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Monday, August 26, 2013

A Timeless Harvest of Knowledge: Interview With My Dad

Having a blog for our company allows us to venture out and get some insight on everyday topics. Sometimes the things we search high and low for are simple and right in front of our faces.  When we put our phones down and take time to have a conversation with people we learn from one another's life experience, trial and error, and good, old common sense.  Simplicity is key to many aspects of life, and I love getting to know people through candid and casual encounters, which allow me to pick their brain and get a better scope of the world we live in.  I have come to realize that routine can easily become a shield that blinds us to the answers we search for daily.

I had the honor of interviewing my father, Larry Telep.  He is a man of few and carefully chosen words but is always willing to share when prodded.  This was a grand opportunity for me to hear some of my dad’s stories, understand his perspective, and find a common ground that everyone looks for in people close to them.  I spoke to my dad about his experience growing up on a farm, surrounded by family just outside of the very city we live in. I got to hear my dad’s stories through the eyes of his youth and experience the things he cherished. 

Times, places, and people all change faster than we like at times, and these shifts can easily be missed until you reflect and see how far we have come.  My dad went from working in the fields, eating fresh and local produce, to fast food and suburban life.  The interview with my dad shines light on the simple truths in life as seen by a Pittsburgh farm boy.


You practically grew up on a farm. Tell me about that.

Not practically…we did grow up on a farm.  Eggs, cows, sheep, horses, and everything to make that farm work!   For example, my uncles used the mules for plowing.  And we had cherries, strawberries, black berries, plums, sour cherries, blue berries, black cherries, eighteen different species of apple trees in the orchard.  It was a fantastic place to grow up as a child.  Acres and acres of strawberries that we picked.  Corn, tomatoes and every vegetable that you can think of. We even had watercress. (My dad can get very Bubba’s Shrimps on me sometimes.. love it!)

Mom never went to the doctor until the end of her life.  She medicated with her herbs.  She would make balms to cure bruises…she had an herb for everything.  She knew where they were and what they were used for.  She was always reading about herbs and how to use them in cooking.  We had tea with herbs, mints and different things.  She used to make her sun tea.  She had a large bottle that she’d leave out in the sun with either black or green tea and the sun would heat it up and cause the tea to brew, and then she would serve it with sprigs mint that were near the house.  I wish I would’ve listened to her.  I really didn’t have much interest at the time.  As a young child, you really don’t pay attention to things like that. 


Grandma had a greenhouse.  Tell me about that.

That's where grandma grew many of her herbs.  She planted them herself.  She would go to a lot of the herb fairs that they had on Wednesday and Thursday nights in Shadyside.  She’d volunteer at different places like Phipps to learn about flowers and herbs.  Her greenhouse was mostly for flowers, but she started her vegetables there first before planting them outside. (Ah, my grandmother never shared much of anything with her life, but I do revel in knowing that she had a passion and sought it out!)

Who built it for her?

My dad built the house and the greenhouse.  When I was young, he and my mother put the roof on and they had me tied up with a rope attached to the roof so that I wouldn’t slide down because there was a rope around my waist.  People might see this as child abuse today!  They built the house from scratch.


You had meat and veggies on the farm.

We had over a hundred chickens. We always had fresh eggs and fried chicken and chicken soup.


Who would prepare those chickens?

The women got them and killed them.  You dunked them in hot water to get the feathers off.  I remember my grandmother was really somethin’.  There was a stump and a hatchet and she’d get the chicken and kill it.  We had rabbits, too, and they would snap their necks.  My uncles were hunters and trappers, so there was always turkey, deer and rabbits to eat.


Do you have a memory of being stunned by the process?

Once when I watched my uncle kill a pig I wouldn’t eat bacon or ham for months.  Seeing it done puts you off.  I was maybe ten or eleven years old and I didn't want anything to do with pork products.  Also my grandmother made all of her own butter, cheese, cottage cheese, and she made her own root beer. It was wonderful.  In the spring time we always went looking for mushrooms that grew around the farm near the trees and watery banks.  It was always a fun thing to do together.


What was set up of you family dynamic. Where did everybody live?

Until I was 6 we had all lived at my grandmother’s house.  My father served in the army, and my mother and myself lived with my Uncle Joe, Uncle Steve, and Aunt Helen. We’d get up and have a hardy breakfast of eggs, pancakes, and donuts. Everything was made from scratch.  There was no Dunkin Donuts, Crispy Cream or Horton’s.  My grandmother used to make these donuts with a dried paste that she made from the prunes that grew right behind the house.  They were so good, so delicious that you just couldn't stop eating them even if you were full.  We'd have our chores, and everybody would go out to do what they had to do, and you wouldn't see them until lunch time.  Then my grandmother would prepare lunch for everybody and have it ready by the time they got there.  Everybody would eat, rest on the front porch for half an hour, and then continue to do their chores.  You had to put a lot of hours in.  Living on the farm you work from sun-up to sun-down.  We had television, but there was no cable. There was only TV from 6-9 o’clock at night.  After 9 o’clock it was dark, so you’d go to sleep and wake up and start all over again.


That’s very different from today.

Much different, but it was a wonderful life.

Since you had so much on the farm…what was the grocery experience like?

We’d go to the grocery store maybe once a month for flour and salt.  We had milk, cheese, and butter on the farm.  When we went to store, we’d all stop at this ice cream shop and have an ice cream before we went home. That was a big treat.


