My Ketogenic Experiment Part II: How did I start my first two weeks on Keto?

Week 1: How to Keto

Where did I hear about the ketogenic diet?

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The first time I heard about the "ketogenic diet" outside of medicine was a few years back while perusing YouTube, I came upon a video where a guy was describing his technique for entering ketosis. This piqued my interest as I have been studying the effects of nutrition on health since I started practicing medicine 5 years ago and this was the first time I heard of anyone altering their diet to purposefully put themselves into this metabolic state. He explained how he would begin by fasting for 48-72 hours consuming only water and electrolytes in the form of bone broth. He would then periodically check his blood ketone levels to ensure they reached 0.06-3.0 mmol/dL which was consistent with being in "nutritional ketosis" (btw - since ketosis is based on strictly regulating carbohydrates and increasing fat intake, all ketosis is nutritional). After he entered ketosis, he would continue to monitor his blood ketones several times a day and strictly adhere to preset macro-nutrient ratios composing approximately of he daily calories consisting of 70-90% fat; 5- 20% protein; and 0-10% carbohydrate. 

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Wow... going keto seemed like it would be a total pain in the ass! And if you are jumping right in without research and preparation, it will be a pain in the ass! I have to disclose a few things that were working in my favor as I began this journey. Last year I implemented various types of intermittent fasting (IF) into my life. IF is an entire topic in and of itself and I could write a book about the many benefits of getting in a regular fast here and there but we are trying to stick to the keto topic today. In short, IF will teach your body to tap into its fat stores for energy after it depletes its glycogen stores, which is essentially stored glucose. Initially, your body may try and break down protein into glucose to get this energy (this is bad) but our bodies have had millions of years to adapt to intermittent feeding periods and after a few attempts at IF your body will activate genes that allow it to burn stored fat as energy and spare muscle mass. This, in essence, is a type of "intermittent keto" as the process is basically the same. So with a little IF prep work (as little as 30 days worth), your body should have the machinery in place to begin burning fat a lot quicker than if you cut out all the carbs cold turkey. Does this mean I had no carbohydrate cravings? Nope! I fell face first into a pile of chocolate covered Oreos left over from Christmas on day 2 and to start all over. But luckily, that was my only hiccup. The next day I got rid of all chocolate and sweets in the house (except for Alter Eco Dark Chocolate, I could eat 2-3 squares of that a day and it only had 2-4 grams of carbohydrate) because after I saw those first ketones register on the meter, I didn't want to ruin all my hard work.

Weeks 1 & 2

 I bought this set which has worked well for me.

I bought this set which has worked well for me.

Before I started, I bought a blood ketone meter. I have mixed feelings about this and for most people, you really don't need one. For one, it is a great way to measure your state of ketosis. It will give you an accurate measuring of your body's ability to create ketones in the absence of glucose. However, this can be a nuisance as well. Our bodies will go into ketosis despite whether you check the levels or not. I guess a ketone meter plays a role in experimenting on which foods you can safely eat and which will drive your levels down. Also, if you're like me, I like to see measurable results and checking my ketones daily was a way for me to record my progress and give me something for which to strive. It was difficult to reach 1.5 mmol of ketones and I sure as shit wasn't going to ruin it with another chocolate covered Oreo! On the other hand, if you check it too often, you're going to drive yourself crazy <- Trust me!!! So my recommendation is to check your ketone levels, initially, every day at the same time. I did this every morning and watched the levels slowly creep up (0.0, 0.1, 0.2, 0.4).

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My ketones levels were undetectable in the first 3 days and then fluctuated widely as my body learned to operate without glucose. Then I had to pee! I mean A LOT! I woke up 2-3 times a night to hit the toilet and forget about holding out till 9 or 10 am to drop off my first few cups of coffee. I was literally peeing every 30 minutes during the first few days. When your body burns through its glycogen stores, you lose a TON of water. You store about 3 grams of water for every gram of stored carbohydrate. So if you go from eating 300-500 grams of carbohydrate per day to 25-50 grams - you're going to lose a lot of water my friends.

 LYTEshow Electrolytes are a must to avoid the "Keto-Flu"

LYTEshow Electrolytes are a must to avoid the "Keto-Flu"

 It is important to know that as you lose your water, you lose your electrolytes as well. I initially knew that I was in ketosis when I was woken at 3 am with a muscle cramp in the instep of my foot. It was quite painful but I was expecting it nonetheless as I had done plenty of research and knew that getting your electrolytes in check was a critical step in feeling good throughout the process. At first, I remedied this with a ZMA supplement at night and a teaspoon of salt in 8 ounces of water every morning. But then I found an all in one electrolyte supplement called LYTEshow that came with a nifty travel dropper bottle. I just tossed it in my bag and poured a dose in my water 4-5 times a day. Once I got my lytes in check - I was truly good to go! 

The Dreaded Keto "Flu"

I never felt sick entering ketosis. Most folks I've found will complain about feeling fatigued, sluggish, and generally "foggy" at first which is dubbed "The Keto Flu" and from what I heard, the symptoms can be quite severe. I experienced none of this. Except for the occasional muscle cramp, I suffered no ill effects. In fact, the muscle cramps actually served as a reminder that A. I was indeed still in ketosis and B. I needed to up my electrolytes.

Athletic Performance

 This is me climbing a mountain in Nevada fueled solely by glucose. A few minutes later... I bonked!

This is me climbing a mountain in Nevada fueled solely by glucose. A few minutes later... I bonked!

The biggest change I encountered was a significant drop in athletic performance. This can be a HUGE issue for folks may be the deciding factor when it comes to trying their own self-experimentation with keto and this is understandable. I don't compete in jiujitsu anymore nor run 5-10k races, so I really wasn't concerned about a temporary drop in performance. I do enjoy high-intensity exercise with my body-weight, kettlebells, dumbbells, and sandbags. However, without sufficient glycogen storage, my muscles would bonk out rather quickly (bonk is used by athletes to describe the state in which there is absolutely no fuel left in the gas tank). For example, instead of being able to hammer out 20-30 burpees in a minute, I would run out of gas at 15 and need a good 3-5 minute break in-between sets. This was a weird feeling and took some getting used to. I no longer participate in long-distance endurance sports, so I have no personal experiences with how keto affects those activities. From what I would imagine is that long distance aerobic activities would improve after becoming keto-adapted - improved ability to metabolize fat as efficiently as we metabolize glucose. Why? If we are glucose dependent and not keto-adapted then after we burn through our glucose stores at various rates and when we hit "empty" we experience the dreaded bonk. I experienced this phenomenon out in the Nevada desert during a particularly grueling 100+ mile bike ride back in 2010 (before I was aware ketosis was even a thing). I literally rode till my legs quit. I had no more energy in reserve to keep going so what I had to do was slosh down sweet glucose filled jelly supplements and gooey syrups in order to power myself to the finish line. How would ketosis have helped me back then? It's hard to say but I imagine my body would have been able to easily switch fuels from glucose to fats and left me with a virtually unlimited supply of energy to keep me going without having to suck down sugar every 15 minutes. So athletic performance may be a concern in the short term but if you're a weekend warrior who wants to up his game, ketosis may work for you. A period of metabolic adaptation can take anywhere from 1-6 months for most folks forgo this process. You need to ask yourself, what do athletics mean to me? If you're covering an NFL wide receiver or hitting home runs for a living - maybe not for you. Do you enjoy the occasional community  5-10k or even marathons... it may fit you perfectly.

So that covers my first few weeks of the ketogenic diet. Stay tuned next week for weeks 3-8. Topics include sleep, weight loss, muscle gain and much more!

Part I - Part II

 

 

 

I Experimented with the Ketogenic Diet for 90 Days. Here is how I did it! Part I

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Typically I eat what I consider a healthy diet which is based on five years of personal research and trial and error through my medical practice. Last year I simplified my diet by switching to a paleo-type plan with some dairy included. I dubbed this lacto-paleo. Simplification is key for sticking with a diet and as long as I stayed within the parameters set forth by this eating style, I was fine. However, this past fall, I put aside my diet, for reasons I can only assume were not at the conscious level and indulged in a plethora of sugar and wheat-based holiday dessert items which were dropped off at my house by numerous well-wishing friends and relatives. I had fallen into the false "I can treat myself this one-time" mentality which snowballed into treating myself almost every day!

