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I lost my covid weight.

Before you cough and sputter about me not having much weight to lose, let me tell you that I had gained 5% of my body weight with all the stresses, changes of routine, having more family around and different eating patterns, food choices, restrictions on where I could and could not go, etc, etc, etc. The Covid-19 (weight gain) is a real thing.

Once people gain 5 % of their body weight, it seems to trigger even more weight gain. That’s why I make this the REACH OUT weight in my Weigh Different program. Reach out and get some help!

To get back down to my pre-covid weight, I chose to fast for five days. Now before you start getting all impressed, I should clarify that it was five days of fasting mimicking. I know, I know, my husband asked me the same thing: if you are eating food, how can it be considered fasting?

I used a Prolon fasting mimicking kit. The food was scientifically designed to provide micronutrients while restricting macronutrients. It came in nicely packaged boxes for each day of the fast. The idea is to get the benefits of fasting without the pain and hunger of fasting. And I did.

I have talked about healthier energy in the form of real food and whole food consisting of plenty of non- starchy veggies, grass-fed, free-range or wild protein, and healthy fats from avocado, olive oil, fish and nuts and seeds. I have talked about the energy that comes from exercise and sleep and drinking water and the sun.

But NOT eating food boosts energy too.

Fasting counteracts energy storage, yes. But it does more a lot more than that. Fasting triggers stem cell production, the brand-new baby cells that keep us feeling young. Fasting stimulates autophagy, the breakdown of old and damaged cells. Fasting improves muscle performance and mental clarity. And fasting can improve metabolic health.

I want to point out there is a difference between fasting and starving.  It is all about choice and your brain and therefore, hormones know the difference. Another word for this is hormesis: the favorable biologic response to a low dose stress, in this case, fasting.

The Prolon kit also came with daily emails to help me know what to expect. That was helpful. But what was even more helpful was having four friends fast with me. That was a game changer. Everyone chimed in via group text about how their day was going and what challenges and successes they were having.

Here are a few excerpts I have been given permission to share:

“My first brave step was to leave the cream out of my coffee today.”

“Black coffee in hand. I am ready. I am worth it.”

“Ordering, possibly for the first time in my coffee drinking history, a Starbucks iced coffee with NOTHING IN IT!!!!”

I can’t tell you how helpful this was for me because as I have proudly proclaim purposely putting butter or cream or and coconut oil in my coffee and blend it to a beautiful creamy frothiness that I look forward to every morning. How was I going to live one day without it?

Knowing that others were challenged by the same thing and overcame helped me to take that first brave step too.

We shared what our expectations from  the fast:

               “positive food habits, food for nutrition and not emotion, decrease visceral fat, realign metabolism.”

We shared pictures of us eating soups from the kit and our families eating big dinners:

“My husband has been eating dinner for ten minutes and it still looks amazing!”

“I am at work and I want to order a burger so bad…..ahhhh!”

               We shared how our strategies and changing self-talk aligned with our goal:

“I am keeping this thought in mind today: ‘if it is important to me, I will find a way. If not, I will find an excuse.’ This is so true for me because it’s easier to talk myself out of (healthy habit) than to stick with it and do the hard things, I am thankful for you all on this 5 day FMD challenge.”

“I just read the statement that made me pause: we change best by feeling good, not by feeling bad.”

“I have to admit I was not sure how day three would go but so far so good. I met up with friends for breakfast and brought along my nut bar (from the kit) and ordered a black coffee. I drank a bit of the L drink (from the kit) before I left. Preparing for what each day holds has been helpful to me.”

“This has been challenging – I can’t believe I am on day 4. My family has been so supportive. (“I am not going to let you fail, Mom.’ ‘You can do this.’) I would usually feel shame about admitting to “dieting” or drastically altering my food intake. But this is for my health and my future and it will benefit all of us. The group has made a big difference for me too. Whew. Almost.There.”

“One more decision. One more meal. One more day.”

Together we completed the five day fast. We felt a sense of accomplishment, a sense we had at least started the process of unchaining our food responses to stressful situations, and a renewed energy to maintain healthier choices going forward.  

We did not starve. We chose to fast. For five days. And it has made a huge difference.

If you have gained Covid-19 weight and are interested in different approaches to weight loss, please contact us at Oregon Weight and Wellness at 971-273-7143

She could not have known when the lily cuttings she brought to the office that day would unfold.  She could not have known what memories and emotions the perfume of the lilies would unfasten. She could not have known the depth of conversation the beauty of the lilies would unfurl. She simply shared the flowers from her garden as an act of kindness and hoped they would be a blessing.

I walked into the office earlier than usual on Thursday morning July 16^th and was struck by a familiar fragrance. “The lilies must have opened,” I thought to myself.  It was a strong fragrance. It caught me off guard at first and I felt uneasy though I couldn’t quite put my finger on why.

We were chatting over coffee in the breakroom before patients arrived when Stephanie commented on the flowers. She noticed their splendor as she walked in the front door of our office. I breathed in their aroma and told her a patient had shared them from her garden. In the next breath I recounted how lilies always reminded me of death.  My son’s death.  I explained without much emotion that we received so many flowers from loving friends and family around that time, and that lilies were invariably among them and tended to overpower any of the other flowers’ fragrances. Funny how the sense of smell is uniquely wired to memory.

