Monday, January 20, 2014

Want to change your ways? Then act like it.

The majority of our clients seek weight loss.  Our health coaching programs begin the same for every client: a very long, comprehensive health history.  The majority of what you read about the science of weight loss revolves around thermodynamics: eat less, exercise more. Yet we know from experience that this advice isn't sufficient.  In fact, if you gave 100 clients a list of basic recommendations, 90 of them would fail to lose weight.  The art of weight loss is less about the specific lifestyle modifications and much more about human behavior than the media and the majority of trainers divulge.  So what do successful dieters have that separates them from the pack?  Successful dieters act like successful dieters.  This is simple advice, but it requires some patience to apply it to your life.  

Don't be mislead; this is not a guide for how to lose weight.  The purpose of this piece is highlight one of the more important components of behavioral change.  It shouldn't be that hard to believe that if you want to lose weight you have to act like a person that has successfully lost weight.  You can apply this logic to any venture.  
  • "I want to be rich.": If you want to make more money, then you have to act like a person who has earned a lot of money.  
  • "I want to be a better hockey goalie.": To improve your competency in net, you need to act like a star goalie. 
  • "I want to win the 2014 Crossfit games.": You want to be the best at working out?  You might want to take some notes from other successful Crossfitters.
  • "I want to be more productive.": The first step is to find out how productive people pack so much into their days without losing their minds.
  • "I want to start my own business.": A good first step in starting a business is to read about the experiences of other successful entrepreneurs in order to learn from their mistakes.
Any new behavior requires practice to make it perfect, and the same goes for healthy lifestyle. If you want to live a healthier life, you need to start acting like a healthy person.

There Are No Secrets to Weight Loss

Wouldn't it be great if your failure to lose weight was due to you simply missing an important memo?  If only you knew the secret to weight loss, you would have achieved your optimal weight long ago.  Right?  

You will never have my shoulders.
Never.  Ha!
The bad news is that there's no secret.  Your genetic blueprint provides a foundation for how your body stores fuel.  Then your mother's lifestyle while you were in her womb laid the groundwork for the metabolic programming that dictated the way that your body has handled carbs vs protein vs fat since then.  Genes load the gun; lifestyle pulls the trigger.  Without lifestyle modification, you'll never achieve optimal, healthy weight loss.  The first, most important step is to start acting like a person that looks and feels the way that you want to look and feel.  

Now now now...before you get your pretzels in a twist, I should emphasize that I'm not refuting the importance of bio-individuality.  You are a unique snowflake in this world, so even your most driven, stubborn efforts will at best give you the optimal results as dictated by your genes.  In other words, spying on Dwight Howard for a year, and modeling your entire day to a T after his isn't going to give you shoulders broader than the Titanic.  Likewise, eating the same diet and adopting the same workout routine as Lindsey Vonn aren't necessarily going to launch your ski career.

If you want to lose weight, then act like it...

It takes a lot of courage to change your ways.  Many chronic dieters were raised in households that indoctrinated poor eating, sleeping, and exercise habits.  Weight loss is even more difficult when you are chronically stressed from work, the loss of a loved one, a difficult living arrangement, or financial ruin.  In our first session with clients, we try to expose some of these stressors so that everything is out on the table.  Adopting lifestyle change is most difficult when stress leads to overeating.  There's often little that we can do to help a client with some of these often tragic events in their past, yet they have approached us because they want help losing weight and improving their mood despite these difficulties.  Once you have decided that you want help with developing healthy habits, then the conversation really gets juicy. 

The conversation around behavioral change often starts with a question to myself or one of our health coaches: How do you stay so thin?  If you follow us on Facebook, Instagram, or Twitter, you might think that we are sustained by copious amounts of kale and sunshine alone.  In reality, we pay little mind to what we put into our mouths. (queue the shock and awe)  Before you call horse shit, read that again.  It's not difficult for me to eat healthy. Sure, I indulge on occasion, but I never have to think too hard about what to order at a restaurant because I know that crappy food is detrimental to my goals whereas the good stuff is beneficial.  Eating healthy is not a task for us; it's a habit.  We don't struggle to make decisions around what to eat because healthy food is what we enjoy.