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January 2, 2018 rolled around and I jumped out of bed, refreshed from my brief but much needed holiday break from work. I went about my morning ritual but when I tried to cinch up my scrub bottoms I noticed they weren't fitting like they normally do. I had to pull the drawstring extra tight to gather up enough to tie a knot. Throughout the day, my normally comfortable, pajama-like work attire felt tight and uncomfortable. I like to encourage my patients to measure fat loss success by the fit of their clothes and I was now experiencing how well that strategy worked. In a moment of curiosity, I decided to get on the scale to see the damage. Ooof! I had gained eighteen pounds in about three months by my best estimation! My first thought was, "Why the hell didn't anyone tell me I was getting tubby!?" And then quickly shifted to, "I better take this weight off or I'm going to follow the path of my father and grandfather and wind up a cardiac patient or worse, dead! (If you're reading this and have a loved one who is packing on the weight, here is a tip - let them know! Making the necessary lifestyle changes sooner rather than later, maybe save their life.) I had to make some changes before I settled into this heavier version of myself. I was already paleo and that apparently wasn't restrictive enough. I had to consider that I had an "allergy" to excess carbohydrate that manifests itself as excess fat. It was time to implement a strategy I use on many of my patients struggling with weight management: the ketogenic diet.

If you haven't heard about the ketogenic diet by now then I would like to personally welcome you back to Earth. How was your trip to Mars? What was it like to be completely out of touch with the rest of the society? Okay, enough about you Mr. Astroman... let's get on with my article!

What exactly is "ketosis?

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Ketosis is a metabolic state of for which metabolically active ketone bodies (derived from fats) are utilized for energy instead of human's primary energy source, glucose. Ketones are produced by the liver when the body breaks down fat for energy. This typically occurs when an individual is in a fasted state or in instances of starvation but can also occur when carbohydrate intake is so low that glucose becomes unavailable to meet daily metabolic needs. Humans get our glucose primarily from carbohydrate consumption and then from protein consumption if needed. When there isn’t a sufficient level of available glucose and insufficient glucose stored in the body in the form of glycogen, blood sugar and insulin are lowered and the body looks for an alternative source of fuel.  And when the body begins breaking down stored-fats for energy, a process called beta-oxidation, ketones are formed and become the primary fuel for the body and brain. This is known as being in a state of ketosis.

Great! So there is a complicated physiological process which allows the human body to switch primary fuel sources from glucose to fat. Who cares? And more importantly, why should you go through the hassle of triggering this process? For one, the benefits of being in a state of ketosis include less reliance on carbohydrates for energy. This means a virtual elimination of sugar crashes many people experience between carb-rich meals. When a person who is fully adapted to a ketogenic state their body simply alternates between utilizing glucose and fat as its primary energy source. This results in reduced cravings for high carb foods as the body doesn't panic when glucose stores deplete because it has the metabolic hardware to use fat as a back-up and in some cases as it's main fuel source. A common theme among folks who try keto is hunger becomes more of a manageable afterthought rather than a pressing issue. I can attest to this (more on that in a bit)

Could the Ketogenic Diet KILL ME?!?!

Wait... hunger control, fat loss, blood sugar control, anti-inflammatory, mental clarity, increased energy?! If any of this was true, it could be a panacea to the modern epidemic of metabolic syndrome, a combination of poor cholesterol levels, obesity, high blood pressure and pre-diabetes. When I think of the countless medications on the market that claim the above effects but come with a boatload of side effects (some severe), it makes me wonder why this diet isn't recommended by practitioners to more of their patients. I think the most obvious reason is that when you increase your fat intake, you will undoubtedly increase your LDL or as some call it, "bad cholesterol." But simply looking at a total cholesterol number doesn't tell the whole story. In order to tell the whole cholesterol story, we need to look at your diet to determine what foods are driving up your LDL and then examine your triglyceride and HDL levels. By looking at the various ratios of these blood lipids, we get a complete picture of your heart health. There is a TON I have to say about understanding lipid profiles (your cholesterol numbers) and that will have to wait for another article. But for time's sake - yes, a ketogenic diet raises your cholesterol. However, this may not actually be a bad thing! But everyone is different and in order to truly know, you should get a full cardiac lab workup before you venture into ketosis. (WellnessFX.com has a plethora of labs you can buy on your own). I took some simple labs in my own clinic and here is how my numbers looked prior to ketosis:

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  • Total Cholesterol: 210 
  • LDL: 120; HDL: 33
  • Triglycerides: 145
  • VLDL: 29
  • HgA1C: 5.2
  • Waist to height ratio: .60
  • Body Mass Index: 29
  • Blood Pressure: 138/88 

None of those values are exceptionally good. In fact, medical markers such as my triglyceride to HDL ratio (4.4) and waist to height ratio (.60) were telling me that I was skirting the edge of metabolic syndrome and on my way towards heart disease! PANIC! It was definitely time to make a change! As a practitioner, I dove deeply into the medical implications of ketogenic diet and certainly didn't want to add to my risk of heart disease and stroke. I knew, through my medical knowledge and experience that cutting my carb intake below 25 grams per day would slash my average blood sugars and thus my insulin levels - both precursors to obesity and diabetes when elevated. This was good. However, approximately 20-25% of your cholesterol is dietary and I was a bit concerned about those levels jumping up a bit. I simply had to trust the research. It has been proven, time and time again, that increasing healthy and natural dietary fats (really any unprocessed fats including animal fats) would help my body reduce dangerous triglyceride levels, increase helpful HDL levels, and make my LDL cholesterol fluffy, buoyant, and harmless. It's hard to go against 50 years of erroneous medical advice to avoid fats and cholesterol. We have brainwashed to believe cholesterol is the enemy and it turns out, that's just not true. "Trust the science" became my mantra and I was ready to begin!

Part I - Part II

(Mal)Nutrition: Medical Professionals Cried Wolf Too Many Times and Now No One is Listening!

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Many of my patients are frustrated with the seemingly endless stream of conflicting recommendations about the consumption of dietary macro-nutrients. By which I mean - How many carbs, fats, and proteins should a healthy person consume on a daily basis. They have a right to be frustrated! We place so much emphasis on making the right personal choices and blame poor diet and poor health on the "failure" to make these choices based solely on ambiguous and sometimes conflicting recommendations. Think about how many times the "establishment" recommended against the consumption of butter versus margarine! I work in medicine for crying-out-loud and I'm still not clear on the actual establishment recommendations! To add insult to literal injury, when a person's health begins to fail, we blame them for not making better dietary decisions. It's common to talk to a patient about lifestyle modifications and watch them tune out. I can literally see the curtain go over the patient's eyes as their mind drifts elsewhere, far away from the droning of yet another medical professional lecturing on a proper diet.  I DON'T BLAME THEM. Unfortunately, the medical community has cried wolf so many times that no one is paying attention anymore.

 CErtified bad-ass and nazi killer was no match for heart disease&nbsp;

CErtified bad-ass and nazi killer was no match for heart disease 

We were chugging along quite nicely for around 200,000 years with a few hiccups threatening our existence here and there (I'm looking at you black plague) but then suddenly everything changed. Human's got really smart and we let it get to our heads. We figured that Mother Nature had her time in the spotlight and now we'd like a go at this whole "feeding the world" thing. We began to process the sh!t out of everything under the sun; making it last longer, tastier and addictive. We figured out ways to market "food" as a commodity and over the past 50, business has been booming! Humans messing with nature... this always works out! Except, as the shelf-life increased on cookies and cakes, the shelf-life on humans began to decline. We noticed an increase in the amounts of individuals dropping dead with one hand clutching their chest, the other clutching a pork chop. Even our beloved President Eisenhower fell victim to heart disease in the mid-1950s. This is the PRESIDENT who fought Nazis for God's sake! Things had to change! American physicians were perplexed. What was causing this epidemic? Why were we sick? Why was nature's house of cards crashing down? 