“Remind me again when Sammy died,” Stephanie spoke with the empathy of someone who knows the pain and sorrow that motherhood often brings in one form or another. I stared into space just for a second recollecting the day.

“Twenty-three years ago on the 16^th of July,” I answered meekly in utter disbelief that I might have let the day pass without acknowledging my child’s death and therefore his life. If it were not for the lilies.

Guilt taunted me. The guilt of not feeling the pain of grief. As if I should be carrying grief around like a badge of courage and crying on this day represented the pain and not letting go of pain made me a better person, holier, somehow. But I didn’t feel the need to cry right then. Of course, I had not forgotten, and I could never forget. Sammy, my firstborn son, my sweet boy, my treasure in heaven. And the wrestling gave way to wonder. The wonder of God’s love in a fragrance. The wonder of time and space. The wonder of the simplest of gestures, the giving of flowers.

I thanked God for His intimate ways. I thanked him for my patient and her kindness.  She could not have known, I thought again.

God wanted to do more than remind me of Sammy’s day.  “Consider the lilies”, He was saying, “How they grow. They toil not, neither do they spin.” He wanted to remind me how he had grown me through ups and down, sorrows and joys, with His redeeming ways.  I did not have to spin.  I did not have to hold on to pain for the sake of holding on. And it didn’t necessarily mean I had  “worked through it” or “was over it.” As if it had to be either or. It just meant I was where I was. In process.

It was a perfectly balmy day. The sun shone through the neighbor’s scrub oaks which shade the back yard at the office. Stephanie and I shared lunch under clear blue skies at the picnic table that Zeke built.  We talked about the seeming paradoxes that we encounter in life and the black and white/either-or scenarios that did not make sense anymore. “Maybe, with God, there is room for both and…”  

And I gave myself permission to sit there with both and.Both pain and healing. Both sorrow and joy. Both unrest and peace.

Consider the lilies. Consider the both and…

This year I am required to complete a Practice Improvement module. While I can embrace the spirit of the requirements set by the American Board of Family Medicine(that are put in place to help physicians stay proficient since medicine advances at lightning speed) I do resent being told how to do it. As if by completing this task it will make me a better doctor and without it, I would not stay up to date on my own. Can you hear the enthusiasm in my voice as I tell you how excited I am about these obligations?

Negative thoughts plague my mind and keep me stuck: “I don’t want to do a project.”  “ I don’t have time to do one more thing.” Or my all-time favorite: “I can’t want to!” (This is what my grandson says when he gets stuck.)

After five months of procrastinating, I concluded my resistance was not changing the ABFM. And frankly, my resistance was not serving me.  I still had to choose a project.

Could I think about it differently?

I have to do a project to complete the requirement if I want to maintain my certification, which I do.

How can I make it worthwhile for me, so I actually learn and grow?

How can I make it valuable for my patients that they would somehow benefit?

How can I check the box and get this dross off my to do list?

In other words, could this be a win-win-win? The answer was a resounding YES, I reasoned and felt my mind shift from obstinate and contrary to accepting and even excited.

So what was the next actionable step? Hmmmmm…..

We work on behavior change a lot in my medical practice which focuses on lifestyle to improve health. We work with people to figure out how to stop unhealthy habits and form healthy habits. Admittedly, change is hard.

One strategy I had been highlighting lately is habit stacking. Habit stacking is where you add a healthy habit you have had a difficult time implementing to a neutral or healthy habit that you are already doing. Stack the new habit on the old habit and the old habit will serve as a cue for the new habit.

For example, I have a hard time drinking water while at work and wanted to figure out how to drink more.  Every day as I get to the office, I am already in the habit of unlocking the door, turning off the alarm, and putting my bags in the break room. I do this every day without fail.  Putting my bag in its place could serve as a cue to turning on the water for the tea I am going to drink all day to stay hydrated. I was already in the break room where the water and tea lived. It would just take a few more seconds to get the tea set up. I set my mind to it at first, but now I am on autopilot. Put my bag down, turn the tea pot on. As a result, I have been more successful hydrating with water and herbal teas. And the automation of this habit frees me to take care of other things.

Could I use habit stacking as a Practice Improvement project? Why not?

With the advent of electronic medical records, people are used to receiving automatically generated visit summaries to remind them of their diagnosis and treatment plan.  

I see the value of a visit summary and want my patients to understand and follow through on their treatment plan. My current EMR system does not have this feature, so I have to create it manually. It requires intentionality on my part every time. And frequently I forget.

I decided to make this my project.

Create a meaningful treatment plan summary. Figure out how to habit stack it to automate the process. And then follow up with the patient in one week to see if they were implementing or had any questions or ran into any barriers which we could address before time got in the way and nothing was accomplished between visits.

What was something I was already in the habit of doing at the end of every visit which I could stack the visit summary and follow up text or email to? The answer was obvious: the patient’s invoice.

I create an invoice for every patient visit and I was already attaching it to an email. It would only take another 60 seconds to add to that email a summary of the salient points of the visit, what we agreed the patient was going to work on until the next visit. I usually summarize verbally with them anyway. I could write and talk at the same time. And let them know I would follow up with them in a week to see if they had started the medication or got their lab work drawn or implemented the lifestyle change goals.

