Monday, October 20, 2014

Why Does Exercise Make Me Feel Worse?

Have you ever exercised and exercised and found that you still can’t lose weight?  Do you feel exhausted and even more run down after exercising?  Why can’t you get that runner’s high?

I meet with so many patients who have convinced themselves that they just need to work harder, exercise longer, and eat less to lose weight and regain their health.  The current craze to run a marathon or a half marathon just isn’t smart for most people.  They are putting their bodies through significant physical stress.  They continue to feel exhausted and become prone to injuries.  Their body starts to feel older instead of younger.  Why is this?

Many people have overworked their bodies (physically, mentally, and emotionally) so much over the years that they can no longer handle vigorous exercise without further stressing the system.  I remember when I left my primary care practice almost four years ago.  I thought that I would enjoy exercising every day and getting back on track since I finally had the time.  I started going to classes at the YMCA and found that not only could I not keep up, I felt worn out and awful after I did exercise.  It was rather disheartening.

What I learned about myself, was that before I could go out and start a new activity program, I needed to heal.  I had spent years working in a very stressful field, not getting enough sleep, having my sleep interrupted by night call, and at the same time I was juggling new family commitments.  What I needed when I left my job was about a year of regular sleep.  Then I could finally begin a gentle exercise program of walking in my neighborhood with some yoga mixed in.

I remember feeling like I was lazy when I started getting nine hours of sleep each night.  It seemed like it should be a luxury instead of a necessity.  Eventually I realized that there was nothing to feel guilty about.  If I was going to change the course of my career, improve my health, and alter my life trajectory, then I had to get well.

Intermittently, over the past few years, I would try to add a more intense work out routine again, but found that it still didn’t make me feel good and I couldn’t maintain it.  So, I would go back to my walking.  I was slowly able to add in and tolerate some resistance training for strengthening.

During my studies I learned about adrenal fatigue and knew that I was significantly impacted by this.  I had been living on a high carbohydrate diet for years trying to find enough quick energy to keep going, not realizing at the time that it wasn’t a healthy diet.  I ate some vegetables, but no where near what I should have been eating.  Eventually, I checked my salivary cortisol levels and confirmed that my adrenals were wearing out.  My body was in an ongoing stress response and was never having a chance to get into a repair mode.  The stressors kept coming and then, even when life settled down, my body wasn’t sure how to stop being on constant alert.

In order to heal, it was going to take patience.  I had been living this crazy lifestyle for over a decade, so I couldn’t expect to undo the damage in a few weeks or even a few months.  I think that time is the most difficult aspect of helping patients with adrenal fatigue.  These are usually highly motivated people with busy lives.  Many are mothers.  Many also have high stress careers and very hectic family lives.  We don’t live in a culture that supports slowing down.

In addition to my new and improved sleep schedule, I began eating a much healthier diet which included as many whole plant foods (vegetables and fruits) as possible.  I also worked to take some time for my spirit each day, even if it was only twenty minutes before bedtime.  It is a work in progress.  I continue to work to control my stress levels, do belly breathing when I feel it all creeping in on me, and am constantly working to try to simplify my life.  It will be an ongoing battle, but I am making progress.  I also took some adaptogenic herbs for a few months to help support my adrenal glands and reset their stress thermostat.  These were specifically chosen according to my salivary cortisol levels and pattern.  I check cortisol levels in many of my patients in order to appropriately direct their care.  

Here I am nearly four years into my recovery.  I continue to eat well because I know what a difference it makes in my life.  I love to sleep and make it a priority, but no longer feel tired and nappy during the days.  My energy level is good again.  Recently I was able to add back a more rigorous exercise program to help me regain some muscle mass, endurance, and strengthen my core.  So far, so good.  I actually feel invigorated at the end of my workout.

I share my story because it has been a long journey that continues to take time and effort.  There are no easy fixes and it certainly is not quick.  Taking care of your body is an ongoing commitment that is never complete, but don’t wait to get started.  There will never be a good time to begin, life will continue to throw unexpected challenges at you.  Now is the time to start!