(If you want the full story, check out "Deep Nutrition" by Cate Shanahan)  

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During the 1960s a handsome young fella named Dr. Ancel Keys came along and was very concerned about the health of Americans AND for the state of his scientific legacy (mostly his legacy). He LOVED being in front of the camera and wearing a white lab coat for which it was not easy at all to mistake him for an MD. Oh, you thought he was a doctor? He was... kind of. He was a marine biologist (fish physiology... FISH... not humans) but this wouldn't stop him from harmfully altering human nutrition for a half of century! Through a grant from the government (he had friends), he embarked on an ambitious study of six countries to compare their rates of heart disease against their macro-nutritional intake (Fats, Proteins, Carbohydrates). Guess what? The six countries he studies showed a direct correlation between saturated fat intake and heart disease! Pretty damning right? Great! We have our villain - FAT. Now let's move on and save the world. Enter the low-fat craze of the 1970s-present day. Low-fat meant you could label anything without fat a health food (lollypops, jellybeans, Gummy Bears - all NO fat). 

Once we Identified the culprit as dietary fat, we were free from the adverse effects of heart disease and humans lived long and healthy lives! Well, not quite. In fact, the past 50 years ushered in an all-out epidemic of obesity, diabetes and... you guessed it... HEART DISEASE! Some would argue that it was because Americans are fat and stubborn and didn't heed Dr. Keys' advice but that just isn't true. Americans DID, in fact, cut their fat intake. Butter intake dropped in half since 1960 and gym membership skyrocketed. So what was the deal? What were we missing?

You see, Dr. Keys failed to mention in his landmark study that he researched a total of 22 individual countries, not just six! Why the discrepancy? The 15 countries not included in the final report showed no correlation in heart disease and fat intake. Huh? Really?! Yes, really. When the excluded countries are plugged into the statistical graph (see above), viola... no correlation. Let me repeat that! The study excluded countries that contradicted his hypothesis! He didn't like the data so he through it out! 

So are you saying fats are safe?

Yup! But let me put an asterisk here to avoid confusion: *Natural and unprocessed fats are safe to consume. Clear? I think we need to dive a little deeper here.

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I live by a general rule: Nature doesn't make bad fats. Science is complicated and so too is human physiology. As you may be discovering, science is very gray! First off, trans fats are bad! Very bad! You don't need to know the bio-chemistry properties of WHY it is called a "trans" fat, just knowing they fry your arteries is enough to know that you need to stay away! Eliminating them from the diet should be akin to eliminating smoking cigarettes - there is just no safe amount. However, did you know that the "safe" polyunsaturated fatty acids (PUFAs) contained in vegetable oils such as Canola oil are simply a precursor to trans fats? How might this be? When vegetable oils are in their natural state, that is, contained within the seeds of the plants from which they are derived, they have a beautiful 5-6 sided geometric shape and are loaded with anti-oxidants which neutralize harmful oxidation which tends to occur in nature when the seeds germinate in the hot sun. But when the nuts and seeds are treated high heat and harsh chemicals (look up 'hexane' and see if it is something you'd want to eat) the antioxidants are rendered useless. The previously natural 5-6 sided geometric molecular shapes of the natural fats are mangled and twisted into molecular "mousetraps" which bind to our body's important enzymes after consumption and wreak havoc at the cellular level. These processed fats impair so many basic physiological functions, like circulation and immunity, that consuming them can indeed kill you. That is not an overstatement. Conversely, natural, unadulterated fats (saturated and unsaturated in their raw form) are in fact, good for you. These include butter (grass-fed is the best), virgin olive oil, virgin coconut oil, lard, tallow, palm oil and even peanut oil. Yes butter does undergo a degree of processing, as does cheese and virgin olive oil but this gentler "processing" leaves the basic structure of these fats intact.

Our bodies have had millennia to learn how to digest and utilize these essential nutrients because they were consumed in their natural state. Fat and cholesterol are very important to natural physiological processes and as long as they are consumed in conjunction with whole/healthy unprocessed foods, there is really little to be concerned about. Let that sink in and become the new norm when deciding what to eat: Fats are an essential part of your everyday diet. I can't stress enough the need to research nutrition for yourself. But remember, most of the studies about saturated fat and cholesterol leading to increased heart disease fall into the correlation versus causation trap. Just because we see a correlation does not mean it is the cause. In fact, it was found that individuals who haven't paid attention to the past 50 years of erroneous nutrition advice for low-fat dieting were "medically rebellious" in a sense. This meant they ignored calls for eating less red meat and cholesterol! But more importantly, they also ignored the advice of not smoking, drinking in moderation and exercising regularly, all of which have a CAUSAL relationship with atherosclerosis and heart disease. You also have to take into account genetic profile and congenital lipid abnormalities. A good physician takes all this into account before making dietary advice. 

Below is my A-LIST of nutritional references. Read them and school your friends and neighbors! Knowledge is contageous!

Reaching the right "Fat Loss Mindset" and how weight loss can be as difficult or simple as you want it to be!

An Industry Ripe with Failure

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Most folks who try to lose body fat struggle and ultimately fail to achieve their goals. This is not their fault and neither was becoming obese in the first place. The fault lies within the "system". Without sounding conspiratorial, "the system" represents the advice of working within the constraints of the Standard American Diet and Standard American Exercise Recommendations as the basis for weight loss. The truth of the matter is that trying to cure obesity and all its related co-morbid conditions within the current "system" is like trying to quit smoking by switching light cigarettes.

I can't remember who said "All diets work, all diets fail" but it is the absolute truth in the management of obesity. After treating hundreds of obese individuals, I can tell you that most encounters start with the following questions:

  • What medication can I take to lose weight?
  • What diet should I try?
  • What supplement works the best?
  • Which exercise program works the best?

What do all these questions have in common? They are simply the wrong ones to ask and usually tip me off that the patient is in the wrong mindset for a successful attempt at fat loss. They suggest that curing obesity is a matter of discovering the right fat loss tool which can be adopted into our current way of living that will allow us to enjoy the Standard American Diet (SAD) yet see the weight magically come off.  

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Before weight loss tools are even discussed, it is critical to understand obesity is a multi-factorial disease process in which hormonal regulation, stress, sleep patterns, dietary patterns (both what and when people eat) and most importantly behavioral patterns are all equally to blame. Obesity is caused by an astronomically complicated group of interrelated physiological processes which have fallen into disarray as a result of the processed "foods" (I prefer to call them "edible food-like substances") which have become commonplace in the SAD. Our bodies become overwhelmed with the task of dealing with this highly-processed-garbage deficient in any basic nutrients. Our primary metabolic functions, including cell repair and energy regulation (stored energy versus burned energy), become so dysfunctional that the result is obesity and all its related co-morbidities (diabetes, heart disease, cancer). So, recommending a specific workout routine, supplement, diet, or medication doesn't address the underlying issue. It's akin to turning on the heat in the summer because the air conditioner is set too cold.   

But I Know Someone Who Lost Weight by Drinking "Supplement" Shakes!

I'm often asked, "If convention doesn't work, why do I know people who have lost weight using conventional approaches?" By conventional approaches, I assume you are talking about anything you've seen on TV or heard around the water bubbler at work. Think Adkins, South Beach, BCG, meal replacement plans, point system plans, etc. Typically, all methods will work initially due to multiple variables including the fact that most weight loss regimens require users to reduce "sweets" and cut processed carbohydrates. The problem is that dieters typically cut all foods, the bad and the good, across the board, because they erroneously think weight loss is about reducing your caloric intake and increasing your exercise output. If this were the indeed the case, the record number of Americans adhering to the government's diet and exercise recommendations would be stifling obesity rates yet the numbers are skyrocketing! The truth is, conventional weight loss recommendations (eat-less/move-more) simply do not work and it has been proven time and time again. Why? Humans have overcome adversity (droughts, famines, fires, ice) over the past 200,000 years because our bodies compensate. We mimic these historical adversities by reducing our caloric intake and increasing our exercise. In return, our bodies compensate to keep us alive by slowing our metabolisms.