I was elated with the possibility of this win-win-win situation. A win that patients would receive something meaningful. A win that patients would have additional support in to accomplish their goals. A win that I was modeling the habit stacking I was preaching. And a win that I could cross something off my to-do list.

And I could have been doing this all along.

We all encounter barriers to change. One of the biggest barriers are the negative thoughts we cling to, sometimes without even knowing it.

It took thinking differently about the situation for me to take action. Instead of seeing the ABFM requirement as a chore or albatross, I saw it as an opportunity. My thinking had to change before my behavior changed.

What healthy habits are you putting off implementing that need a fresh perspective? What habits are you already doing that you onto which you can stack another healthy habit? Think different, weigh different.

Can we talk? About Exercise?

It may come as a surprise that I am not one of those people who loves to exercise. When five o’clock rolls around every morning, I have the following conversation with myself:

Me: Julie, ready to run?

Myself: No. It’s too cold.

Me: But you can run inside on the treadmill.

Myself: Well, maybe, if it’s on the treadmill.

Me: You will feel better, energized, and ready for the day, just like you did yesterday after your run.

Myself: Maybe, but I don’t want to run.

Me: That’s ok. How about walking?

Myself: But I don’t want to walk for 30 minutes.

Me: Fine. You can just walk for five minutes.

Myself: Ok I can do five minutes of walking but only walking and just five minutes.

Me:  On your mark, get set, go!

I stepped on my treadmill this morning to walk/run my usual 2+ miles.  With the red magnetic safety button in place, I pressed 3 mph and the green GO square in rapid succession, ready to walk.  Nothing happened.  I pressed everything again, this time slowly and methodically. Still nothing. I checked the power cord. It had a firm connection to the outlet. “Hmmmmm,” I said to myself.

Had my treadmill of 14 years finally given up the ghost? “That would be a bummer,” I thought.

Now I was faced with another decision.  Was I still going to exercise? What was my plan B?

I stared at the control panel remembering when I first got the treadmill. The New Years before I turned forty, I made a goal to run a half marathon and I bought the treadmill as a gift to myself. I was homeschooling three of my four children at the time and my exercise seemed to be a magnet for their mayhem. Every time I even got near the treadmill all hell broke loose.  Eventually I pretended there was an invisible shield around me. Soon my kids learned that unless they were bleeding out, they were not allowed to interrupt me while I was running. I ran every day for one hundred days.  I ran the half marathon I signed up for. Then, like Forrest Gump, I didn’t run any more.

Isn’t it funny (not funny) how hard it is to start a healthy habit and how easy it is to break it?

My treadmill transformed into a kid backpack rack virtually overnight. When my husband noticed it was no longer used for its intended purpose, he dragged it out to the shop with the other exercise equipment I had bought, used, and left for dead. Sort of an exercise equipment graveyard. Sitting in one corner was the Health Rider I got bored with after two pregnancies. Next to it a fancy weight set collected dust. The leg machine I bought to rehab a torn hamstring idled next to the broken, hand-me-down stationary bike my sister-in-law gave me which I never fixed and consequently, never used. Oh, I tried to walk the short distance to the shop to get back into a routine. But the hundred-yard stretch might as well have been a hundred miles some days and if it was raining, forget about it.

Once I had the bright idea to bring an unused elliptical to my office to see if I would be more successful using it there. My plans were foiled when the delivery person (who shall remain nameless) misjudged the height of the parking garage ceiling transforming the metal machine into a mangled mess.

I have tried many things to help make exercise enjoyable: pilates with its promise of toner, leaner muscles, an exercise class at church where I’d meet friends and secretly compete, a gym membership to keep me accountable to the money I was spending. They all helped. For a time. One thing or another got in the way and I got out of exercise.

Then one winter vacation, I started walking on the resort’s fancy treadmill. I walked every day we were there and decided that I may not love walking but it’s what I do best. I am a walker. It’s who I am. I resurrected my old treadmill and made my kids drag it back in the house.

The best time for me to exercise is in the morning. If I don’t get it out of the way first thing, it won’t happen. Sometimes I walk on my lunch hour, but I won’t walk very fast because I don’t want to sweat. And I am not consistent because administrative duties take precedent.  I may not walk on the weekend if outdoor chores prove vigorous enough like push-mowing our acre of lawn or shoveling loads of bark dust or raking leaves. Because I know this about myself, I endeavor to make weekday morning walking a religious routine.

Setting myself up for success is key. I have a pair of well-fitting walking shoes that I only wear inside on the treadmill. I have learned to keep them right by the treadmill so I don’t have to search the house for them and the barrier of “I can’t find my shoes” is removed.

I used to give myself permission to walk on the treadmill in my PJs but found that I never walked fast or long because I never really woke up. I was in my PJs and I associated PJs with sleep and rest, not exercise. So, I found some inexpensive active clothes that I like and removed that barrier.

I listen to music or a book or a sermon or a TED talk so I associate something I like doing with something that I don’t necessarily like doing.