How to act like a successful dieter

Weight loss isn't supposed to feel like torture, but you're kidding yourself if you are looking for an easy way out.  A game plan for developing healthy habits is an important part of the solution to the Gordian knot that is long-term weight loss.  Re-framing your approach to weight loss should begin by thinking like a person that exhibits effortlessly the behaviors that you know for sure are required for you to stick to your New Year resolution.  Not everybody has accomplished what you hope to accomplish in the same way, but there are certainly similarities shared by successful dieters.  Here are a few examples of what successful dieters do:

Hang out with motivated, healthy people - If you have friends that regularly push desserts and alcohol on you, don't hang out with them.  Find friends and family that are supportive of your goals and who are willing to accommodate your special requests and spend more time with them.

Find a community - Crossfit gyms provide more than a great workout.  They regularly host diet/weight loss challenges, and the community fostered in these facilities enables its members to reach incredible new fitness goals.  You immediately become a member of a team of like-minded individuals when you cancel your L.A. Fitness membership and join a local Crossfit gym.  Likewise, you can find weight loss support groups in your city with a simple Google search.  Lastly, if several of your family members or friends have similar goals, set up weekly meetings to discuss your difficulties.  Don't bring cookies to the meeting. 

Shop on a full stomach - Make sure you aren't starving when you head to the grocery store. Structures in your brain called the amygdalae trigger those impulsive snarf-fests when you see a bowl of candy.  You can override this impulsion with practice, but, even if you have relatively good control under most circumstances, going to the grocery store post-workout or on an otherwise empty stomach will likely result in you buying too many crappy, sugary foods.

Don't keep junk food in the house - If it's there, you're going to eat it.  If it's in your mom's house when you go to visit on occasion, this is called an indulgence.  Occasional indulgence is awesome

Substitute water/tea/decaf coffee in for soda/fruit juice/energy drinks - Minimizing sugar intake is critical for restoring insulin sensitivity and thus reversing the metabolic derangement that resulted in your gaining weight in the first place.  Cut out soda and fruit juice.  Also, give your adrenals a break and kick your caffeine habit.

Stop complaining about your diet - While training in Ironman distance triathlon, I wouldn't burden dinner dates with details of my struggles to decrease my swim stroke rate for the same reason that you shouldn't bore your friends with your weight loss struggles.  Save it for your health coach or supportive community.

Focus on the positives - Losing or maintaining your weight isn't supposed to be a perpetual chore that brings you anxiety.  Many of us have a habit of talking to ourselves in a way that we would never speak to a friend, so why is it ok that we put ourselves down? "You're so stupid!" "I can't do this." And so on.  Quit it.

Sleep - Really.

"Acting the role" can be applied to help you learn a new skill, set a new personal weightlifting record, earn that new promotion at work, become rich, or improve your relationships.  If you are trying to improve yourself in any way - physical, mental, or emotional - ask yourself: "What would a successful bi-linguist/olympic lifter/good parent/recently promoted colleague/person with a lot of friends do?"  This stuff works to change or develop any behavior.  If you can ask and answer this question routinely, you won't need much more to help with losing weight.  

Click here for our list of general dietary guidelines.  Couple those with weightlifting three times per week and starting to act like a person that is determined to achieve their optimal weight.  You're on your way...

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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You Are Malnourished; Therefore, You Crave?

I consume food only while the sun is up.  This leads to natural twelve-hour fasts every day while the sun is down.  When I wake up, I usually have decaf coffee with Kerrygold butter, coconut oil, or both blended in with my Nutribullet.  It's foamy, fatty, and delicious!  While I'm preparing that, three or four slices of bacon are slowly frying to perfection.  I'll also eat about a half pound of greens and three or four eggs.  This is my breakfast nearly every morning. 

The hospital cafeteria food stinks, so I rarely eat throughout the day.  On occasion, however, I'll get a hankering for something around 10:00am.  This is especially true when I completed a particularly hard day of Krav Maga, Crossfit, climbing, or some combination of the three the day before.  The grumbling in my stomach doesn't discriminate when it comes to food.  I'm not craving a specific nutrient, I just want something in my face.  The coffee cart, gift shop, and cafeteria offer quick, easy calories in the form of candy, cookies, syrups for coffee, pastries, etc.  Thirty percent of the time, I cave, snarfing down an extra-large cookie or candy bar.  It tastes great, and I can eat it while I'm walking between patient rooms, but then I'll become hungry just an hour later.  On the other hand, I could go to the cafeteria and order two or three servings of their vegetable of the day, throw a pad or two of butter on top, squirt on some lemon juice, and I'm set until dinner time.  I'm often consuming less calories by choosing this path, yet I'm satisfied for longer.  As my Canadian friends might say: curious, eh?