What was with all of the fridges in grandma's house?
(Note: From as far back as I can remember my grandparent’s home had a fridge in the kitchen, a small soda cooler, a fridge in the basement, a fridge in the garage and two large ice chests where you could store 4 dead bodies…if needed)

My mother canned canned a lot of stuff.  We froze vegetables 52 weeks in a year, so you’d have 100 packs of corn and 100 packs of beans, peas and whatever stashed away.  She also canned tomato, peaches, plums and a lot of other fruits.  She would make her own pesto and freeze it in ice cube trays, and put the cubes in freezer bags and put them in the freezer.  She did that with a lot of different herbs, so that she could put an ice cube into a dish she was cooking.  The reason that was a lot healthier is because you didn't’ have to add salt to it as a preservative.  We always had lunch meat.  But not like you have now.  She’d have a used brisket and a slicer and slice it down.  Everything was sliced down with a slicer or knife.  Everything was from scratch.  Not like now at the deli with the preservatives.


There must have been a shift. When did you experience that shift?

I think, for me, it was probably in college.  I ate lot of fast-food, and I was constantly focused on getting things done as quickly as possible.  I worked at McDonald’s, so I ate there a lot.  When I was in the service, I don’t think the food was all natural.  I think that was the shift...when I went to college.


Where was the college?

I grew up in Coraopolis.  I went to college at Lycoming, which is in Williamsport, PA.  I lived there for four years.  I only came home for the summers.


Did you see any changes in mood or weight?

I was always very active, so I didn't see any change in my weight but I could see that I was...I don’t know how to say it..more tense, I think.  When I was on the farm I was much more relaxed.  It was a much more relaxed life.  With my diet and busy schedule in college, I noticed it affected the way I responded.  I would respond quickly.  I seemed to question everything.  I just know that there was a mental shift.  And now that we are talking about it, I wonder if maybe it was due to the change in food.


Maybe deadlines and way of life could have done that, too.

Could have been...while I was away from home at college I would get sicker and have a lot of colds and sore throats.  Maybe it was because of the living arrangements, but it could have been nutrition. also.  I wasn't really eating a lot of vegetables.  It was imperative that we’d eat a lot of vegetables at home.  That was something that I was lacking while in college.  We had our own property with our own gardens, orchards, blueberries, strawberries, raspberries, we always had corn and tomatoes and zucchini.  Everything that my mother did was home-grown.


When do you think the shift for your parents happened?

Probably in about their 60's.  They were starting to move to the advertising at that time for TV dinners, and, since there were only two of them, the farm was a lot of hard work, and it simply became too difficult.  I think since there were just two of them they went out to eat more often.  I guess when you get to be 60 or 70 years old you want to take the path of least resistance.  You don’t have the stamina.


That’s an interesting point – because people now have the same mentality at a young age.

Well, yeah.  I would think that the big thing is television.  Now there is television with 300+ channels all day.  Before, you could only listen to the game on the radio.  We’d plan our chores so that we could be near a radio when the baseball game came on.


And how were the Buccos doing then?

Well in 1960 they won the World Series. They were always a good team. They always had a strong following.


So it’s the TV and lack of experience in hard labor?

There is something out there.  There were no water-slide parks, and all of these things to go to.  You had to be inventive to make up your own games and entertain yourself.  Going to Kennywood was something you didn't even think of.  I really can’t say because the world today is so much different than the world I knew growing up.  There’s computers and Facebook.  There are people who spend half of their life watching television and the other half on Facebook.  I really don’t know how to relate to that. It’s just a different world.  There’s more commercial during a scheduled TV show than time for the programming.  There are a zillion and one things to keep you entertained, and kids today are still bored.


How did the farm and cooking translate into your adult life?

It made me more conscious of eating a lot of organic fruits and vegetables.  My uncle, who is 89, still has a small garden and he provides me with fresh zucchini, beans, tomatoes and peppers.  He can’t keep it on the scale that he had before.  He had acres and acres of garden, and now he has just a small plot.  He likes to keep himself busy and work with the soil.  He has fig trees, peach trees, and apples.  Now that my mother has passed away, I don’t think anyone grows asparagus.  She always had rows and rows of asparagus.  She called it her spring time treatment.  Every spring we had asparagus at every meal.  Steamed, grilled or she’d cut it up raw in our salads with our own lettuce, tomatoes and carrots.


It seems like you have a sixth sense about food...

That’s true.  I saw on the news that they have these dead zones across the US where people are unaware of different vegetables.  They don’t even know what an apple is.  Their whole diet is chips or ding-dongs.  Fruits and vegetables are foreign to them.  That’s kinda sad.


Your childhood was so different and you saw the shift. What will the next generation be like?

I saw the other day that they are making hamburgers from cow stems. I have no idea what the future will be like.


What do you think is most important for people to do now, today, for good health?

I would think that living on a farm we got good exercise.  We were exercising from morning to night. I don’t think people do that anymore.  I think exercise is good – just moving around and being active really helps protect you from illness.  I would say exercise and nutritious food are the mainstay of health.  That will never change.


What do people have to do to change that?

People have to want to change.  I mean, you have to make the commitment based on how you want you to live your life and how you want your body to be. 



Stephanie Telep is a co-founder 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 is inspired to help others make necessary changes in their lives while fostering a positive and healthy path. She can be reached at stephanie@sweatandbutter.com





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Wednesday, August 21, 2013

Why I Became a Health Coach: The Unprocessed Truth

I’m going to lay it out and strip away a few layers of professionalism, because I’m in the business of connecting to people and coaching clients through some very personal transformations.  I want to provide a very honest and raw account of why I do what I do and why I love doing it to give you an opportunity to understand where I’m coming from.  Hopefully you can connect it to your own personal journey on some level.

It wasn’t easy to write this, and it’s definitely going to force some skeletons out of my closet, but health coaching and personal transformation are all about coming to terms with who you are and who you’ve been, no matter how off-track that person may have been.  Society tends to assume that health coaches never needed coaching themselves.  Some believe that because they are in a position to help others through a transformation that these coaches haven’t struggled with it themselves.  In my case, the exact opposite happens to be true...

When asked why they chose their field, it’s common to hear from health/fitness professionals answers like: “It was the natural progression.  I had always been an athlete and into health and fitness.” That’s not exactly the case for me. I definitely have had a consistent interest in athletics throughout my life, but had I told you that I was passionate about health and fitness I would have been lying…mainly to myself.  I didn’t fully understand my motivation for the interest in food and exercise.