Let me tell you that if at any time during my morning, my well-intentioned husband asks me if I am going to walk that day, the answer is N-O, NO! For the mere reason that he mentioned walking, I will not walk. That’s the Rebel/Questioner in me. I learned this about myself from reading Gretchen Rubin’s book, The Four Tendencies. She sorts out human motivation in four different categories Upholder, Obliger, Questioner, Rebel. I think I could be any one of them, depending on the situation.

The Upholder in me exercises because my patients expect that I exercise, and I have made a commitment to practice what I preach.

The Obliger in me exercises because I want to be around for a long time to play with my grandkids.

The Questioner in me understands all the reasons exercise is good for me; and it’s so much more than just weight regulation.

The Rebel wants to do exercise my way, not the American Heart Association’s prescribed 30min five times a week. I’d rather walk 29 or 31 minutes, not 30 minutes. And I’ll walk when I say, not when my husband suggests.

Before going to my plan B, (my kettle bell routine) I checked one more thing on the treadmill. Turns out  it wasn’t broken. The connection was faulty on the receiving end. A little cord wiggling and it was good as new. The bells and whistles indicated my session started and I finished my five minutes.

That wasn’t so bad. I think I’ll do another five.

What do you like to do that you are willing to do and why? If you are not sure, give us a call at Oregon Weight and Wellness where the exercise conversation will be way different.

PS To find out your tendency, you can take the Four Tendencies Quiz here.

Everything is different during the 2020 Covid Quarantine.  Even Vet Visits.  It is not that I wanted to go, but it’s been one thing after another with my dog Maisie.  And, well, I’m a doctor, not a veterinarian.

In late February Maisie got into something in the yard and developed hot spots. Big ones. In two different places.  Maisie was a hot mess.  I had to shave her beautiful tri-color coat.  She moped around forlorn, like she had leprosy.  She even self-isolated in her kennel.  She never goes in her kennel, at least not without a treat. 

When I first called the vet, they were not offering appointments. They made a few recommendations and told me to call back if things were getting worse.  My kids whose dog had the same issue last year coached me through a treatment plan and soon Maisie was on the mend.  

Before I could get too pleased with my new vet skills, Maisie developed an abscess.  I tried to ignore it, but it grew to the size of a baseball within 24 hours.  Again, the receptionist at the vet’s office could not schedule an appointment.  My son, home from college and bored, took it upon himself to nurse her back to health.  With frequent hot compresses, I am happy to report his treatment worked.  She was back to her playful puppy self.  

All was right in my dog world again. Right as rain.  Until it rained.

Maisie was outside for her usual morning romp last Saturday, happily chasing hapless birds. I was weeding in the garden.  She careened around the backyard fence and slid down the sidewalk, newly wet from the morning’s rain.  Evidently, she clipped her paw on a fence post because she yelped in pain and dropped to the grass, instantly immobilized.  I ditched my garden tools and ran to her aide. She pushed my hand away with her long snout. I spoke in a low, soothing voice.  “Let me look, Maisie.” She cautiously allowed me to palpate each of her limbs.  It was obvious even to me that the third digit of her left hind paw was dislocated.  With gentle pressure it popped back in place, but Maisie would not walk on it.  I waited an hour and when she still would not move, I called the Vet. This time we got right in.

The Vet tech came outside to my car wearing PPE to collect Maisie for her appointment. She dutifully limped behind him; however, it took some coaxing to convince her to cross the threshold of the office.  She looked back at me mournfully.  I felt a little more emotional than usual and big tears welled up in my lower lids. I shoved my arms across my chest. Damn Covid, I muttered.  I swallowed hard, feeling forced by an invisible power to just sit in my car and rebreathe my air.  While I waited, thoughts about Maisie cheered me and helped pass the time.

We had been several years without a dog, but I suddenly felt the need for one when my youngest son graduated from high school and was preparing to go away to college last summer.  Maisie was a gift from my husband for my 54^th birthday, a beautiful Bernese Mountain Dog with gorgeous markings including a white blaze that runs perfectly in the middle of her forehead.  She was little and fluffy and cute, just like a stuffed animal.  But she did not stay little for long and clearly needed training. So, when Maisie was 6 months old, I signed us both up for a dog obedience course which my church offered for free.

Excited for the first lesson, we showed up early and eager.  Nine other dogs of all shapes and sizes meandered into the gym along with their owners.  As it happened Maisie was the youngest and the biggest and apparently the friendliest in her class.  This is a difficult combination when the instructor does not want you getting to know your fellow classmates.  I understood that it was for safety and liability reasons, but Maisie didn’t. Consequently, I spent the entire time yanking on her leash, pulling her away from the other dogs and off their owners.  Maisie spent the entire time choking and spitting and coughing the way dogs do when you are trying to hold them back from sniffing and greeting.  It was exhausting.  By the end of the hour I was drenched in sweat.  My arms were all but pulled from their sockets.  I hated it. I did not learn one thing.  I take that back.  I learned that being the youngest and the biggest and the friendliest was not a good combination in dog obedience school.  Maisie?  She loved it!  She was still smiling and wagging her tail as I dragged her out to the car away from her new best friends.

“You may want to consider a different kind of collar,” mentioned one of the other owners, trying to be helpful.  Her dog was perfectly behaved.

The next week was only a little better.  Even with the different collar.