Physiologic control of cravings

Man vs Food vs Diabetes
One of the most important things that you can do for yourself is to be cognizant of your nutrient intake. I'm not asking you to count carbs, protein, and fat.  This isn't about calories, nor is it about counting milligrams of vitamins or minerals. Simply stated, I believe that you are less likely to overeat if you eat nutritious food. 

My mother has always stated that her hunger persists perpetually throughout the day, regardless of how much she eats.  She can graze all day long on snacks around her office place, yet, without fail, she's hungry an hour later.  You've probably experienced something similar.  After a large meal of pasta, bread, and a few scoops of salad all of which is topped off with a big bowl or two of ice cream, you are aghast by the fact that you find yourself fumbling for munchies just a few hours later.  What gives?  You stuffed yourself Thanksgiving-style at dinner, but now you are hungrier than ever!

There are a variety of hormones that have been found to play some role in regulating appetite (see table).  We tend to explain the regulation of these hormones as a reflection of caloric deficiency, but, if this is the case, why is your hunger intractable to constant grazing? 

From: Austin J, Marks D. Hormonal Regulators of Appetite. Int J Pediatr Endocrinol. 2009

The nutrient deficiency hypothesis of hunger

It has been proposed that hunger is influenced by nourishment: the more nutritious a meal, the more satisfied you feel.  Put another way, cravings could be interpreted as malnourishment.  This isn't a new concept, as research efforts have been made to link glucose homeostasis to nutrient-sensing pathways in the hypothalamus; however, it is still unclear how exactly the brain or tissues detect these deficiencies.  

Overweight individuals tend to be deficient in various nutrients and vitamins, including selenium, iron, vitamins C/E, and vitamin D.  Indeed, a paper from 2009 started off with this in their introductory paragraph:

"The presence of nutritional deficiencies in overweight and obesity may seem paradoxical in light of excess caloric intake, but several micronutrient deficiencies appear to be higher in prevalence in overweight and obese adults and children. Causes are multi-factorial and include decreased consumption of fruits and vegetables, increased intake of high calorie, but nutritionally poor quality foods, as well as increased adiposity which may influence the storage and availability of some nutrients"  

A relevant question would be, "Are you nutrient deficient because you are overweight?  Or are you obese because you are consuming excess energy in response to nutrient deficiency?" Several interesting studies have been conducted to answer this question, but the data is inconclusive.  One study showed that "multivitamin and mineral supplementation during a weight-reducing program seems to have an appetite-related effect in women." [emphasis mine]  They asked women to rate their cravings throughout the weight loss program, and the multi-vitamin + multi-mineral supplement "had a beneficial effect on appetite-rating variables in women...even when change in body weight was taken into account, suggesting that an adequate intake in vitamins and minerals might influence satiety."   In other words, when we correct nutrient deficiencies, it seems to curb overeating.

Possible role of serotonin in linking cravings to nutrient-deficiency

Serotonin is a neurotransmitter that improves mood but reduces sexual desire, body temperature, and appetite.  Nutrient deficiency has also been linked to serotonin deficiency and thus poor appetite control.  If serotonin is deficient or unable to do its job (i.e. can't interact with receptors), your mood may turn downward but your appetite will be enhanced.  On the other hand, if serotonin is present in large quantities, you'll experience the opposite.  Similar to the influence of high insulin levels in the blood in the development of insulin resistance, chronically high serotonin levels can result in the down-regulation of serotonin receptors on your brain neurons, leading to a state that mimics deficiency.  That is: too little serotonin or not enough receptors will lead to deficiency in the action of serotonin.  