If you look at my health history on paper, it doesn’t look all that bad.  I was an athlete in high school and taught aerobics in college.  After college I had a string of break-ups with gyms around the world and brief love affairs with yoga, Windsor Pilates, Insanity, and Billy Blanks Tae Bo. My best friend even convinced me to run a half marathon with her about four years ago (which is also about the last time I ran…and ever will! Forget that full marathon...you know who you are).  I’d be fully committed to each one of course, whole-heartedly believing that this was the program that would finally get me the body I had always wanted, which I had always thought was my true motivation.  I could almost see myself modeling it in the future for the infomercial that sold a given program to me at 3 AM on a Saturday (while smashing a box of Cheez-Its, of course).

Nutritionally, I wasn’t much better off.  Fad diets had me on a lifetime of yo-yo dieting until I went just about crazy.  My low point was freshman year in college. To this day, I don’t know what tipped me over the edge.  It started with an attempt at the South Beach Diet.  I gave it a shot and started losing weight.  It was like a drug; the more weight I lost, the “higher” I felt.  Enter calorie counting, the perfect storm.  The less I ate and the more I burned, the more negative that number was at the end of the day.  I had all kinds of calculations that I worked from to predict how thin I could be by certain dates.  Add in eight different diet pills, eight hour gym workouts (no, I'm not exaggerating) and you get one skinny, crazy, hopped-up girl with baggy clothes and no friends.

Bare with me, it’s about to get a little worse.  This is the moment that I reflect on to appreciate how far I’ve come.  I discovered anabolic steroids from the Chinese pharmacy from which I was ordering my four kinds of ephedra.  As I was about to confirm my purchase, I decided to read one more review to make sure they worked.  I had read over and over that the risk of sudden death from heart attacks from taking these was almost a sure thing, but I just wanted to make sure I’d actually lose the weight it promised me.  I found a review by this woman who had taken them, lost a ton of weight then suffered a major heart attack leaving her partially disabled.  In my mind at the time, what was more important was that she also destroyed her metabolism.  She stated that she couldn’t so much as eat a bowl of spinach without putting on weight.  My thought process: F*%k that.  I’m not taking that shit, it’s dangerous. Clearly, I was not only burning fat cells, but also brain cells for even considering this route!

That spring break I went home for a week and something snapped back into place.  I still don't fully understand it, but I attribute it to the fact that I was back at home with family and lifelong friends. They’re not as forgiving of your isolation and self-destructive behaviors as your college drinking buddies, so it made it impossible to maintain the insanity.  In addition, my roommate finally flushed my pills in the toilet (a la Saved by the Bell: Jesse goes crazy episode), which made it harder to maintain the rigorous workout schedule I had been keeping (thanking her still).

I can’t say I was totally healthy after that, though.  I spent a few more years cycling through self-criticism and fad dieting to try to lose those elusive last 5-10 lbs.  I guess it’s probably not such an atypical story, but it is what led me to my belief that many people walk around with more thoughts of self-criticism than self-worth and the struggle to lose weight while loving themselves unconditionally is easier said than done. But we don’t talk about it...and we put on masks to try our best to look like we have our shit together. Well, let me tell you something. Most people I know who have their “shit together” are standing in it at the time.  Life is messy.  Changing your lifestyle is hard.  It can feel isolating, yes.  But in the end, it’s never about those last five pounds.  Chasing down those last five pounds was as realistic as finding the end of the rainbow with a leprechaun sitting on a pot of golden, healthy Cheez-Its.  Do I need to say that they didn’t exist?!  My struggle was not in losing weight; it was in freeing myself of the burden of the incessant feeling of the need to lose weight.

I found that freedom in learning about nutrition.  At some point I decided that I couldn’t live like I had been any longer, and I knew there had to be an answer.  Not everyone who was skinny (yeah, yeah, mentally I was still there) lived like this, and, frankly, I was sick and tired of thinking about it.  I asked myself what on earth I would think about all day if I wasn’t picking apart my body and freaking out over food.  That was my “Ah-Ha!” moment.  In order to answer that question, I enrolled in a health coaching program without the intention of becoming a health coach necessarily but rather to learn everything I could about nutrition.

The next year would change me in ways I could never have imagined and would never have believed if someone had told me about it beforehand.  Physically, I felt better.  I stopped snacking, had more energy and my frequent and severe mood swings disappeared (ask my family). I didn’t lose a ton of weight, but I didn’t care (Reread that… I didn’t care!).  I felt like I had discovered the secret to life. EAT MORE KALE! That’s all I had to do (ok...there’s a little more to it than that, but you get the point).  Why didn’t anyone tell me this before?  I had chased my tail for so long and so unnecessarily. Emotionally and mentally things just didn’t seem like they were quite as big of a deal.  It was like waking up with 20/20 vision after a lifetime of wearing scratched lenses.  For me, this knowledge really was power.  Previously, my food choices had been based on whether or not I would feel guilty after a meal.  Now, I understand that food serves a purpose, at the cellular level, for every function of my body.  By making good choices, I was optimizing each of those functions.  Don't get me wrong, this new understanding of food didn't resolve my issues entirely, I’d be lying to you if I said that, and what would be the point of that?  After reading this, you’ve practically seen me naked.  I will say, however, that I now feel that I have the tools to steer my life - and the life of my clients - in a healthier direction.

It’s been almost four years since I graduated, I still have my moments and have definitely fallen off the wagon more than a few times. I've said it before, and I’ll say it again: lifestyle change is tough, and the habits we’re trying to break run deep.  I have realized that so many of my issues with food weren’t about food at all.  I needed to fortify my relationships by spending more time laughing with friends and on the phone with my mom than on the treadmill.  I needed consistency: good food, high quality nutrition and daily workouts over time.  I made time my goal, not weight. Maintain balance over a year instead of aiming for a number and instant gratification.  That way, even when those old thoughts try to resurface, they’re powerless because they're irrelevant to your goal.