Thursday, March 20, 2014

Lessons from 007

In his 1961 book, “Thunderball”, Ian Fleming’s first chapter is titled “Take It Easy, Mr. Bond. “  James Bond has been living a very unhealthy lifestyle, is run down, and just wants to treat himself with aspirin so he can keep going.  M then replies:

“That’s just where you’re making a big mistake, James.  Taking medicine only suppresses these symptoms of yours.  Medicine doesn’t get to the root of the trouble.  It only conceals it.  The result is a more highly poisoned condition which may become chronic disease.  All drugs are harmful to the system.  They are contrary to nature.  The same applies to most of the food we eat—white bread with all the roughage removed, refined sugar with all the goodness machined out of it, pasteurized milk which has had most of the vitamins boiled away, everything overcooked and denaturized…there is no way to health except the natural way.”

Wow!  That is pretty astounding stuff, right?  The American health system, by and large, still does not embrace food as medicine.    Yet, back in 1961, the author of the James Bond novels had a great grasp of how to be healthy.  Ian Fleming was not a physician, he was a writer of action novels, but he got it.  Why are we so far behind?

There was an article published last year in the Journal of the American Medical Association (JAMA) titled, “The Paradox of Disease Prevention:  Celebrated in Principle, Resisted in Practice.”  It listed twelve obstacles to prevention.  I will highlight several of them. 

  1.  Success is invisible:  There is really no way to document that an individual’s prevention efforts improved his or her health, because it is rather difficult to prove that they didn’t get something based on what they did (like eating a healthy diet, not smoking, exercising, etc.)
  2. Lack of Drama:  There are no TV shows about preventative medicine.  If there were, they would probably not have much of a plot line.  Instead, we love shows about the emergency department or dramatic rescues.  We need to stop getting into health messes, rather than waiting for someone to save the day.
  3. Long Delays Before Rewards Appear:  Delayed gratification is not a trait that is often valued in our society.  Our expectations typically revolve around the quick fix, often involving medication or surgery rather than lifestyle change.
  4. Benefits Often Do Not Accrue to the Payer:  Insurance companies have a difficult time wanting to pay for programs that will not give them short term payout.  Likewise, hospitals can’t make any money if patients are healthy and no longer need to be admitted.
  5. Changing or Inconsistent Advice:  We all hear in the news about changing preventative guidelines, such as with the age when mammography screening should be started.  The public wants hard and fast rules.  There is a ton of research about the benefits of good nutrition, but the food industry and government guidelines muddy the waters.
  6. Persistent Behavior Change May Be Required:  In order to really benefit, people must adhere to healthy choices day after day.
  7. Double Standard in Evaluation of Prevention as Compared with Treatment:  When studies compare a new medication treatment to non-treatment, the result is judged by whether the treatment made a difference in the outcome.  Prevention is looked at differently.  Prevention must be efficacious and cost-effective, but also produce net savings in resources.  This means that prevention is judged on different merits than treatment.
  8. Commercial Conflicts of Interest:  This one seems rather obvious to me.  The American medical system is an industry.  Industries exist to make money.
The author goes on to discuss possible strategies to overcome these obstacles including:  paying for prevention, making prevention cheaper than free, involving employers, trying to reengineer ways to reduce need for individual action, using policy to make the right choices easier, and using the media to help reeducate the public.  I agree with these in principle, but I currently don’t have a lot of faith that our leaders will ever agree on enough points to make meaningful public health policy changes.

So, it is likely going to come down to people (like you) making informed decisions for their own health and wellness.  This is unlikely to ever be resolved from the top down.  If you are reading this on my website then you are likely already well on your way to thinking in a preventative manner.  Spread the word!  Share articles with friends.  Share recipes and insight.  Form health communities.  You know that there is value in prevention.  If you are making good choices, you will benefit.  This is not rocket science:  an author in 1961 knew that nutrition matters, I know it and base my practice on it, and you know it too.  Let’s apply what we know.  Poor nutrition drives chronic disease.  There is no reason to wait for the wonder drug to be developed.  You can prevent disease with the choices you make each day.  Health begins with your fork.