Psychiatrists often prescribe serotonin-selective re-uptake inhibitors (SSRIs), a class of drugs that prolongs the life of serotonin in the brain, to treat depression.  By enhancing the activity of serotonin, these drugs improve your mood but also decrease your appetite.  The side effect profile of these drugs includes weight loss in the beginning, but long-term therapy will eventually lead to weight gain.  This makes sense.  When you first start taking an SSRI, you experience high serotonin levels.  After all, this is the purpose of the drug!  Subjectively, you will experience improved mood, decreased appetite, and decreased sex drive (no comment on how this might secondarily kill your mood) due to high serotonin levels.  On the other hand, after you've been taking an SSRI for a year fews, you slowly become desensitized to serotonin due to the aforementioned down-regulation of receptors.  You experience a relative increase in appetite, and the drug will become less effective at positively influencing your mood.  Bingo.
S stands for Serotonin and Satiety

So what does this have to do with cravings?  As it turns out, correcting nutrient deficiencies - namely amino acids (e.g. tryptophan), vitamins (e.g. B6), and other nutrients - may be a viable non-pharmacological treatment for depression by optimizing serotonin levels.  Could this be the link between nutrient deficiency and cravings?  The truth is that I don't know; our understanding of these relationships is tenuous at best.  Because serotonin synthesis is also benefitted from exposure to sunlight, if there is a true link perhaps your office job is what's driving your hunger rather than nutrient deficiency after all.  Or maybe it's a combination of several factors producing your symptoms.  A lot more work needs to be done to further elucidate the role of nutrient deficiencies in craving control.  

Behaving Your Craving

The obvious problem with responding to cravings by munching is that convenience foods are often loaded with calories but otherwise relatively deficient in nutrition.  The fact that you reach for a bag of pretzels when you're hungry isn't proof that your body is deficient in sugar (or pretzels...though that would be awesome).  This is naive from both a physiological and evolutionary standpoint.  If you have extra pounds that you want to lose, your body is screaming "Fill me up!" for entirely the wrong reasons since there is plenty of fuel laying around.  

Furthermore, sugar does, in fact, trigger a release of serotonin from the brain, but this might only be as useful as pounding a diabetic's blood stream with insulin in order to chokehold their insulin-resistant tissues into responding.  After all, people who are depressed tend to eat more sugar (and gain weight as a result) because of the serotonin-sugar link, but an underlying problem plausibly still exists, and deriving happiness from Pixie Stix isn't a feasible solution.  In addition, let's not forget about your amygdalae, the structures in the brain that drive your impulsive snacking behavior.  The fact that you feel compelled to eat convenient junk foods is obviously more than just a sign of nutrient deficiency.

Yet, nutrient deficiency likely contributes at least in part to your perpetual cravings, even though the clinical evidence hasn't been sufficient to prove it just yet.  If this is the case, deficiency in X may be stimulating your cravings, and no matter how many calories you consume of a food that doesn't contain X, your cravings won't subside.  In fact, you could eat five times your regular caloric intake, but you'll remain deficient in X if all of these extra calories are deficient in X.  If X happens to be a precursor to serotonin production, then this is very likely the case.   Paul Jaminet describes this beautifully in Chapter 17 of his book, The Perfect Health Diet.  

Regardless of the source of your cravings, you know that proper nutrition is critical for optimal health.  Your bio-individual blueprint requires its own personalized proportion of vitamins, minerals, and macronutrients, so it's difficult to declare the specific proportions of ingredients to add into your body's milkshake in order to bring all the boys to the yard.  If you are eating a nutritious diet loaded with healthy saturated fats, sustainably-raised protein, and select starches, you're probably going to fare better than if you try to stave off cravings with the "empty calories" found in soda, pretzels, and candy.  

Try eating a truly balanced diet for 30 days, and reflect on how you feel.  Our basic dietary recommendations can be found here.  I'd bet that you'll start feeling better, sleeping better, and craving less.  

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, January 8, 2014

Guest Post: On How to Be A Raging Failure

Here’s how the typical story goes: You don’t eat sugar.  You wouldn’t touch a Cinnabon. You’ve finally come to accept that sugar makes you fat and weak.  Reaching for ice cream when you’re frustrated is easy, but you’ve learned through the wisdom of others and your own trial and error that there is a better way.  It’s plain to you now that you feel better when you eat high-quality whole foods.  Now that your gut is clean, the junk food you used to eat makes you feel sick.