So I’ll say it again: It wasn’t just about the food.  I was neglecting many areas of my life that needed attention, but without understanding nutrition and removing that hurdle of lies and inaccurate information, I couldn’t see clearly enough to focus on what those real issues were.  So it was kinda about the food, too.  I know you're wondering...Yes, I can finally answer that question I asked myself way back when: what would I think about all day if I wasn’t criticizing myself and obsessing over food?  Well, the answer is…food, and can't we all see the irony in that?  Moreover, we give food the power to blind us to the issues that really nourish us as social and spiritual beings.  What I focus on now is how important it is for me to coach as many people as possible through their own version of this story and help them to really live their lives, to laugh and play, to enjoy each day in vibrant health, to dream bigger than a smaller jean size, to love themselves unconditionally, to finally appreciate the hard work and sweat it takes to get there, and to live for the butter!

Vanessa Alberts is a co-founder and health coach at Sweat and Butter. She received her training at the Institute for Integrative Nutrition and holds a master's degree in Health Policy and Management from Carnegie Mellon University. She coaches clients to optimize their health and happiness through nutrition and personal evaluation. She can be reached at vanessa@sweatandbutter.com.



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AHS13 - Going Forward: The Power of Health Coaching

Figure 1. Ancestral Health Symposium by the numbers

(Disclosure: I am the co-founder of a health coaching company called Sweat and Butter, so I am biased in my views on health coaching.  However, my optimism that health coaching is a plausible solution to the most complicated patient problems was the driving force behind the establishment of Sweat and Butter.) 

The Who's Who of Paleo
The 3rd Annual Ancestral Health Symposium (AHS) took place this weekend in Atlanta, Georgia.  It was a meeting of the minds among physicians, dietitians, optometrists, researchers, biochemists, athletic trainers, chiropractors, anthropologists, biologists, and neuroscientists.  I've been practicing a "primal" lifestyle for nearly four years now, yet the conference was a refreshing change of pace because the ancestral health community is beginning to more heavily attract the likes of economists, historians, philosophers, statisticians, and politicians.  It also continues to drive an outcropping of grass-fed, all-natural, free-range, sustainble edibles and toiletries, evidenced by the various vendors at the event's expo.  Farmers are showing up to share their difficulties in balancing food politics with consumer demand.  Lawyers are dropping in on the conversation in an effort to strategize how to take the food industry to court for their sins.  This whole thing is becoming fun!

I first discovered the Paleo diet when I began working out at Crossfit South Hills in 2010.  Prior to that, I had been the typical wheat-guzzling triathlete, but this new diet worked for me.  It was easy to follow: eat loads of vegetables, buy quality animal products, minimize dairy consumption, and cut out wheat, processed foods, and vegetable oils.  It was transformative to my performance, but, more importantly, it opened my eyes to a community of people that were working towards the same goal: get healthy while utilizing sustainable means for the sake of a healthier environment and community.


An Interface Between Biological Science and Patient-Clients
My conversations with attendees and speakers this weekend have made me think more deeply about the need for health coaches to meet the demands of our nation's growing health problems.  Health coaches could potentially serve to interface medical science with patient-client lifestyle modification.  In the five minutes that I spend with a patient in the clinic, I don't have time to review diet, sleep, stress, relationships, and movement.  It would be hugely beneficial if a health coach could work with a patient in between office visits to ensure that they have the resources and know-how to develop healthy habits for the betterment of their health.  

If we could collect data on which interventions work best to control various health conditions and for how long these interventions need to be applied, we may be able to convince health care payers that health coaching is a worthwhile, cost-saving mechanism for improving the population's health.  The problem with this is that we've shown that patient compliance is poor for many interventions, even prescription pills, which require little effort on the part of the patient.  Perhaps the problem is that people tend to not take advantage of services that they don't value.  In developing some of these ideas with Jacob Egbert of Primal RX, he drew comparison to business training services that were gifted to him. Despite a high monetary value, he would go months without even cracking into a service that he received at no cost to himself.  On the other hand, paying for a service made him feel obligated to stick with it over the long haul.  


If They Try It, They'll Be Sold
Despite a long list of hesitations and excuses, even the most difficult patients respond to lifestyle modifications as a means of addressing their health woes provided they actually do what their physician recommends.  The holy grail to getting patients to subscribe to lifestyle modification recommendations is for them to try it.  Robb Wolf dedicates an entire chapter to this principle in his book, The Paleo Solution.  If a patient sticks through a cleaner diet for 30 days, they'll likely see improvements in energy levels, mood, sleep, weight, and digestion.  Add in some movement and an hour or two more sleep per day, and they'll start feeling great!  Indeed, you can modify your lifestyle ad infinitum and continue to see improvements.  Patients will likely grab the wheel after they see that losing weight or improving an inflammatory process is possible, but they have to see and feel those results first.  The health coach's job is to hold a patient-client's hand until they're convinced that they can hold the reigns and start calling the shots.  And this occurs not long after the patient sees the remarkable results that lifestyle modification can bring.

The reason that lifestyle modification - when done correctly - works for most people is analogous to a mattress salesman persuading you to make a purchase by allowing you to sleep in one of the store's display beds for a few nights.  SOLD! Once a Sweat and Butter coach gets you over that threshold, the patient-client will begin practicing healthier habits on their own, but it's unclear how to define or quantify that threshold.  I have seen it take anywhere from weeks to years for this transition to take place.  Assuming we know what's best for a patient's health (yes, we have a pretty good idea at this point), many questions remain: How long does a person need to be led by the hand in order to feel empowered to take their health into their own hands?  What objective or subjective metrics are important for them to be satisfied with their progress?  How do we measure these objectives? We need data to answer these questions.