Here is an oversimplified rundown of the typical weight loss attempt: 

Your body needs a certain amount of energy to run its functions throughout the day (breathing, pumping blood, repairing cells, growing hair, etc.). Let's say it is 2000 calories. You have excess fat to lose so you decide to only consume 1200 calories a day. In theory, you should be left with a caloric deficit (meaning your burning more calories than you are eating) and have to tap into your energy stores (your fat) to make up the difference. And this is true, temporarily at least. There are a lot of things going on which will actually cause your daily caloric expenditure to fluctuate by several hundred calories a day (but that is for another post). When we deprive our bodies of the required caloric intake, it responds by saying "Hey?! What the hell is going on here?! Eat something dummy!" These cues (hunger & cravings) are hormonal and cause the familiar gnawing hunger of a calorie-reduced diet. But, because you're determined to lose weight before summer, you ignore these hunger cues and continue your caloric deficit for... say... 3 months (in my experience, that is the average). At first, the weight comes off fast, then it slows, reaches a plateau and ultimately starts to come back on! But why?! The answer is simple: you purposely denied your body nutrition and this freaked it out. The human body worked hard during the caveman days to keep us alive through the good times and the bad times. During the bad times, the body slows down various processes to conserve energy. This is why when you're dieting you often feel fatigued and cranky, your immune system dysfunctions, sometimes your hair will thin, your sex drive decreases (a starving person is not a good candidate for reproduction) and the weight comes back on despite the fact that you're still denying your body the calories that it is pleading for. Think of this like using power saving mode on your cell phone. You can't do any of the fun stuff with it until it's recharged. You can argue with me all day about the validity of this process but ultimately, nature and evolution are right. 

The Reward Cycle

The current system is built on triggering your evolutionary program to eat foods that give you reward. I was there, I know. I would go to bed looking forward to breakfast. Breakfast made me feel good because it was a reward. Who doesn't like a tall stack of pancakes with syrup? Then I would look forward to my mid-morning snack - trail mix or a granola bar: reward. Then lunch - a sandwich and some kind of chips/crackers: reward. Dinner was the same. Fridays were the best because it was pizza night: BIG REWARD! It's no wonder we crave the food we crave because they are full of rewards and this genetically programmed reward system kept us hunting for foods that were high in energy for eons.

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Curing obesity is both exquisitely simple as it is infinitely difficult! A key point is the need to work within the confines our physiology and genetics rather than against these processes with drugs and unsustainable diets. This current paradigm forces the individual to approach their weight goals through the act of constant DEPRIVATION. This runs in contrast to our genetic programming to seek out rewards to ensure survival. For instance, we decide we are going to deprive ourselves of ice cream, beer, sugar, carbs, pizza. etc. This becomes a lifestyle of negativity and of constant reminders of what you cannot eat and certain foods become taboo. The "aha!" moment comes when you realize that losing weight is not about making a list of foods that you have to avoid and restrict. It doesn't mean taking three months off these taboo foods only to have a cheat day or to return to them after bikini season. The point I am trying to make is that a successful weight loss inducing diet is not about restricting things from the Standard American Diet but about shirking the Standard American Diet altogether.

Food is Sacred

I encourage patients to think outside the box and remove themselves from the current nutrition paradigm. Their relationship changes from being controlled by cravings and struggling to limit the processed foods to one where foods are worthy of their consumption. You can get to a place where you ask not "when can I eat a piece of cake" but "why would I even want to eat that piece of cake?" I encourage patients to ask themselves "what will the food do for me?" Is the self-ridicule, the feeling of cheating yourself or the feeling of defeat worth three minutes of "yum"? Once a patient realizes their body is sacred and the food which fuels it is sacred as well, they reach a zen-type level of understanding nutrition. When the paradigm shifts from RESTRICTING certain foods from the SAD framework to eliminating the framework altogether there comes the realization that you are not restricting anything! You CAN teach your taste buds to enjoy the endless combinations of flavor available from nature rather than allow chemical cocktails to hijack your evolutionary responses and make you crave the unnatural.

Our grandparents (and generations before them) understood this principle and is why they had the skills and knowledge to bake and cook from whole foods scratch to grow and can foods for storage, and that some foods were indeed a reward and reserved for special occasions (once, maybe twice a year). Once you "see the light" and recognize real food, you simply ignore the junk and trust me... YOU NO LONGER CRAVE IT! You are not depriving yourself of cakes, sugar and processed carbs, you are deciding that those food-like-substances are not part of your ecosystem. And yes, you'll get looks at holiday dinners and birthday parties when you push away the pastries but you have to realize that it is their issue, not yours. If they want to tease you because you won't eat a piece of chemically generated sugar filled, trans fat laden cake for little Johnny's 3rd birthday party, let them. 

So you may ask, "What program is healthy and how do I start it?" I am a HUGE proponent of the Paleo lifestyle (follow the link for a brief description). YES, Paleo people can be as annoying as vegans (not really) and I understand that no program is one size fits all. The biggest takeaway from Paleo is to just stick with natural whole foods. That's it. You can adjust your macros if you want, you can try "going keto" knock yourself out; if you want to try vegetarian (and miss out on essential nutrients from a balanced diet which includes meat) then hey, it's a free country. If you're frustrated and confused the BECOME AN EXPERT YOURSELF! Here is a partial list of books that completely changed my way of thinking about nutrition: Paleo/Whole Foods Resources.

Nootropics: A Limitless Cognitive Enhancer for Your Brain or Just Another Health Gimmick?

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Let's start with a disclaimer: I am a formally trained physician assistant and nationally board certified to practice medicine. I am expected to interview patients, perform physical exams, run laboratory tests, and make a diagnosis and treat my patients accordingly. I am 100% western medicine 100% of the time. I have faith in my training, faith in my research and faith in my career field. With that said, the age of information has ushered in alternative approaches to a host of chronic conditions, including obesity, fatigue, pain disorders, and insomnia. Have witnessed a failure of conventional medicine to treat these "diseases of civilization", I remain open-minded to the exploration of supplemental approaches. I say this having witnessed the remission of chronic conditions with intensive lifestyle modifications to include dietary modifications, meditation, and yes - use of supplements.  

The latest buzzword among supplement fans and so-called bio-hackers of the 21-century  is NOOTROPICS (noh-ə-TROP-iks). Often marketed as "smart drugs" (in not so many words) and "cognitive enhancers" they are said to improve cognitive function, particularly executive functions, memory, creativity, or motivation, in healthy individuals. Think Bradly Cooper 2011's movie Limitless, where his character stumbles upon an illicit substance which allows him to access the mythological 90% unused portion of his brain. Although seemingly a modern concept, nootropics are actually decades-old (centuries old if you consider any stimulant, including caffeine a nootropic). In fact, the word nootropic was coined by a Romanian psychologist and chemist, Corneliu E. Giurgea back in 1972. The word translates to "mind-bend" or "mind-turn" depending on your translation. 

What Nootropics ARE/AREN'T

The secret to successful supplement launch is in the vagueness of its supposed effects. If one applies the basic definition of nootropics, we can begin to see how widely this term can be applied to a host of compounds. Take caffeine as an example. I drink it every day starting at 6:30 am till usually around 3:00 pm. Why? For one, I love it (Black Rifle Coffe - Support Vets and BUY SOME!). I love the flavor, the smell, and the warmth but I also drink it for its kick to my cognition and its ability to fire me up for my lunchtime workouts (you too can workout anywhere this these pieces of equipment).


Nootropics are naturally occurring compounds that claim to help enhance the cognitive abilities of the brain including logical reasoning, motivation and mental energy, memory formation, recall, learning, creative thinking, concentration, and mood. These are known to have a positive effect on memory and some are even used for medical conditions such as Dementia and Alzheimer's. They can also help students to absorb and memorize more information. These smart drugs can improve attention and focus too, but with fewer side-effects than over-consumption of caffeine. (If you've never experienced the jittery nausea and stomach cramping from drinking two pots of coffee during an all-night study block, then you haven't truly experienced college).

There are several different types of Nootropics. These include: 

1.Choline & Acetylcholine Intermediates.
2.Synthetic B-Vitamin Derived.
3.Ampakines
4. Racetams
5.Natural peptide-based smart drugs.


To understand their function, it is essential to know about the different neural pathways that exist within the brain. Neural pathways are composed of neurotransmitters and the receptors. Neurons are the basic building structures of the central nervous system. Nerve signals are sent from one neuron to another through the action of neurotransmitters. These neurotransmitters can either be excitatory or inhibitory. The excitatory neurotransmitters are the ones that broadcast a message to other neurons while the inhibitory neurotransmitters are the ones that keep the messages from being sent or received. Based on these received messages, the neurotransmitters then bind to the receptor sites on nerve synapses. There is a myriad of different neural pathways in the brain. Nootropics interact with the central nervous system by boosting the efficiency of these neural pathways leading to improved cognitive functions.