And for whatever reason, I could not get us to the next two lessons. Either I was super tired, or it was dreary and rainy and cold. When I finally got the gumption to go again, I showed up on the wrong day.  I showed up on the wrong day two weeks in a row.  Where had I put that paper that had the meeting times listed?  

Maisie and I only made it to one other lesson, mind you, so we were way behind all the other dogs.  When the instructor called about the graduation class, I braced myself to be un-invited.  To my surprise, even though we had only been to 3 out of 7 classes, she encouraged us to participate in the final exam that next week.

I did not want to go.  

I did not want to go because I was afraid of failing.  I was afraid of failing because if I failed, I would feel embarrassed and ashamed in front of all the other dogs and their dog owners.  If I could not succeed what was the point of going?   And if I was brutally honest with myself, maybe I even started the downward spiral of self-sabotage after the first two classes, finding any reason not to go.

I could relate to my patients who start a weight loss program highly motivated and then after a few months, drop out.  I can relate to the patients who tell me they sit in their cars outside my office agonizing whether to come in or not, afraid to step on the scale because they know they have not lost weight or worse, they may have gained weight.

And I told myself the same thing I tell my patients:  Imperfect progress is still progress. Everything worthwhile takes time and hard work. 

There is more than one way to measure success.  The most important appointment to keep is the one you are afraid of.  Winston Churchill said it well: “Success is not final.  Failure is not fatal.  It is the courage to continue that counts.”

Maisie and I practiced the exercises every day after work that week and we showed up for the final exam.  We paced nervously along the sidelines carefully studying the way the other dogs and dog owners carried out the exercises one by one.  Finally, it was our turn.  My heart pounded as we waited for the start signal from the instructor who clutched her clipboard ready to critique our performance.  I whispered a few words of encouragement in Maisie’s ear and we began.  

Confidence grew in me with each step as I called out the commands to Maisie, praising her for her obedience, correcting missteps with a gentle tug of the leash.  A few minutes into our performance, I realized we were doing great.  Not perfect.  Not 100%.  But we were doing great.  The other dog owners cheered as we finished.  Maisie earned a third-place ribbon.

My cell phone rang and woke me from my stupor back to the reality of my car and Covid. It was the Vet.  Maisie broke her toe in four pieces and would need a surgery to correct or amputate.  If it’s not one thing it’s another.

 At Oregon Weight and Wellness, we understand weight loss is difficult.  And it is even more difficult during this time of increased distress. Still we encourage you to keep showing up. Keep showing up and you’ll be sure to weigh different.

When was the last time you thought you were eating something healthy only to find out it’s not so healthy after all? I had this painful and unpleasant experience just this last Saturday.

I was sharing a beautiful breakfast with my husband who had lovingly prepared a pastured egg, spinach and avocado omelet. I savored the delicious food with all its complex flavors and textures.  I enjoyed every gram of cancer fighting herbs and spices and muscle building protein and microbiome feeding fiber and luxuriously satisfying fat that I was putting in my body not just for fuel but for repair of my damaged cells and to nurture the creation of my new cells. 

Kenny and I sat together at the table and made small talk enjoying each other’s company. The sun was shining through the winter whipped windows reminding me I needed to add spring cleaning to the calendar. But that did not rattle me. I was relaxed and I thoroughly relished the meal.  I had even toasted a piece of low carb lavash bread so I would not feel “bread deprived” having chosen to eat few starchy carbs due to my own insulin resistance.

I took another bite and nonchalantly turned the bread wrapper over. Apparently, I made a horrific guttural sound which stifled my swallow and I spit my food all over the kitchen table. “Are you choking?” my husband yelled as he simultaneously stood and reached around my waist instinctively prepared to administer the Heimlich maneuver. I shook my head “No” but remained dazed and speechless.

“What is it then?” he asked almost irritated that I had broken the spell of the morning. “Look!” I wailed with shock and dismay, “Soybean oil!” and I thrust the plastic in his face in the most Scarlet O’ Hara kind of way. Admittedly, he had every husbandly right to retort “Frankly my dear, I don’t give a d*mn!!” Instead my heroic husband grabbed the package, read the atrocity for himself, and flung the remaining bread into the compost bin.

I hung my head in disgust. Here I was eating and recommending my patients to eat a certain flat bread with all it’s great nutrients like flax seed and oat bran and whole wheat. And guess what? It has corn starch, soy protein isolate, and soybean oil. One may be able to argue their way through the innocuous properties of corn starch or soy protein but soybean oil? What was I thinking? How did I let this one get past me?

My husband sat back down and picked up the bottle of Vitamin D3 that was sitting on the table in front of him. He had innocently purchased it from a local pharmacy because we had run out of the one we usual use. And guess what? Soy bean oil! Arrggghhh!!!!!!!

What’s so bad about soybean oil you are asking. Well, just as we are trying to avoid processed and refined carbohydrates, we are also trying to avoid processed and refined oils.  Soybean and canola oils are the most common and are found in most packaged or bottled grocery store items. They are referred to as vegetable oils (which is confusing because the oils come from the seeds not vegetables) and also include safflower and sunflower oils. They are deemed healthy because they have polyunsaturated fats which are supposedly healthier than saturated fat and therefore are given the heart healthy stamp of approval by the ADA and AHA. (More on this later).