Marco!....Polo!
What I would like to see is a comprehensive health program whereby a physician makes lifestyle recommendations to patients (old news).  Then, a well-paid health coach spends as much time as necessary with the patient to ensure that they are empowered to make further lifestyle tweaks autonomously.  Health coaching is a relatively new principle, but Iora Health has been utilizing coaches for several years. They have a few clinics across the country, and they hire nine coaches for every two physicians.  Their primary health outcomes have improved across the board, and they have plans to open up more clinics across the country.  Although the evidence that they report is only moderate in strength, it's a start.  This concept is theoretically sound, but it's going to take a lot more data to prove that it works.  

Our healthcare system needs an interface between the medical sciences and our patient population.  This interface, ideally, would be (a) sympathetic to patient needs, (b) designed around healthy habit formation for long-term compliance, and (c) utilize well-trained, passionate coaches.  The conventional health insurance model requires zero responsibility on the part of the consumer.  If a patient doesn't have to pay for it, then they likely won't ascribe to it.  But they also hate to disappoint their doctors. With only fifteen minutes per office visit with a physician, there is little time for sufficient Q&A about lifestyle.  It's too easy for patients to simply nod and smile as we ask scripted questions like, "Have you been eating more vegetables?"  Health insurance may pay for this, but it doesn't mean that they'll utilize the service.  After all, prescription pill compliance is a huge issue, and this only requires swallowing some pills once or twice per day, let alone making changes to your eating, exercise, and sleep habits.  

If you are a member of a Crossfit gym managed by trainers and owners that are fully invested in improving the health of their clientele or if you found your physician through the Paleo Physicians Network, then CONGRATULATIONS!  You've already got a health coach!  For the rest of the population, consider this: what if a personal health coach met with you bi-monthly instead of the once per three (or six) month schedule to which patients have grown accustomed with their physicians? Furthermore, these coaches would work with you to overcome the emotional and psychological barriers you have to healthy habits.  They could help you plant gardens, teach you cooking methods, and guide you towards better sleep hygiene.  They would also address the [lack of a] support system at home, give you a shoulder to lean on when things get tough, whatever it takes...Would this system work for you?

I've been watching these transformations happen for several years now with even the most stubborn clients, and I think it would.  Many people across the world have been playing a game of marco polo with health professionals.  They're yelling "Marco!", and the best that our system has been able to provide is a 15-minute office visit whereby we physicians have little time to address sleep, stress, food, movement, and relationships as components of a healthy lifestyle.  It's no surprise that the system doesn't work!  The deep seated beliefs and misconceptions about diet and exercise alone require more delicate handling, and patients need to be held responsible for enacting change when they're given access to good advice.  Sweat and Butter and the Paleo community at large are screaming "Polo!"


Monetary Investment vs Handholding
Unless our government crumbles to the ground because of the growing national debt, we're stuck with a system that prizes a large, expensive, and convoluted model for health care.  If we want to do right by our patients, we need to make access to the system affordable.  As I mentioned before, when consumers aren't connected to the price of a service, they begin to take it for granted.  An office visit is devalued by the fact that it was seemingly given to them for a small co-pay, and the physician-patient relationship has been warped as a result.  Physicians are expected to take care of a patient's needs without a patient blinking an eye at the price.  The current system claims to be making great efforts to improve preventative care, yet it doesn't place any responsibility on the patient to work on implementing healthy lifestyle modifications in between visits.  I see two ways in which we can get people to value a lifestyle modification program:

1) Patients must invest monetarily (i.e. Fee-for service)
The problem with this model is that it only works for those who can afford to buy in.  In an ideal world, the income inequality gap wouldn't be so large, but that's the way things go for the time being.  The success of the Crossfit community is that its clients prioritize a relatively large sum of money (anywhere from $95 up to $300 per month) to be a part of a community that works to engage them in lifestyle change.  Crossfit gym members prioritize the price of their monthly membership because the workouts and community helped them realize a sense of well-being that they had never before experienced.  When Obamacare kicks in in 2014, the incentive for the underinsured to take better care of themselves will also be removed.  The bottom line is that if you are relying on health insurance to keep you healthy, we've proven that our current health care model is inadequate, and a big part of the problem is that patients don't have to big deeply into their pockets when they get sick.

2) Patients are under regular supervision
If a health coach was part of the deal, the patients would be held accountable for meeting the recommendations made by their physicians.  The key here is to get them to try a few small modifications.  They'll see the results in their weight, mood, digestion, etc. and this is important for the formation of healthy habits.  They don't have to pay for the health coach out of pocket, but they certainly have to answer to them.  When they start to feel great, they'll be hooked for life.  The many success stories that come out of the Paleo community corroborate the notion that an improvement in symptoms (e.g. patient experience) can drive healthy habit formation.  The price tag becomes a moot point.

Of the two options, the latter might have a better chance of succeeding once we scale this up.  The patient is accountable to a health coach in between physician check-ups, and, eventually, time spent with the health coach could be weaned until the patient doesn't need to have their hand held any further.  They will have developed healthy habits because they began to experience subjective improvements in their well-being.  Their biometrics (e.g. lipid panel, hip-to-waist ratio, blood pressure, etc.) also will have improved.  Get a health coach into a household, and we'll likely see their positive improvements taken up by family members and furthermore driven deeply into communities.  Until health insurance subscribes to this concept, health coaching may only remain a solution to the growing health concerns of the affluent (e.g. health coaching as an out-of-pocket expense), as even very affordable programs such as those offered by Sweat and Butter aren't accessible by the lowest income groups, but it's reasonable to assume that it can eventually be applied to all sociodemographic groups. 