Here are some of the common nootropics and their claims (all should be used under medical supervision only):

1.Noopept
Claim:  improved learning ability, reduced anxiety, advanced logical thinking and an overall increased cognitive performance.

2.Pramiracetam
Claim: improved cognition, increased attention span. Neutral effects on mood or anxiety level.

3.Modafinil
This is one of the strongest available and should be used with under medical supervision. This drug is used to improve the alertness. It is considered to be a potent wakefulness agent. It can help get rid of sleepiness and persistent fatigue. It also has significant cognitive effects such as increased focus and improved mental energy.

4. Adrafinil.
Claim: very similar to Modafinil, as it converts to that compound in your liver. 

5.Aniracetam.
Claim: provides relief from stress and anxiety and allegedly positively enhances mood.

6.5-HTP.
Claim: a substance that is made in the body from L-Tryptophan, which then converts to serotonin in the brain. Serotonin is responsible for regulating mood neurotransmitters. It prevents you from over-excitement.

7.Huperzine A.
Claim: it helps raise the Acetylcholine levels in the brain. This is an important neurotransmitter and can help with not only memory but other cognitive functions and processes.

Although there are reports of positive benefits from these, you should still approach with caution and consider that any evidence to their efficacy is contaminated with confirmation bias and placebo effect. As with anything new, it is recommended you consult your doctor before using any of these chemicals because of their interactions with serotonin especially. Everyone and their brother is on some kind of serotonin modulator and excessive amounts in your system can cause serotonin syndrome.

Nootropics are available pretty much anywhere. My recommendation for those who have never tried them is Onnit's Alpha Brain and New Mood. Onnit does a lot of legwork in the field of researching their claims. I still hold a bit of healthy skepticism about their claims as all Onnit studies are self funded but are of good method. Take that for what it is worth.

My Favorite Piece DIY Workout Gear And How You Can Easily Make One Too!

 The canvas daypack.&nbsp;

The canvas daypack. 

 The Tool Bag - Hand for size reference&nbsp;

The Tool Bag - Hand for size reference 

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My life is a bit busy with raising two kids, running a medical clinic, producing a podcast and writing for the Civil Primate Blog! So, I have to fit my workouts wherever and whenever I can. I've put together a list of workout products over here which have made fitness possible without excuses! If I don't get my workouts in, I can only blame myself!

This particular set up I made back when I was in the service. I traveled a lot and my hours were all over the place (days, nights, weekends). I didn't have the time or energy to make it to the gym, so I made my own gym and threw it in the back of my truck. The set up has three main components: 1. The day-pack (complete with C-130 blood stains); 2. The canvas tool bag (probably 20'' x 10'' x 9''); 3. The sand. 

It's really simple to put together. I bought a 50-pound bag of play-sand at Lowes Home Improvement and wrapped the entire thing in duct tape. I then put it in an industrial trash bag, trimmed the excess and wrapped it again in duct tape (I planned on tossing this thing around and wanted to ensure it wouldn't split open and bleed out its sandy guts). Lastly, I put the whole thing in the tool bag, zipped it closed 15 years ago and haven't looked inside since. It has held up to some serious punishment and has never lost a grain of sand. You can use the tool bad alone or put it in the pack for weighted pull-ups, push-ups or take it on a 3-mile ruck! (check out these youtube vids for sandbag workout ideas)

Below are some links for the equipment found over at Amazon. I recommend getting the sand at Lowes for $3-$4 versus $30 on Amazon but hey, that's just me! 

Or you can just buy the thing ready-made!

Functional Medicine? Dysfunction in Disguise ;-)

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I am formally trained in the western medicine (WM) philosophy of treating human disease and injury as a Physician Assistant (take note that I am not a Physician's Assistant... that little apostrophe can kiss my... sorry... back on track!). I'll be the first to admit that there are some flaws to WM but in the same breath, I cannot begin to describe the emotion feel when listening to the beating of a donor's heart in the chest of patient who would otherwise be dead. The feeling is a combination of awe, inspiration and a bit of pride to be a member of a system that made something like this possible. I have learned so much in my practice and I have developed a deep respect for this centuries old art. The truth is, no matter what criticisms you bestow upon WM (I admit there are plenty), you cannot deny the substantial victories it has claimed against the onslaught of human pathology.

With that said...

   ...where does WM fail? We are really really good at TREATING DISEASES. I mean crazy good. Like Lebron... no... JORDAN good at it. But we seem to only focus on the end game which is disease. Time for a sports metaphor? Sure! Lets say you're a golfer and you go to a practice putting green ever day and to spend hours honing your short game. You learn to analyse subtle dips and rolls of the short cropped grass and perfect the very slight power adjustments and angular trajectories in order to get the ball in the hole. It is the perfect problem solving scenario ripe with analyzing the physical world and controlling the mental. Your time and energy on the green should pay off in your ability to sink the ball with precision and perfection time and time again! But, in a typical par 5 course, the green should only represent about 20% of the game? What about the 80% of the course which came before it? How did you move the ball 300 yards to the putting green in the first place? 

 Jason Seib - One of the best Paleo coaches on the planet! Read his books!   

Jason Seib - One of the best Paleo coaches on the planet! Read his books!

 

Well, WM is quite similar. Most of the time, people come to me when they are already sick (on the putting green). I still like to hear about how they played through the green (this is called the Patient History). Getting this right is important... like REALLY important. In fact, back in PA School, we were taught that the "history is 90% of the diagnosis." But history is history, the damage is already done and I am typically forced to treat conditions with a host of medical interventions to include medications and physical therapy and maybe even surgery. To keep with the metaphor, ideally, I sink the ball with as few strokes as possible. I love chalking up "Wins" in the "Cured" column! The problem is that the "Win's" can be hard to come by (see Jets 2017... sorry), especially in the realm of chronic disease. So how do we improve our "Wins"? We focus on the rest of the game! In medicine, this translates to identifying contributing lifestyle factors that increase chances of developing disease states. This is fine and most medical practitioners are aware of this. But keep in mind, most practitioners are running a business and they need profits to grow and make payroll. Today's fee for service, insurance brokering, overcharging, inconsistent medical payment atmosphere, if you spend the necessary 60-120 minute encounter with patients, then your business will fail. So yes, we need to improve and everyone is aware of this. This also creates a market for "alternatives" to the current paradigm. Is there room for these alternatives? Maybe. Should we give them the same clout as western medical facilities... nope!

Enter Functional Medicine (dysfunction in disguise)

The term "functional" is being added to the beginning of lots of terms these days to denote a sort of better quality/healthier choice. I've heard of functional diets, functional eating patterns, functional yoga, functional exercise, and now functional medicine. The problem with "functional-anything" is that the term is ambiguous and can be used as a marketing scheme to drive customers to a product. Let's focus on medicine. In most cases, functional medicine is a unscientifically verified "medical" methodology claiming good health and vitality to it's users. (yeah... snake oil promises this too). Functional medicine claims to be a developmental practice that addresses the healthcare needs of the 21st century. Instead of treating disease states, functional medicine centers around the causation of disease. So far, this sounds okay but it gets a bit fishy.  Functional medicine was invented by nutritionists Jeffrey and Susan Bland (<- not Medical Doctors... or even lowly PAs!). They founded the Institute for Functional Medicine back in the early 1990s. 

Their site claims:

Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, Functional Medicine addresses the whole person, not just an isolated set of symptoms. Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, Functional Medicine supports the unique expression of health and vitality for each individual.
— Institute for Functional Medicine

This all sounds good on the surface, but Dr. Harriett Hall (real doctor) does a nice job dismantling the claim on Skeptic.com:

 Dr. Berry give a great critique to modern western medicine!

Dr. Berry give a great critique to modern western medicine!

[The claims] sound good, until you realize that it also describes good conventional medicine. Conventional medicine always addresses the underlying causes of disease: when you have appendicitis, you don’t just get morphine for the pain, you get an appendectomy to remove the cause of the pain. Conventional medicine deals with real underlying causes; FM makes up hypothetical, speculative, or imaginary causes.

Conventional medicine uses a systems-oriented approach when appropriate, but it is not helpful for setting a broken bone. Conventional doctors always engage their patients in a therapeutic partnership; the days of paternalistic medicine are long gone. Conventional doctors have always addressed the whole person. As early as ancient Greece, Hippocrates said it was more important to know which person had the disease than to know which disease the person had. Conventional doctors have to spend time with their patients, since the history is 70% of the diagnostic process.