It is true that the oils in the seeds in their natural state are the polyunsaturated omega 3s and 6s we require because our bodies do not make them; so eating the seeds raw or lightly roasted (not honey drenched or barbecued) can be part of a healthy diet. But once the oils are extracted, usually at very high temperatures, they become rancid or spoiled. Spoiled oils. Say that five times fast. They stink in this changed state and must be deodorized with chemical solvents before being packaged into bottles and placed on grocery store shelves for human consumption. Even expeller or cold pressed seed oils are unstable which is not good news for our cell membranes or our fat cells, their usual final resting places.

I have written about how refined carbs raise blood sugar and glycate or damage the proteins our bodies make for cellular function. Well, these unstable oils oxidize or damage our cell membranes. In other words we rust. All this leads to the dreaded inflammation and increased risk of chronic disease, cancer, unhealthy aging, and weight dysregulation.

I can see her now, my sweet grandmother perched in her rocking chair in her front room. “What the hell am I supposed to eat?” I can hear her say. (This is a vivid memory for me as a young child because it was the only time my grandmother every swore).

Thank you for asking, Grandma.

Healthy fats include cold pressed olive oil, avocado oil, coconut oil (all fruits, by the way), oil from fatty fish like wild caught salmon that ate algae, and butter from cows that ate grass.

To Michael Pollan’s oft quoted “Eat real food… mostly plants,” I would add:

 Yes, eat your vegetables!  Skip the vegetable oil!

And to myself I say “Physician, heal thyself.” Or at least if you buy something in a package, Julie, read the label!

(If you want to do more reading and research on the subject, let me recommend Cate Shanahan’s book, Deep Nutrition. She also has some interesting interviews on YouTube.  Nina Teicholz and Gary Taubes are good sources for digging into the research on saturated fats.)

Next weekend my family is gathering in Kempner, Texas to celebrate my mom’s 80^th birthday. Children and grandchildren will fly in from all parts of Texas and beyond to honor this tiny Texas Aggie. That’s her name, Aggie, short for Agnes.  

We will eat delicious barbecue smoked to perfection by my brother, Steve. We will laugh at tall Texas tales describing Mom’s hilarious escapades told by my sisters, Beth and Amy.  We will listen to sappy songs sung by beloved grandchildren. We will admire a very special gift carefully planned by my brother, Greg. And yes, we will eat cake baked by my sister-in-law, Amy, chef extraordinaire.

It’s not a surprise party. That failed early in the plotting. We had a stream of group texts between siblings, and somehow Agnes got in on it. We didn’t even realize it until she chimed in with a few of her own suggestions. Oops. But then again, Mom could never be surprised. She had an uncanny way of finding things out.  She’d talk to one of her kids, then innocently question another as if she knew nothing. Yes, the planning had to go deep into stealth mode. We kids still have a few tricks up our sleeves.

Mom has always been petite, 5’1 1/2” at her tallest, but has shrunk to a diminutive 4’ 9” not from osteoporosis but from scoliosis. She may be tiny, but she is a vivacious. Apart from arthritis which eventually led to replacements and of both knees and one shoulder, Mom is in great shape. She takes no medicine. She goes to her gym three days a week. She volunteers at the community hospital and takes meals to the elderly. She plays Bunco. She travels.

For eighty years now she has worked hard and played harder. She was never afraid to try something new. She raised 5 kids, added 3 more, ran an ER early in her nursing career, and trained many a doctor, including me.

So a few years ago when I told her the orange juice she was drinking on a daily basis was not good for her, she looked at me cross-eyed. “It’s fruit!” she informed me and continued pouring. Of course, she comes by this misconception honestly. Its what the old dog organizations like the American Heart Association and the American Diabetes Association and the USDA have told us for years and are still telling us to this day: 100% juice is a nutritious choice. Even the hospital from where her husband had been recently discharged, like most hospitals for that matter, suggest orange juice in their post hospitalization, heart healthy diet plans.

I took the hospital where I serve on associate staff to task on this once. I was so adamant that they should not sell or serve any sugary beverages including orange juice that I refused to get the required flu shot in protest that year. I’ll show them! Primum non nocere and all that! I was going to change the world, at least this hospital. I felt exuberant like I did in 1993 when I was chief resident and I protested my hospital’s sale of candy cigarettes. That was when hospitals still allowed smoking. Well, I bought all the candy cigarettes on the hospital’s dime and handed them out to my interns. We moseyed down the halls like James Dean with the packs rolled up in our scrub sleeves and the powdery cigarettes hanging from our lips.

In both instances something changed. Smoking was banned in the Kentucky hospital. And the other hospital cut out deep fried foods shortly after my rant. Now whether I actually had anything to do with those changes is not the point. Old dogs can learn new tricks.

I am so very passionate about avoiding sugary beverages including juice because they give the body a one-two punch.  Yes, juice comes from fruit. But just as you would not eat ten oranges in one sitting, you should not drink the juice of ten oranges in one sitting. The fructose overwhelms the liver and addicts the brain to sugar while the

glucose overwhelms the pancreas, spiking insulin and inducing energy storage. Additionally, the brain does not recognize the calories from sugar sweetened beverages and hunger is not diminished. Ghrelin does not decrease when you drink soda or juice or energy drinks. You are no less hungry, so you keep eating despite drinking hundreds of calories. Over time this firestorm of out of control hormones causes the liver to store fat, and the body goes down the slippery slope of weight gain and insulin resistance all the way to Type 2 diabetes.