Data Drives Decisions
Collecting data to answer our research questions is the tricky part.  Getting clients in private health coaching companies to sign on as part of a research project may be easier than it seems, but we won't know for sure until we try.  Biometrics are necessary, and technology companies such as Dan's Plan might provide important insight into how to track a patient-client's progress over time and help them identity for themselves common trends over the course of their transformation.  Food journaling and subjective markers like a sense of general well-being will also play a role.  

The face of healthcare is changing, and we need to consider a variety of disciplines in finding an answer to our nation's growing health woes.  The Paleo community is becoming a confluence of hundreds of disciplines, providing the unique opportunity for academics and practitioners to share ideas and hypothesize such solutions.  More importantly, we're starting to put this stuff into practice.  Eating a Paleo diet makes sense, and it works.  Thousands of patient-clients can vouch for that.  But how do we make it accessible to all?  Our nation's health care model doesn't work, so perhaps health coaching and technology are, in the very least, worth a shot. 

When people start to feel healthy, they will become subscribers to lifestyle recommendations.  They will begin voting politically through sustainable food purchases, they will become more productive at work, and they will be generally happier.  If you've found things that work, you need to continue to espouse your views to friends and family.  If they won't buy into your ideas, then a health coach can step in and work their magic.  Our coaches have the gift of empathy, enabling them to pick through a client's excuses by addressing the psychological and emotional stressors that have kept them from stepping out of their comfort zone and towards a healthier alternative.  With proven modifications in hand (e.g. Paleo dieting, high intensity training, sleep science, etc.),  human psychology and behavioral science can be applied to create lasting changes.   For the time being, health coaching works remarkably well as a private service.  Once we get some data, we can hopefully convince health insurance providers and corporate work places to subscribe to this concept, too.

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 nathan@sweatandbutter.com.





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Wednesday, August 14, 2013

The Adrenal Glands, Part 2 - 9 Steps to Reversing Adrenal Fatigue

In Part 1 of our discussion on adrenal fatigue, we discussed the biochemistry and physiology behind the impacts of chronic stress on your physical health.  To sum it up: we're working too hard, doing too much, and sleeping too little to recover from this stress.  It's making us sick and keeping us fat, and it's of utmost importance to reverse adrenal fatigue if you are hoping to lose weight or perform your best. Indeed, when you register for health coaching through Sweat and Butter, one of the first things that our coaches will address is stress.

In Part 2 of this discussion, we'll give you a head start on fixing adrenal fatigue.  Swallow these 9 pills, and let us know how you feel in the morning (we already know the answer):

1) Clean up your sleep
Sleep hygiene is all the rage these days.  It refers to optimizing your sleep environment in order to maximize restfulness when you're asleep.  Improving your sleep habits is the number one thing you can do to prevent recurrent adrenal fatigue symptoms.  Remember: when you sleep, your adrenals sleep, too.

The jury is still out regarding exactly how much sleep we humans need, though it's probably somewhere in the range of 7-9 hours per night.  But the quality of sleep is even more important than the quantity.  The science of sleep is still in its infancy, but studies suggest that you will find sleep most restful when (a) the room is pitch black, (b) the room is quiet, (c) you go to bed with a clear mind, and (d) you limit light exposure prior to laying down (light disrupts your circadian rhythm through the dysregulation of cortisol and melatonin).  If improving sleep hygiene isn't sufficient, limited research supports magnesium supplementation as a sleep aid.  Steer clear of melatonin supplements.  It's a hormone, and supplementing with hormones can throw you way out of whack.

As you already know, sleep is one of Sweat and Butter's five major categories of lifestyle modification because it influences so many metrics of health.  Stay tuned to the Sweat and Butter Journal for future posts on this important topic.

2) Meditate
Yes...I said it.  Meditate.  This doesn't require you to pack your bags to some far-off ashram in India. All that I recommend to my patient-clients is to find a quiet room, dim the lights, reduce distraction and sit still.  Focus on your breathing.  Imagine you can watch the air around your face being inhaled then exhaled.  Set your phone to airplane mode, start a timer for 5 minutes and relax your mind until the timer goes off.  Don't continue your meditation beyond the 5 minutes, even if you feel like you could go for 10.  Turn off the alarm, and carry on with your day.  Try this for 30 days, then bump it up to 6 minutes.  I have to give Chris Kresser credit for finally getting me to try this.  He mentioned this 5-minute smartphone alarm strategy in a podcast a while back, and I've been hooked ever since.

3) Increase your consumption of starchy vegetables and tubers
If you recall from Part 1 of this discussion, your adrenal glands help regulate your blood sugar.  If you eat a diet with too few carbohydrates, your adrenals have to work double-time to maintain sufficient blood sugar levels to feed your brain's insatiable hunger for sugar.  Processed carbohydrates are always going to be a no-no, but if your adrenals are smoked, increasing your carbohydrate intake will likely alleviate that groggy feeling you've experienced from chronic stress, excessive exercise, and sleepless nights.  Hold off on the sweets, bread, and pasta.  You can get all of your carbohydrate needs from sweet potatoes, yams, squash, and nuts in addition to increasing your consumption of vegetables.

4) Ease up on exercise
Exercise is an incredible tool for weight loss and vitality.  It is implemented in the military forces to train tougher soldiers and by professional sports teams to develop stronger, faster athletes.  It is the mainstay of many transformative weight loss and general fitness programs (e.g. Insanity, P90X, Crossfit, etc.) because it helps increase muscle mass, a necessary component of restoring insulin sensitivity in your body.  But exercise is a huge stress on the body, and, in excess, is no different from any other stress.  If you are working your butt off in the gym for hours on end, we are talking to you!  Many individuals have found that a combination of high-intensity exercise and low-carb dieting is the magic combination driving their successful weight loss stories, but too much of this potent combination wreaks the same havoc on your adrenals as any other stress.