In other words, WE DO THE SAME DAMN THING! Yes, I get it. The current leaders within the paradigm (western medicine institutions) receive the brunt of the criticism and they rightly should. It is only through criticism that we adjust and perfect. And I DO like some premises of functional medicine especially in the evaluation of the entire individual's life, not a single encounter's "snapshot" of their health and I think this is an important concept. Today, a typical family practitioner has around 7 minutes to walk into a room, greet the patient, discuss current medications, ask how they are feeling, perform a physical exam and then make a recommendation. Remember, most medical providers are running a business and they get very little in compensation per patient, so they are forced to fill their schedules. When the suggestion to shift medicine from a fast-paced disease management system to a more patient-lifestyle approach, people are going to feel empowered and folks will respond. From what I have read, these "practitioners" invest a lot of energy with their patients and tune in to their personal histories, while assessing their living environment, lifestyle choices, and hereditary factors. This approach offers patients a one of a kind hands-on personal involvement in healthcare, which prompts higher engagement. That's not a bad thing. 

So, What's My Final Verdict?

I may be hard on functional medicine and I would suggest my critiques are well founded (the whole avoidance of the scientific method really sets off my bullsh!t meter)... BUT... western medicine may want to take a chapter out of the functional medicine playbook. Spending time with patients, listening, and reassuring pays a lot of dividends. Unfortunately, this may not be feasible within the confines of the current model as reimbursement plays a major role. This is why many practitioners are bailing completely from the insurance reimbursement model and opening old-school fee-for-service clinics. 

Let's revisit two things I opened the article with. First, western medicine, for all its faults, is still the Michael Jordan of all medical models. Don't believe me? I would love for you to feel the rhythmic thump of a donor's heart in the chest of a patient that has peaked behind the curtain of death but came out the other side healthy and enjoying life. That would be unheard of without the marvels of modern medical practices. However, I think the western medical model needs some fine tuning and we need to find a way to address the many lifestyle factors that relate to health and wellness. We need to see patients when they are WELL and preempt disease before it leads to death and disability. 

 

Hope you enjoyed the latest Civil Primate Blog post! Looking for a Podcast that inspires and motivates through interviews with authors, filmmakers, and everyday philosophers? Then look no further! Check out The Wait What If Podcast on iTunes, Podbean, or Stitcher.

Cheers - KS

Is The Paleo Diet Right for You?

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  WWI Podcast listeners save $7 on Waiola Coconut Water Till 4/9/18

WWI Podcast listeners save $7 on Waiola Coconut Water Till 4/9/18

The answer is a resounding YES! There are zero negatives for which switching your diet to ancestral whole foods based eating plan. Humans have been around for approximately 200,000 years. That is a long time for the trial and error dependent tools of evolution to hone our physiology into well-orchestrated perfection. However, the story takes a turn for the worst. Back in the mid-20th century, humans decided to capitalize on nature with a pathetic attempt at improving on her methods. Rather than relying on food which grows from the power of the sun (all real foods come from the sun... even MEAT... queue vegan gasps!), we switched to foods mass produced on assembly lines pumped full of sugar and dangerously unstable and highly processed vegetable oils! What has resulted? A worldwide epidemic of chronic medical conditions set to bankrupt our society and send our children to early graves. That's right, we've reached the first generation of humans who may live shorter and markedly sicker lives compared to their parents. 

Here is Everything You Need To Know About the Paleo Diet

 

What Is Paleo Diet?

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The Paleo Diet refers to the consumption of foods that were available during the Paleolithic period. That means consuming plant and animal products that were available to humans 2.6 million to 12,000 years ago when the earth was in its purest state. Scientific studies in various fields of research including biology and biochemistry suggest that this diet is highly beneficial to humans. More specifically, it facilitates our physiological processes naturally. It helps us fight diseases as well. In contrast, modern foods are full of preservatives and artificial flavors among other chemical products. They work against the body leading to the development of diseases such as obesity, diabetes, cancer, and heart disease among others.

Paleo Foods

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Sources of protein on a Paleo Diet include beef obtained from grass-fed cattle. You can also eat chicken, bacon, and pork to get this nutrient. Other sources of protein include fish, geese, and oysters. Vitamins are another critical food group in the Paleo Diet Plan. You can eat fruits such as mangoes, papaya, pineapples, and oranges among others. Recommended vegetables include asparagus, broccoli, collard greens, and kales. Sources of fat while you are on a Paleo Diet include avocados, coconut oil, ghee, and lard. You have to avoid some foods if you are on this diet. For example, avoid dairy products including milk, yogurt, ice cream, and cheese. Remember, the consumption of these products started in 9,000 to 8,000 BC, which is past the Paleolithic period that ended in 12,000 BC. Other foods to avoid include grains, legumes, and starches. Moreover, the Paleo Diet discourages the consumption of all processed foods and sugars. Even alcohol is not okay. In other words, the Paleo Diet encourages you to eat foods that nature designed for you.

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The Benefits of a Paleo Diet Plan

A study by S. Linderberg and J. Soffman among other researchers determined that a Paleo Diet improves the level of glucose tolerance in people who suffer from ischemic heart disease. In fact, they compared it to the Mediterranean Diet over a twelve-week period, and they found that the Paleo Diet was better than the Mediterranean one when it came to helping people who are living with Type 2 Diabetes. The publication of these findings took place in the September 2007 issue of Diabetologia. Other studies have shown positive results for people who persist with this diet plan. For example, some of them indicate that a Paleo Diet leads to a reduced risk of developing heart disease. It improves your immunity as well. Finally, Paleo foods are an excellent source of monounsaturated fat lowering your risk of becoming obese. Remember foods in contemporary society are rich in saturated fats, which are bad for your body. Avoid them as much as possible by switching to a Paleo Diet as soon as you can.

In conclusion, the Paleo Diet Plan is a way of improving the physical health of your body naturally. It does that by helping you consume foods that facilitate physiological processes in your body. Remember, the Paleo diet is the key to health and wellness in life. Start your Paleo Diet Plan today and stick to it.

THe Absolute BEST Sources for Paleo Lifestyle:

The Paleo Solution to Office Work: Should You Invest in a Standing Desk?

Even the crossfitters who are recovering from reconstructive knee surgery gain a few healthy benefits from their activities.
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I am asked by a lot of patients for my opinion on the new trend of using upright/standing desks. Are they a healthy alternative to sitting at a desk all day long? Will they aid in weight loss? Should I spend the money? The best short-answer I can give would be and ambiguous “definitely maybe.” But who likes short-answers?! Not this guy (as evident by my tendency to talk… a lot).

So how about some clarification? I guess my answer would depend on your goals in the realm of health and wellness. First and foremost, if your goal is losing weight, shedding fat is a complicated physiological process which takes into account hormonal regulation largely influenced by dietary choices versus physical activity. By “largely”, I mean your diet takes greater than a 95% burden of weight loss. This means the hours upon hours you slog out in the gym, blowing out disks at crossfit, running on a treadmill and yes… standing at a desk while working, only equates to a minimal change in body composition. This isn't to say that increasing physical activity, any way you can fit it in, is not good for you… it most definitely is! Even the crossfitters who are recovering from reconstructive knee surgery gain a few healthy benefits from their activities. But I digress… let's look at the data.

 Human hamster wheel! Overkill?

Human hamster wheel! Overkill?

Luckily for us, studies have already been done evaluating the benefits of standing versus sitting at your workspace. And doing so does, in fact, increase your energy expenditure (total calories out) compared to those who sit. And for those hardcore office-dwellers who level-up on their peers and choose to stand on balance boards while working, they have an even greater total energy expenditure throughout the work-day. This is great... amitrite?!  Well, again… yes and no (why does everything have to be so damn ambiguous???).