I have heard it said 22 teaspoons of sugar a year for 20 years will cause diabetes. But our kids are drinking orange juice and Big Gulps and energy drinks and coffee drinks to the tune of over 40 teaspoons of sugar a day. And as a result, our kids are developing fatty liver and diabetes at alarming rates and at earlier and earlier ages. Not to mention they are hungry all the time.

What you eat can decrease hunger not just due to sheer volume but due to how certain foods activate hormones to talk to your brain. Protein (best from the highest quality your budget allows: grass-fed, free range, or wild) causes the release of GLP1 from the small intestine. GLP1 tells your brain you have had food and you are going to make it for another few hours. GLP1 slows food moving through the gut so you are fuller longer. And GLP1 assists insulin’s work in the cells which gives the pancreas a break. Lower insulin, less energy stored in fat cells. That’s a triple win for weight regulation.

Non-starchy vegetables have fiber. Fiber makes you full and feeds healthy gut bacteria. Healthy gut bacteria can decrease calorie absorption and improve weight regulation. Healthy fats from avocado, olive oil, fish, and nuts and seeds, make you feel full and satisfied and help the absorption of certain essential vitamins.

The message is clear. Eat food. Drink water. And eat food that makes you full: high quality protein, non-starchy vegetables, and healthy fats, and you too can live weigh different.

Happy 80th Birthday, Mom! I love you! And now that you have given up the juice, you’re going to see 100!

I have the privilege of working with third- and fourth-year medical students from Western Oregon University in Lebanon, Oregon. The school has a Lifestyle Medicine track which fits very well with my new specialty, Obesity Medicine. I enjoy demonstrating to them in very practical ways how I work with patients in the areas of nutrition, activity, sleep, and stress management to improve health and if possible, avoid prescribing medication. The work is energizing, and I love it.

Each student brings a unique set of strengths. I am always impressed by their intelligence and well-rounded experience which gives me hope for our future. In addition to their stellar academic achievements, they have accomplished near Nobel prize winning research or joined the Peace Corps or traveled the world or some other amazing or incredible thing which did not even come into my view finder when I was their age.  I wonder if I could make the cut in today’s competitive med school meat market. To be sure medical school and medicine have changed.

When I was a medical student, all I did was study. I went to every class, listened to every lecture, bought every note from the note service whether it was worthwhile or not, spent every Friday in the cadaver lab going over and over anatomy, and consequently, stunk like formaldehyde which made it impossible for me to go out because it would take the whole weekend to wash that acrid  stench from my pores. Who had time for travel or research or bathing, really? When I was on call, I’d try the Crash Cavern, a huge pitch-black room filled with bunks stacked three beds high. It was impossible to sleep, beepers going off incessantly and in irregularly irregular rhythms akin to atrial fibrillation so my brain couldn’t make it white noise. People snored, and loudly. Or they did other things. All this to say, sleep eluded me. I invariably ended up searching the corridors of the hospital wards for an empty room and dozing at least a few moments on a hospital bed or in the cot in the corner hidden from Nurse Cratchit’s view. Not every nurse was Nurse Cratchit, but there was always one.

I remember an Internal Medicine rotation at Houston’s Hermann Memorial, rounding on an elderly African American woman who had been admitted with an exacerbation of heart failure. Her lungs were filled with fluid and she struggled for every breath. She talked slowly and in spurts, “Good mornin’… Chil’… how is… the worl’… treatin’ you…t’day?”

Though she struggled she was at peace. I sensed a sacred presence in the room as I approached her lying there in the bed, despite the irreverent red lights and screeching beeps coming from the monitors snitching on her lack of normal vital signs. But there was no monitor for the spirit in her, the inner strength that exuded her small frame. I could hardly bring myself to invade the sanctuary of her personal space. Yet I felt compelled to know that space.

With my right hand I placed my stethoscope softly on her left chest over her heart and steadied my left hand delicately on her right shoulder. A serene smile unfolded across her entire face like a gentle wave on the ocean shore. “You have healing hands,” she said, her eyes closed as her warm breath exited her slight body.

In my youthful naivete, I did not know what to think or how to respond. I suppose I felt a sense of pride. I took her hand and thanked her. I quickly completed my exam and exited the room to finish my rounds for the morning.

Now that I am teaching medical students, I realize my patient was not reporting about my unique abilities as if I possessed some supernatural power as a rookie medical student. She was declaring something over me. It was a kind of prayer or a commission even.

“You will have healing hands,” she was praying as a hope for my future.

“You! Have healing hands!” she was admonishing me as a necessity for the challenging work to come.

“You have healing hands,” I said to the most recent medical student I hosted as she practiced her osteopathic skills on one of my willing patients. And as I said it, I realized just how far adrift I had gone from this original calling. In the recent years I could see how I had allowed the evolving institution of medicine to give way to busy-ness and crowd out the real vocation of medicine which is healing. The pressure of RVUs, Meaningful Use, Medical Home, CCO, ACA, MACRA, USTSPF, have basically stripped away time spent with the patient and the physical exam and therapeutic touch. Stop the world (of medicine) I want to get off!