You don't have to cut all exercise out of your life.  When you find yourself sleep-deprived or working longer hours than usual, I recommend limiting the high-rep, high-intensity workouts and opting instead for a few sets of heavy weight lifting.  When I can tell that my body needs a break, and I still want to do something physical, my go-to is the following:
  • 5 sets of 5 reps - Heavy back squat
  • 3 reps, then 3 more reps, then 2, then 1 - Heavy deadlift
  • 4 sets of 2 reps - Light snatch
Note: Increase the weight such that your first set of heavy back squat is lighter than the following set, etc. You can substitute any weight training movements into this sequence, and I encourage you to mess around with various rep schemes.  The lower reps keep your muscle working, but it's not as taxing on your adrenals as the aerobic, high-rep sessions that form the foundation of most clients' exercise programs, particularly women.  And please, for the love of the tender baby jesus, don't attempt any movement using heavy weights without some form of professional instruction beforehand.

5) Use your vacation days or call in sick
If you speak to citizens of virtually every other country in the world, you'll find out that we are the laughing stock of the world with regards to the amount of hours we slave away at work.  A 2007 report by the Center for Economic and Policy Research found that, of the 21 richest nations in the world, the US of A is the only one that doesn't guarantee workers paid vacation days or holidays:

Our culture views hard work as virtuous, and perhaps it is, but the number of hours that we spend working cuts time from our relationships, meditation, education, fun, and all of the other things that we are saving for retirement.  If your work place allots sick days or vacation days, USE THEM!  If it helps to ease your conscience, call them "so I don't get sick down the road" days.

I'll never forget those days that my mom took off from work to help out at my elementary school functions.  She's a busy hospital administrator who regularly works ten-hour days before spending her evening at home preparing to do it all over again the following day.  When she managing to find time to chaperone a class party or Boy Scout function, it meant the world to me as a child.  In addition to bolstering your relationships with friends and family, you can use the free time to kick back with a beer and simply enjoy a sunny day out from behind your desk.  This stuff is important!!

6) Unplug
We are on information overload.  Texting, tweeting, Facebooking, Instagramming, podcasting, audiobooking, blogging, and the TV dominate our lives.   Our drive to "get 'er done" is now manifesting as an anxiety-ridden information free-for-all, and it's hurting our health.  You remember how great it was to spend the weekend at that cabin that was so deep into the woods that you didn't get cell phone or 3G reception so you were forced to go without it?  How about that time when the power went out, and you were forced to sit around and talk to your family?  It felt great to be unplugged from your electronics, right?  We're all guilty of this, even those of you who claim to live a life free of TV.  Our society is geared around 24/7 entertainment: elevator music, multiple TVs at bars, music while we are on hold with customer service...it's everywhere because we have been conditioned to need it!


Information overload is stressing you out by making you feel compelled to check your Facebook newsfeed or how many people re-tweeted that picture of your breakfast.  Re-create these golden, unplugged moments regularly to give your mind a break from the action: turn off your phone, steer clear of the news if the negative and/or irrelevant headlines are bringing you down, and leave your iPad in the kitchen.  Or, better yet...

7) Go outside!
A Scottish study found that city dwellers had a higher rate of medication prescription for depression, anxiety, and psychosis.  What does this mean?  Well...it merely shows an association, which doesn't necessarily mean that living in the city causes these disorders.  But have you noticed a difference in your stress levels when you spend time in a rural setting away from the noise and distraction of city streets?  Every time I go into the woods for even a few hours, I re-emerge with a clear mind and a subjective feeling of happiness.  Another thing that you can try once in a while is simply walking around in the grass barefoot.  One of our health coaches, Vanessa, even goes barefoot while walking her dog!  It feels great to be contact with the dirt, and you'll soak in some sunshine in the process.  The next time you attend an outdoor concert, slip off your shoes and squeeze the grass and dirt between your toes.  Getting funny looks?  Just tell them: "It's therapeutic, baby."

At Sweat and Butter, we respect the inner-animal in all human beings.  There is evolutionary rationale for the benefits you reap from nature, but you'll have to wait for future posts to read more.  I can say that the advantages of unplugging from life are the primary motivators for Sweat and Butter's much anticipated health retreats that we will begin hosting the spring of 2014.  Stay tuned!

8) Love thy neighbor
Community is key.  If you aren't making time for the people in your life, you aren't doing your stress levels any favor, which means more pressure on the adrenals to keep you moving (GO! GO! GO!) from the moment your alarm clock jars you from your sleep.  A study on friendship and stress concluded that having a best friend present during a stressful experience attenuated a person's stress response.  Translation?  A little friend time will go a long way in reducing your stress levels long-term.  

To make matters worse, if you feel stressed then the people around you can probably feel it, too.  Set some goals to implement these changes into your life.  By making this transformation something that you do with your spouse, partner, or colleague you help one another mitigate the effects of stress, which, as we have discussed, is critical in meeting your other health goals.  Schedule time with friends that have similar health goals as you, and be sure to incorporate stress-reducing activities into your exercise and diet plans.  This will make your time together more meaningful while helping one another keep stress at bay.

9) Drink less caffeine
Our nation consumes, on average, three 9 oz cups of coffee per person daily, and 60% of coffee drinkers state that they require coffee in the morning.  Caffeine bullies the adrenals into working harder, and coffee is loaded with it.  Many people swear by coffee and, indeed, can't get through their day without several cups.  These same people are likely in some degree of adrenal fatigue.  Kicking a horse that has keeled over with exhaustion might convince it once or twice to get up and keep running, but, eventually, that horse is cooked.  Coffee and energy drinks work the same way, by kicking your adrenals to ramp up epinephrine, which spikes your blood sugar in the morning as part of the "flight or fight" response. You should be neither fleeing nor fighting first thing in the morning, but, if your adrenals are fatigued, you need the caffeine kick to get moving.  Caffeine is also addictive.  If you're a caffeine addict, you need to try to break the addiction, because your 24/7 consumption of coffee is forcing the adrenals to work beyond their capacity.  It's likely also screwing up your circadian rhythm (see Step #1).
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We have covered a lot in these two posts.  Part 1 helped you understand why it's important to minimize stress for the sake of our adrenals.  Part 2 outlines an action plan for you to make some of these changes in your life in order to recover from adrenal fatigue.  My last piece of advice on this topic is to not attempt to make all 9 changes simultaneously.  That's asking a lot of yourself, and it increases your risk of failure.  Start with one of them, feel it out, and implement it for a few weeks before trying to incorporate a second.  This strategy will slowly develop these activities into healthy habits, and that's the point of this transformative game. 