I'll start by explaining the “yes”. In my personal medical opinion, anything we can do during the day to mimic our ancestral pattern of living is a move in the right direction (pun intended). Humans are designed to traverse rough, uneven terrain while hunting and gathering food. Anything that mimics this lifestyle is bound to activate our genetic proclivity to adapt and survive. Of course, I wanted to try this out myself to add some anecdotal evidence to the mix so I spent the last three months either standing in front of the computer, standing on a balance board at the computer or sitting in a prototypical ergonomically insufficient office chair. After roughly 90 days, at the writing of this article, I feel that I have experienced some benefit which will be difficult to quantify. When I sit at a desk for long periods of time, my butt starts to ache and I start to get antsy. I'm driven by restlessness to stand and walk around or my skin starts to crawl. Conversely, while standing at my computer, I experienced no restlessness. When I did eventually sit to take a break, I get that subtle glow in my legs reminded me of the typical post-workout buzz (to a much lesser degree, but it is there.) So, in short, standing at a desk (especially on a board) did make me feel better. Take that for what its worth.

 The Poor Man's Standing Desk

The Poor Man's Standing Desk

Now I'll explain the “no”. The majority of individuals seeking to make a physical change to their day ultimately want another tool for weight loss. However, studies show increasing energy expenditure on a daily basis doesn't typically lead to a caloric deficit and subsequent weight loss. The human body's metabolism is just too complicated for such an easy solution. If increased daily activity lead to a chronic caloric deficit for our ancestors then they would have withered away and died from malnutrition eons ago. Unfortunately, (or fortunately as it helped humans survive long enough for us to have this conversation… potato/potata), our metabolism adjusts widely on a daily basis. Some estimates suggest it varies by as much as 50% on any given day based on energy consumption versus expendature. This has been proven time and time again. One famous study was performed by Dr. Herman Pontzer who studied the hunter gatherer Hadza tribe of Tanzania. The Hadzas traveled 15-20 miles every day in order to gather food. Dr. Pontzer discovered that “despite all this physical activity, the number of calories the Hazda burned per day was indistinguishable from typical adults in Europe and the US”! (Pontzer H. Debunking the hunter-gatherer workout. NYT 2012, Aug 24.) So there it is… standing at your desk can make you feel better and may be one of many steps to optimize healthy living. In my medical experience, I found that most folks who want to be healthy seldom make one change. It is typically a complete lifestyle overhaul complete with increased daily activities and better dietary choices and this is what leads to changes in body composition.

So my two scents: Standing while working, even for some of the day, will definitely make you feel better but don't expect miracles. The small study referenced above showed an increase in “pain” for folks who stood at their desk. This number increased after 10 minutes and decreased after 20. I can attest to this. I performed this self-experiment while keto-adapting and I did notice some fatigue (much like lactic acid buildup during exercise) in the small muscles in my feet, legs and back. I am not sure if this is due to my depleted glycogen stores resulting from being keto or if constant activation of leg muscles is just so foreign to modern humans that my body was rebelling. Either way, I just sucked it up.

If you want to learn more, Paleo Godfather Robb Wolf of the Paleo Solution Podcast" has a great article about standing desks you may enjoy. Check it out here

The "Paleo Fitness Plan" that Saved My Joints!

Imagine never doubting yourself physically. Always being up for activities as experiences present themselves. Waking up everyday without any worries about nagging pains or limitations. Instead, you feel anticipation for the possibility of fun and exploration in the day ahead.” - GMB Fitness

Survival of the FITest

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I've been on an ancestral-type lifestyle program for about two years now and have reaped many benefits which include- higher energy, decreased joint pain, increased mobility and better overall health. How/why did I make the transition from traditional thinking? First of all, I was all-in, "hook line and sinker" with the paradigm "eat-less/move more" for optimum health. I was definitely moving more, often exercising intensely 6 days a week with crossfit-type workouts. I was lifting heavy and pushing myself hard. Interestingly, I didn't feel great. In fact, I felt terrible! I was always tired, my joints ached and I was plagued with vague bouts nerve pain. This wasn't supposed to happen! I am a medical professional and have been counseling my patients to do the very same things I was doing even though I was feeling horrible. The 'ah-ha' moment came when I turned forty last winter and realized if I felt this way now, how bad would I fell at fifty, sixty, seventy, and so on? I was simply doing it all wrong.

Magnificant Machines

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Humans have been around for about 200,000 years. Our bodies are magnificent machines which work like little organic all-terrain vehicles specialized to navigate the variable terrains we encounter here on Earth. The mechanisms of evolution have fine tuned our cardiopulmonary, musculoskeletal, and even our digestive systems from the slow-and-steady pace of nomadic migrations to the stressful sprints of big game hunts. We adapted a body composition and metabolic processes to adjust for periods of plentiful bounty followed by periods of famine. This was our way of life for millennia after millennia until we figured out ways to increase the efficiency of movement by reducing workload.

Our bones, once strengthened against the punishment of long treks, and our skin, once thickened and calloused for grip, have been dangerously softened. Our posture once tall and outstretched to spy predators and prey is now slumped as we sit at desks tapping away at keyboards. The fundamental issue being we've lost touch with one of our body's most basic human functions: movement. 

 

Moving Forward by Looking Back

 Katy Bowman

Katy Bowman

Katy Bowman, author of Move Your DNA and creator of Nutritious Movement, elegantly describes the modern limitations imposed on our body's natural abilities as casting, similar to the medical casts we apply to broken limbs. A cast purposefully limits the mobility of a broken bone in order to reduce mechanical stresses to allow the bone to heal properly. Bowman applies this principle to everything in our lives which limit natural movements. Take, for example, the athletic shoe  which binds the natural contours of our feet, reducing inefficient movements and isolating single muscle groups. This ignores the process of adaptation. Our feet are designed to take a beating. The outcome of constant cushioning is weakness and deconditioning. Bowman suggests the idea of casting can be applied to almost every area in our lives. Casts weaken historically strong muscles resulting in dysfunction and leading to abnormal wear and tear setting us up for injury and chronic pain.

 

This Gets Personal

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In the winter of 2016, I decided to set a goal to deadlift 400 pounds before my odometer clicked past 39 years, 11 months and 31 days. Some may say that this goal was foolishly fueled by the prototypical mid-life-crises and those individuals would probably be right. Despite a decade passing since my “twenty-something” perception of invincibility, I decided to set this deadlifting goal to become the strongest I had ever been. Unfortunately, no matter how much will and dedication I applied to this task, my body remained insubordinate through chronic aches, pains, multiple injuries. Somewhere between the numbness in my fingertips and the rational part of my brain, reality set in and I chose to readdress my fitness goals while I still had the ability to move my limbs.

I researched bodyweight strength and flexibility oriented programs to try and loosen up my rusty old spine and protect it for future endeavors. I avoided most programs which were too similar to others I had completed in the past. I had a lot of fun with CrossFit programs and they work well in their ability to pound you into shape but if my body was still injury prone, what would be my motivation to continue with these? Aesthetics? Therein lies an important distinction everyone must address when considering a workout program. Am I doing this to look good or am I doing this to feel good? I had never taken time to consider feeling better as a fitness goal. My motivations were always aimed towards lifting heavier, going farther and getting faster. What if I changed that mindset to moving better, feeling better and increasing my flexibility

Always with a Smile

 Ryan Hurst from GMB Fitness showing "unparalleled" strength. (lol - get it?)

Ryan Hurst from GMB Fitness showing "unparalleled" strength. (lol - get it?)

Enter the guys from GMB Fitness. I discovered their website after seeing a lot of chatter about them on twitter. They talked about mindfulness, listening to your body and exploring movements through various workflows. Their website showcased videos and images of athletes bounding around on all fours like monkeys, jumping like frogs and balancing in contorted poses sometimes on one hand, one leg, or upside down and most importantly always with a smile. It was the first paragraph on the website caught my attention the most:

Lately, the word “fitness” has been perverted to mean shaming yourself into doing things you hate to impress people you don’t like with a body that looks good but is too beat-up and tired to do anything fun.