Thursday, July 11, 2013

Wonderful Kale

I have been under the weather for the past week with a frustrating summertime cold.  All that my throat wanted was warm liquids, but it was incredibly hot and humid the first half of the week, so I refrained from making soup.  Well, last night the front moved through and the humidity broke.  Today I decided to muster up the energy to make some soup.  Based on the ingredients, this would typically be considered a winter soup, but I had a fridge full of kale waiting for a recipe.  I found a good one from the Harvest Eating Cookbook by Keith Snow.

Kale and Potato Soup
3 Tbs extra-virgin olive oil
3 cloves garlic, minced
Kosher salt, to taste
Freshly ground pepper to taste
½ cup sliced onions
1 quart chicken broth
3 russet potatoes, peeled and diced
6 oz chorizo, cooked
5 cups fresh kale, chopped
3 cups water
1.       Heat oil in large soup pot.  Add onion and garlic and sauté for 5 min.
2.      Season with salt and pepper.
3.      Add the chicken broth and potatoes.  Cook for 25 min.
4.      Mash 2 of the potatoes, then add 3 cups water.  Add the cooked chorizo, diced potato and kale.  Cook for 15 minutes.
5.      Enjoy!

Kale is a superfood.  Its dark green leaves are full of anti-oxidants, magnesium and calcium.  I thought that the soup was wonderful.  Enjoy it in sickness or in health!

Thursday, June 13, 2013

What Can Functional Medicine Do For Me?

I am often asked to explain what Functional Medicine is and why it is so different from conventional American medicine.  There is so much I want to tell you about this amazing discipline and how it can help transform your life.
Functional Medicine is a roadmap for health.  If I only look at a patient’s current symptoms, then it is often very difficult to know how to best help them.  What I do instead, is look at the whole map.  I need to see where they came from and which roads they took to get to their current state.  Functional Medicine is often called “upstream” medicine.  It is critical to understand the lifestyle, genetic, and environmental factors that contribute to someone’s current condition. The goal is to discover the root causes of the current symptoms. This is a place where conventional medicine falls very short.  Conventional medicine focuses on how to manage or mask current symptoms, usually with pharmaceuticals, without concern for what driving factors led to the disease in the first place.  This creates a big problem, because with this approach the disease process is not changed.  Different patients can end up with similar symptoms that come from different causes.  Conventional medicine tries to apply the same protocols and drugs to all of these symptoms, rather than individualize the approach to target the actual cause.

Functional Medicine recognizes an often forgotten fact:  our bodies were designed to be healthy.  Over the past few decades, Americans have gotten so used to being sick that many just accept that they don’t feel well.  I have had so many patients say things like, “Well, I am forty now, so I figured it was normal to start having problems.”  With the average life expectancy close to 80 should people really resign half of their life to not feeling well?  Health should be the norm, rather than a rarity.

Functional medicine focuses on helping the body regain balance to promote health and vitality.  By really listening to the patient’s story, I am able to piece together a restoration plan that often involves extra attention to nutrition and movement. The plan can also utilize integrative, preventative, lifestyle, and even conventional treatments.  Developing a therapeutic relationship with the patient is critical in order to give them new tools and help motivate them on their path to wellness.  Practicing this way allows me to offer patients the best of all worlds for optimal results.
Functional medicine takes time, care, and patience.  I spend between 60 and 90 minutes with all of my new patients in order to have enough time to really listen to a patient’s story and then begin the detective work to uncover their path back to health.  The rapid pace of conventional medicine does not allow for this.  Conventional medicine is great for managing medical and surgical emergencies, acute infections, and trauma.  But the majority of illness today is due to chronic diseases such as diabetes, autoimmune diseases, fatigue, heart disease, digestive problems, etc.  The Functional Medicine roadmap allows me to help patients improve, and often reverse, chronic diseases by addressing the inter-related biological networks that are not limited to just one organ system.  Addressing the entire person is the key to helping a patient regain health.
Functional Medicine is 21st Century medicine.  This is how American healthcare can be transformed.  Imagine the money that can be saved, the energy that can be felt, and the life that can be enjoyed by embracing a personalized approach to health.  There is hope.  Come and find out what my practice can do for you.