You're welcome, adrenals.

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 nathan@sweatandbutter.com.





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Saturday, August 10, 2013

Guest Post: What's Your Boston Marathon?

Last summer I was invited to a medical student event about Integrative Medicine, a field that combines our American “western” medicine with all other methods of healing out there: holistic medicine, osteopathy, acupuncture, herbal supplements, all around health and healing. Attendees for the event consisted of myself and about 30 other medical and osteopathic students from all over the US. On the first night we all introduced ourselves by talking about an item that is sacred to us. My family doesn’t have any jewelry to pass down, and I think with the exception of my pictures, I see the other things I own as replaceable. So I picked something that was very special to me, and had good meaning behind it – I picked my medal (completion medal, this girl came no where close to winning) for the 2011 Boston Marathon.

I love to run. Love. To me, running is a gift. Running, along with good nutrition, is the core to my physical and mental health. It is gives me cardiovascular stamina, muscular endurance, and the “runner’s high” from endorphins being released are undeniable. Running has helped give me balance in my life. I do not run everyday, and I also know what happens to my body if I run too much. Running is a gift that I do not want to take for granted, but I also do not want to abuse it. I think that especially for women, it’s important to exercise – you absolutely should do it, but do it in a way that is best for own body.

After college, I wanted to give the marathon a try. I surprised myself by qualifying for the Boston Marathon after running my first marathon in Philadelphia, and I decided to give Boston a shot. My training for Boston was lame. I fell way behind a training schedule (Philly becomes a tough place to run in the snow) and, in large part because I was in my first year of medical school, I let myself get way too stressed out. I was all set to bag my spot in Boston, but, after talking to Nathan about it…he gave me a long talk about how quitting would be really stupid, and I will never forget him saying, “What do you think your kids are going to say? Do you think they are going to say, ‘Mom, tell us about that quiz in medical school’. No! They are going to want to hear about you running the Boston Marathon!”

And that was it. I sucked it up with my training, got a peak run in, and made the trip up to Boston. Oh my, it was worth it. The whole weekend leading up to Marathon Monday was exciting, and I was so proud to be a part of the party. I learned why this marathon meant so much for the city of Boston; a marathon that now means so much to our country after this year’s tragic events. I ran the Boston Marathon in 3:29:57. I could see the clock far down Boylston Street and made myself get under 3:30, much slower than my PR, but I didn’t care. What mattered was that I took a crappy situation that was making me consider quitting something I loved, and I stuck to what I loved even when medical school was starting to pull me away from it.

That night as I told the story behind my Boston medal I said, “I believe that everybody should have something that medical school can’t touch.” For me, I don’t want my career to come near my running. At times it certainly has…any medical student knows during third year you struggle to maintain your physical health. I have learned how it feels to have something pull you in the direction opposite your dreams and also create poor health habits. Running the Boston Marathon taught me how it feels to prioritize your health and take care of yourself. For me, between medical school, getting proper nutrition and enough sleep, exercising, and maintaining a relationship…this is a balance I am still working on, as I can imagine so many of you are as well. I still do not have it figured out, but it feels good to know that I have initiated the journey to better health.

Everybody has a Boston Marathon, a goal that they can accomplish, or a dream of being something different, doing something new that can create a healthier life. Everybody has something in their life that pulls them away from what they love or that dream that  they want to achieve. Your Boston Marathon could be reaching a healthier weight, taking the trip to Spain for the tomato festival, learning how to cook healthy meals, creating that backyard garden, coming out to your family about your sexuality. It could be the Boston Marathon, an Ironman Triathlon, running 4 laps around a track, or finally signing up for yoga classes. What are some things you have wanted to do for yourself to become physically and mentally healthier?

Your medical school could be your current job, pressure from family, financial troubles, or the fear of putting yourself out there.  The obstacles to maintaining a healthy lifestyle are endless, and I know first hand how it feels to not have the energy or time to exercise, cook a meal at home, do some yoga, or call a friend.  But change is always possible, and it can happen everyday!  The first step to a positive change is realizing your dreams and goals, and then coming to terms with your internal and external obstacles.  It is the first step to a life-changing transformation.  It all starts with small changes, and you can take back the life you want to live.  I understand that it's not easy; pursuing your dreams and being true to yourself can be a very vulnerable feeling.  There is a fantastic Ted Talk by Brene Brown called "The Power of Vulnerability".  She talks about putting yourself out there to change: "I'm just so grateful, because to feel this vulnerable means I'm alive."


I will end this with a quote from the short film “35”, a quote I taped on my refrigerator. “Inside, we are all capable of surprising ourselves. We all have dreams, but they don’t mean much if we don’t act on them.” Life is too short to let medical school touch your Boston Marathon.


I am very grateful to be a part of this journey we are all on, and I look forward to the connection, education, and relationship we will all gain from Sweat and Butter.

Casey Meizinger is a medical student from Philadelphia. She has a deep interest in integrative musculoskeletal medicine and plans to specialize in Physical Medicine and Rehabilitation.  Casey has a passion for promoting sustainable health and wellness - she majored in Exercise Science in college and she introduced her medical school to Integrative Medicine.  She is an NSCA Certified Strength and Conditioning Specialist and loves yoga and long-distance running.  Casey is excited to empower others with a sustainable, healthy life.






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