Hey, that sounded familiar. Why had I chosen the 400 pound deadlift as a goal? I wanted to prove that I wasn't getting older. But to who? The fact is, I am getting older and that's okay. Humility teaches us that most people don't care how you look and could care even less about how much weight you can lift. The creators of GMB Fitness, Andy Fosset, Ryan Hurst and Jarlo Ilano, developed their approach to fitness by embracing this very concept. Their backgrounds in martial arts, gymnastics and physical therapy allows for a program which combines medically appropriate movement, athletic flexibility and functional strength at the pace and intensity of the user. Their approach is simple: relearn the ways our bodies were meant to move and celebrate your improvements. So, for 12 months, I put down my barbell and found myself  focusing on bear crawls, monkey walks and frog jumps. My first attempt at bear walking for 5 minutes resulted in my collapse to the floor in only 45 seconds! I could snatch a 32 kg kettlebell overhead but couldn’t walk on all fours for a minute! Eventually, the movements became smoother, easier and almost felt cleaner. I would reach a level of relaxation and mindfulness that carried beyond my workouts and

I learned to measure goals by performance and flexibility. I've returned to a modified injury free weight training program (thank you Body by Science). Yet, I never really stray far from the GMB basics as I don't want to stiffen up. I plan on incorporating these lessons throughout my life and hope to stay limber, strong and pain free till I'm old and gray (well, older and grayer).

 

If you want to learn more about GMB Fitness, Ryan Hurst appeared on The Wait What If Podcast to discuss the essentials of human movement and further talk about the GMB philosophy. Visit GMB Fitness at www.gmb.io

Yes, there are decent alternatives to YETI!

Check Current Yeti Prices

So, a lot of my listeners are into fitness, outdoor activities and most importantly, the consumption of liquids. I know, I know, that's kind of a generalization that can be made about all humans... I'll give you that. How about I further sub-categorize my listeners as people who consume fluids, on the go? That's better. 

I rarely recommend a product unless I have given it a true shakedown cruise. (if you don't know what that is, you probably have never served in the military, so just google it and thank a vet). In this case, I have only put the main character to the test - my 30 ounce Yeti stainless steel coffee mug. My assistant bought it for me about 3 years ago and it has been a solid addition to my EDC. I've filled this thing with coffee in the wee hours of the morning and it can still be found, steaming hot, mid-afternoon. Yeah, it's really that good. The only downfall is that Yetis tend to be pricey but you are spending money on a quality-made kick ass product.

If you've never owned a Yeti or don't want to drop the cash on one, I've researched some decent competitors that may give you the same quality at a fraction of the cost.

1. Orca Coolers 

Check Price at Amazon

Orca takes the top spot on my list because they are MADE IN THE USA! I think they are a true Yeti killer as that little nugget has earned them a following of loyal customers. They come in a bunch of sizes and colors and have great customer reviews over at Amazon. When it is time to part ways with my Yeti (which has built up a formidable coffee-colored stain over the past 3 years) I may have to go with Orca because... 'Merica! Amirite ;-)

 

 

2. RTIC

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I used to have an RTIC tumbler back in the day but I left it at the gym and never saw it again. I probably would have bought another but then I was gifted my current Yeti. The RTIC slogan is: "Half the Price; Double the Ice" which is a nice dig at Yeti and may be true! So true in fact, it led to a court dispute that Yeti ended up winning. As a result, RTIC had to revamp their product and dropped a whole new line of coolers. If you're looking for quality and really don't care about that brand name stamp then this one is for you. 

3. Pelican

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In the performance category, we come up with this little gem from Pelican. Pelican has a cult-like following of outdoorsmen who swear about their superiority to all competitors. As a result, you probably won't save much money buying one but you'll definitely win some street-cred... er... woods-cred(?)... from your fellow outdoor enthusiasts.

 

4. Grizzly

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Grizzly Coolers are the grandfather of high efficiency coolers... well maybe the cool uncle, who used to be in special forces, and lives in the woods, and can rock a pair of ranger panties with pride (again, military joke here... look it up civilian!).  They've been around since I was a wee tot and their claim to fame is that they are indestructible! They back up that claim with a life-long warranty. So, if that cool uncle left you his Grizzly from 1983, it should work as good as new or they'll fork over another one (maybe... better ask them first).

5. Meadowcraft

Check Price at Amazon

This is a sleeper brand and it is well worth checking out all their products. My friend has one of their coolers and after messing around with it during a fishing trip, I'd be hard-pressed to tell you the difference of feel and performance between this and a Yeti. It had a cool feature - a pressure relief valve that assisted in opening the cooler when there was a pressure differential due to temperature differences inside and outside. I am not sure about the quality of their tumblers but if it is anything like the cooler and priced just as low, it is worth checking out.

So there you have it! If you feel like you need to keep your fluids chilled or warm over extended periods of time or just want to make it look like you are transporting radioactive plutonium to and from the driving range, then check out the aforementioned coffee rigs. 

If you are all about bio-hacking, living life to the fullest, contemplating our existence or just plain curious at what makes us tick, then check out the Wait What If Podcast Episode Archive.

My wife always asks: What EXACTLY do you want for Christmas?

Here's the problem. I am a 40-year-old nerd that rarely ever "needs" anything and if a "need" arises (usually in the form of podcast/fitness equipment), I typically just buy it. This frustrates the hell out of my wife because she never knows what to get me. My answer is usually "I'll love whatever you get" but she calls my BS. 

I'm sure there are other folks in the same situation! So I decided to put together a quick list of things I would love to get under the tree. If your significant other is a nerd like me who loves cool things and enjoys fitness, health, and tech... these gifts will be a hit! 

Top Five Gifts for the Guy Who Has Everything

1. The Mini Museum

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Let's start things off with getting our geek on! I got my first Mini Museum a few years ago for Christmas/Birthday. Yes, I one of those folks who get combined gifts due to the fact that my birthday is one week before Christmas. Some would think this is a bad thing but I disagree. it usually means folks are willing to spend a few extra bucks on a combined gift and this results in really cool gifts like the Mini Museum!

What is a Mini Museum? It is a clear resin block containing fascinating specimens from around the world personally collected by its creator, Hans Fex. The current iteration (Mini Museum 3) contains ancient Egyptian Papyrus, a Viking ax, a piece of Steve Jobs iconic turtleneck, various fossils, and even a piece of Prince Charles' and Lady Diana's wedding cake! (just to name a few). This was one of my favorite gifts of all time and it inspires imagination and awe from all my friends and family who pay the 25 cent cover charge to see it ;-)

(Oh, and I interviewed Hans Fex a few times on the show. Check out his latest appearance here.

You can buy your very own mini-museum here! 

2. Kettlebells

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If the person you're shopping for is a fan of health and fitness, I highly recommend buying them a kettlebell. Unless you've been spending time off the grid, in an underground bunker (avoiding crossfitters) you should have heard of these nasty little beasts by now. They are basically cannonballs with handles. I love them because of their compact versatility. Just one 30 lb kettlebell can be enough to beat that soft squishy office body into a Spartan soldier! I keep a 45lb and 25lb kettlebell under my desk at work. Sometimes all it takes is getting up and doing 10 kettlebell swings every hour to knock you back into shape! They're not that expensive

Here are some kettlebells over at Amazon for a great price!

3. Steel Mace

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While we're on health and fitness, you can't have a kettlebell without a matching steel mace to boot! What kind of soft-skinned-desk-jockey are you you shopping for anyway?! If your significant other wouldn't know which side of a hammer to grab onto then maybe consider a steel mace. Again, these babies tuck away in the corner of your office and getting up once an hour to swing away like John Henry will have you tearing the palms off every person you shake hands with! Just start slowly... these can be dangerous. On a serious note, I rehabbed my bad shoulders back to health with a 15lb mace.

Here are some Steel maces over at Amazon!

4. Books

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I mean... They're books. I'm pretty sure I don't have to talk these up, do I? If you are leveling-up your "savageness" by swinging around some iron and steel then why not work-out your mind as well?

If you really know the person you're buying for then pick a topic and go to Amazon. If you follow my link then you'll help support the podcast!

5. Coffee Booster

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I know, I know... this is totally random but I LOVE thi stuff! I've been on the high-fat/low-carb eating style lately and found this to be the key to sustained energy throughout my mornings. You incorporate this into a modified fasting protocol. And if you really want to freak out co-workers then come to the morning sipping on a coffee mixed with a heaping spoonful of grass-fed butter and coconut oil! They'll say "You're putting WHAT in your coffee?" and chide you for being "unhealthy". But you've read the aforementioned books and snicker as you sip away watching them stuff their faces with bagels and donuts.

Coffee Booster is very tasty and I drink this 3-4 times a week. It's not cream and sugar and will take a bit of getting used to but once you switch to this way of drinking coffee, you'll be hard pressed to go back.

The images below contain links to Coffee Booster. I added an electric mixed which is a must for mixing it in. You just can't do it with a spoon!