow me on Twitter @BeyondtheMD