I successfully recovered from my cake addiction years ago.  I gave myself a gold star, ticked the box next to “self-improvement”, and kicked up my feet.  I thought I was done.  In reality, I was ingesting the mental and spiritual equivalent of pounds of sugar a day, by thinking sugary thoughts and taking sugary actions. I had become a psycho-emotional diabetic.  The technical term for this egregious form of “diabetes” is weak character.  I never understood why character was so desirable, and I certainly didn’t expect to come to desire it above all else. 
The good news is that there is no such thing as “type-1 weak character” – no one is born with an incurable lack of character substance.  The bad news is that unlike stomach fat, weak character cannot be seen in the mirror.  It thrives on the darkness of the psyche like the candida in your gut.  The darkness allows you to fool yourself indefinitely; you cannot fix what is unknown to you.  Furthermore, the mechanics of weak character were probably set into motion when you were very young.  This makes uprooting and conquering weak character a gargantuan task.  I should know.  I had a debilitating case of character weakness for 30 years. 

For me it began at age 5 when I rolled into kindergarten.  I already knew how to read, but the other kids in class were struggling to learn.  This meant that I was special.  It seemed as if I were born naturally smart, and they were born…less so.  They had to try in school, and I didn’t.  At the age of 5, I decided that trying is for dummies, and expending effort is a waste of time.  I liked this model, so I kept it awhile.  Yet I found out later that problems occur when you ride out this experiment for a few decades.

Weak character is a slow-growing disease.  It was pretty benign at age 5 – maybe even cute. By junior high, a few red flags were flying.  It was sugary-sweet to feel special, but the more honors and accolades I got – “Cullen is gifted…a charming boy with an exceptional wit…a natural athlete…a born leader…an original musician” – the worse the diabetic rot.  More and more, I found myself protecting my special status by avoiding undertaking any task whatsoever.  I didn’t use my gifts.  I didn’t cultivate my humor or charm.  Instead, I alienated people with a perpetual frown.  Rather than digging in and proving myself, I quit playing sports the first time I was cut from the team.  I was kicked off student council for never showing up. I avoided taking music lessons or joining a band.  And I never, ever studied. 

Only later I learned the hazards and predictability of this trajectory.  Stanford psychologist Carol Dweck, Ph.D., highlights this danger in her book Mindset:  “In a fixed mindset, people believe their basic qualities, like their intelligence or talent, are simply fixed traits.  They spend their time documenting their intelligence or talent instead of developing them.  They also believe that talent alone creates success—without effort.  They’re wrong.”

Later in life, my character took a dark turn as a fixed mindset colored my life philosophy.  At a very young age, I had effectively determined that nothing was worth doing.  By my mid-twenties, the worship of nothing – a self-interested nihilism – was an easy leap.  With this philosophy, serious ethical breaches became commonplace.  Put simply: I did some awful things.  Having alienated friends, peers, potential mentors, and beneficial experiences, I woke up one day to realize that I had failed out of life.  I would have to start from scratch. 

Here is a tried-and-true formula for how to become a raging failure.  In my experience, it works wonders: Believe your own myth.  Choose the easiest path you can find.  Protect yourself. Judge other people.  Treat them as pawns.  Let the law of attraction and magical thinking do the work for you.  Keep the best things for yourself.  Try to be viewed by others as perfect.  When someone criticizes or disagrees with you, yell at them and cut them out of your life forever.  Avoid anything that might make you uncomfortable.  Avoid choosing a vocation. Avoid meeting new people.  Avoid effort, avoid learning, avoid embarrassment, avoid failure, and avoid sticking with anything.  By doing so, you will be avoiding the one thing that can make you successful: growth. 

As Dr. Dweck says, “In a growth mindset, people believe that their most basic abilities can be developed through dedication and hard work—brains and talent are just the starting point. This view creates a love of learning and a resilience that is essential for great accomplishment. Virtually all great people have had these qualities.”

Hi. My name is Cullen, and I have weak character.  Like a recovering alcoholic, the tendency to shift the blame or break a commitment will always be with me.  Whenever I selflessly help someone, put myself out there, or finish a project that I start, I am going up against three decades of malpractice, confronting habits so deeply ingrained that they wholly defined me. The simplest act of compassion or initiative takes a titanic effort of will – and this is great news.  It turns out that the effort itself is the pot of gold I have always been seeking, because it leads to growth, which in turn feeds success.  That bears repeating: Effort itself is the reward I have been seeking.  You don’t eat sugar. You wouldn’t touch a Cinnabon. Why would you compromise your life by making short-sighted choices?  

Don’t cultivate character for the sake of society or lame adults like me.  Do it for yourself. 

Cullen Richardson is a self-described bio-hacker.  He lives just outside of Pittsburgh, PA. Contact him at

Follow me on Twitter @BeyondtheMD