And so, I find myself going rogue, at least for the foreseeable future. I am not sure what this new venture is going to look like exactly or where it will lead, but I am confident it will be way different and closer to my patient’s hopeful, prophetic commission than I have ever come. Healing hands are essential as a physician and I intend to discover them again.

• 

December is a rough month.

The days are the shortest. The weather is the greyest. Vitamin D is at its lowest. You drive to work in the dark and drive home from work in the dark. Energy wanes for after work errands, never mind evening exercise.

Time constraints of the holiday season rock routine. There are office parties and family gatherings, school concerts and tournaments. If you have school aged children, you must figure out different meals and childcare because of the long winter break. And it really does not matter whether you celebrate any of December’s many holidays or not. Some change in routine is inevitably imposed upon you.

Everywhere you go, a relative carb/fat fest awaits. Neighbors shower you with homemade Christmas cookies and candies. Coworkers litter the break room with cheese balls and crackers, party dips and those little sausages. You get invited to party after party and even though you don’t go to the party hungry (you’ve learned that lesson) people look at you cross eyed if you don’t have a plate full of food in your hand. Not a party goer? Doesn’t matter. Grocery stores sample the winter wonderland of delicacies wafting deliciousness down every aisle. The demons of white sugar and refined flour dance with saturated fat like innocent sugarplum fairies whispering sweet nothings in defenseless ears. It’s just one bite. Even the strongest will powers give way. 

I know mine did.

I’d been burning the candle at both ends, trying to finish strong at one clinic all the while readying my new clinic. My sleep, disrupted from training my puppy, became even more frayed with work worry. I was able to keep my exercise routine going but I cut back to a slower pace, brisk walking without intervals. From December 22 on, my adult children rolled in one at a time from hither and yon: Jacob from the Bay area, Zeke from Bozeman, Elena from Bend, and Zach, Carol and Uriah from down the street in Jefferson. In lieu of presents, we logged time together. We took in a movie, caught a Blazers game, ventured to the coast, checked out a new coffee shop. We even coordinated a family photo thanks to Jacob’s friend, Casey, a feat we had not been able to accomplish for ten years.

We logged a lot of time and we ate a lot of food. Good food, healthy food, prepared at home food, but a lot of food. And then there were desserts: ice cream by the pint, freshly baked gingerbread, stockings filled with candies,  cookies from a brother/sister bake off, and some sort of chocolatey concoction that ended up in the cart on one of my husband’s many Costco runs.  While refined carbs usually don’t tempt me, this year, they drew me in. Admittedly, I was more vulnerable. I was sleep deprived. I had less energy.  And everybody else was eating their hearts’ desire. Why couldn’t I?

When you don’t eat refined carbs and then all of a sudden you eat a lot of refined carbs, guess what happens? FLC Syndrome. What is FLC syndrome you ask? Feel Like Crap syndrome. FLC syndrome occurs when your blood sugar spikes, and fructose, the sweetest sugar molecule, hits your brain like jet fuel, you get a drug like rush for brief seconds and then in 30 min or so a precipitous drop in blood sugar which make you feel tired, and wired; sluggish and  jittery at the same time. And you crave the very thing that made your blood sugar spike in the first place: sugar. You have heard me say it before because it is true: Carbs beget carbs. And that roller coaster ride is no fun.

While for some, December heralds joy filled celebrations and festive foods, for others, it is a harbinger of loneliness, sadness and grief. The deployment or dysfunction or death which separates families and friends tends to be felt most in December. I can relate. Though this year ranked in the top 10 best ever family times, in the past I would have done anything to skip December altogether. My son Sammy’s birthday falls on December 17^th. He died from a brief illness when he was just two and a half. In the ensuing years my other young children’s excitement for the season pushed me to at least go through the motions. I often felt guilty if I found myself enjoying life. Sometimes I resented others’ happiness. Food comforts in those dark times.  And most of those comfort foods combine both carbohydrates and fat together.

Think peanut butter and jelly. Think macaroni and cheese. Think potatoes and gravy. Popcorn lathered in butter. Pizza.  Ice cream. Any baked good. Carbs and fat together. When you combine two energy sources, your body preferentially metabolizes the carbohydrate, using it for fuel. Then the break down product of the carbohydrate metabolism signals your body to store all the fat you just ate. In celebration or consolation, if you combine carbs and fat for too many days in a row, it’s a recipe for the roller coaster of weight gain.

I’ll say it again December is rough, especially in the weight loss arena. It is no wonder that most Americans gain at least two pounds between Thanksgiving and New Year’s Eve.

Although I am grateful for the family time and will cherish the memories, I am relieved that January is fast upon us. So long, December. I can get back to my healthy habits.

The good news is healthy habits can be reclaimed. And there’s nothing like a New Year to reclaim them. It’s never too late and you’re never too far gone. At Oregon Weight and Wellness, we would love to help you get off the roller coaster of refined carbs and comfort foods and get back on track with your healthy habits. Maybe start new ones. No impossible New Year’s resolutions, just one small change at a time. Work with us for at least six months and we will equip you with tools so that next December will be way different.