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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Wednesday, February 5, 2014

Fundamentals of Poo

There is no tip-toeing around this subject, so let’s just get to the point. Allow me to be frank (you can be sally): when was the last time you pooped? How was it? Not all poops are the same, and we have all had some pretty surprising experiences. There are those which make you feel inclined to Snapchat all of our friends to display our accomplishments and those which leave you feeling like you should shower immediately after. No matter how much you may want to shy away from it, the truth is that we all poop!

There are many shapes, sizes, and smells to our cargo that can vary throughout the week or even the day! It is important to stay in tune to our different dookie styles, because they may be telling us something. The diversity of our stool can range depending on diet, the stress of anticipating a skydive jump, illness or even a simple cup of coffee. Although the subject can be uncomfortable for some, this is a natural process that may be very telling about your health. A normal poo should be easy to pass, smelly (but not too smelly), and a healthy hue of hazel.
So what exactly are we looking at? With even small tweaks to the system, the matter can change from diarrhea to hard clumps that could cause painful passage and constipation. Here are some of the basics to consider the next time you drop the kids off at the pool.
The foods we eat can cause an array of pigments in our scat. Fibrous greens can pass right through undigested, red beets can tint your poo red, medication and supplements may also be culprits to the rainbow connection, but beware of black waste because it could be a serious sign of bleeding. Reflect on what you have ingested because blueberries, black licorice, iron supplements and even the bismuth component in Pepto-Bismol can lead to darkened droppings.  

Our livers produce bile, which helps with the digestion of food in our gut by alkalinizing the contents of the intestines.  One component of bile salts is bilirubin, a remnant from old blood cells. Bacteria living in our gut breaks down the bilirubin to produce a brown pigment that causes a healthy deuce to take on its characteristic color.
Image: Wiki
Our intestines are coiled around in our midsection which gather our remains for expulsion and a healthy form should be that of an “S” which is the shape of our innards.

Transit Time: The transit time for your bowel movements can be telling of how your body is processing food and its managerial methods of discarding the leftovers. There is a study that looked at the transit time of people in African countries (Somalia, Kenya, and Uganda) and their transit time that occurs within hours of a day compared to the westernized transit time of 3-5 days. This observation is linked to our different diets and how our bodies are equipped to manage foods that we consume. A diet low in fruits and vegetables won't contain sufficient fiber to push your excrement through the passageways of your gut in a timely fashion.

On the flip side, many of us have experienced a slip-and-slide effect after a meal...that awkward moment of putting down the fork and bolting for the white throne really leaves people guessing at times. This could be attributed to food allergies or protein sensitivities (i.e. gluten and other wheat proteins). When this happens, your body does not absorb the nutrients that it needs. Over time, eating foods that cause indigestion not only make your bathroom routine unpleasant but also deprives your body of essential nutrients.

How to better your butt business: 

  1. Drink water.  75% of your dung is made up of water, so don't deprive your body of that H2O 
  2. Keep moving.  Movement helps to stimulate the internal organs to do their jobs. Walking, stretching, running, yoga, lifting, and virtually any other kind of exercise will massage your insides and promote better circulation within the system. 
  3. Eat real food.  Consuming foods that nourish your body is essential to your overall health, and including foods rich in fiber will help with healthy pipe passage.  If you accurately document what you eat, you can also map out how your gut reacts to different foods.
  4. Maintain peace.  Day-in and day-out we are living with all kinds of stressors.  Keep your personal space clean, organized, and calm to recharge after a long day of being bombarded by other environmental anxieties.  Get a massage, go hiking, take the dog for a walk - all of these things will help increase positive results for your body.  When your body is under stress you can literally become anal retentive!
  5. Nourish your gut bacteria.  Fermented foods are a great go-to for a healthy mud-maker!  They contain healthy strains of probiotics that cultivate healthy flora in the gut. Some examples of delicious fermented foods: sauerkraut, kimchi, and kombucha tea. You can also purchase capsulized probiotic supplements.
If you are experiencing difficulty passing your product after implementing these healthy habits, make an appointment with your doctor.  Our bodies are built to react and repair, so if there are signs of strain then this should definitely be addressed (most people move their bowels daily!).  Next time you're sitting on the pot, give yourself some time to relax, allow your body to do what it is made to do, and pitch the shame! You could even try rocking back and forth a bit to encourage some movement so you can get a move on! 

Honestly, one of the main reasons I wanted to write this post was to see how many ways I could describe dumps.  We have a grand total of 18!  [THE CROWD GOES WILD!]

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 

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