We’ve all heard the expression “Rome wasn’t built in a day”.  I believe this resonates with our health as well.  Many studies have shown that quick fixes such as fad diets and even gastric bypass or gastric sleeve procedures (“stomach reduction surgery”) do not often show permanent changes. The human body seems to have a “set point” where it wants to be.  When you deviate from that set point, as when you try to lose extreme amounts of weight, it secretes hormones that make you feel extreme hunger or maybe even depressed which resolve when you gain the weight back.  Some of these hormones are secreted by fat cells that sense they are shrinking.

Think about a long term goal that you’ve had, maybe saving money to buy your first house, planning your wedding, graduating from college, etc.  Could you do any of these in 3 weeks or less?  how about six months?  Probably not.  We shouldn’t think we could get 100% healthy in these time frames either.  Sure, if you restricted your calories and lived in the gym you could probably see dramatic weight loss (like you often see on those TV shows like “Biggest Loser”), but the weight will come back.

How can anyone become and stay healthy?  Just like the analogy of saving to buy your first home, we should think small.  Start with the smallest changes and go slow.  The key is consistency and to keep motivated.

Here are some tips to get started:

• Set a SMART goal each week.  This is something that is specific and measurable.  For example, “The first week of June, I will eat one piece of fruit each day.”  Avoid goals which are less specific such as “I want to eat more fruits and vegetables.”
• Plan ahead, think about what you will need to do to accomplish your goal and create contingency plans.  In the example above with the fruit, perhaps you will need to go grocery shopping and buy 7 pieces of fruit every Sunday.  What if you don’t have time to shop one week?  Maybe you could keep frozen fruit such as bags of berries or peaches (BTW they are delicious) in your freezer that you could defrost and eat.
• Pick low hanging fruit.  Avoid changes that disrupt your life too much.  Going from a sedentary life to saying that you are going to workout daily can be a shock to your body.  Maybe instead, you can add a 5 minute brisk walk each day.  I know that you probably think 5 minutes is too little, but lets remember that 5 minutes a day x 7 days per week x 52 weeks per year, equals a heck of a lot of walking!  Also, you may start off with 5 minutes, but perhaps in a few months, it will increase to 15 or 30 minutes when you lose weight and feel more energetic.
• Think about replacing not cutting out.  If you are a diehard chocolate fan and eat it every day, cutting it out completely may seem like torture/punishment.  However, maybe if you replaced it with non-fat chocolate pudding or sugar free hot chocolate, you can still satisfy your chocolate craving without all the excess calories.
• Pick a diet that works for you.  I get this question all the time in my practice, “What’s the best diet to lose weight?”  I say, it’s the diet that you fits in with your lifestyle, that you can maintain for the rest of your life, and that does not cause you to gain weight or increase your cholesterol/blood pressure.  Everyone is unique and we are learning more and more that our bodies respond differently to the food we eat.
• Write it down. Each week, write your goal for the week down and place it on your desk to remind yourself.
• Recognize obstacles in your path.  These can be situations or even people who will unknowingly throw you off.  For example, if you decide your goal is to reduce your alcohol intake (alcohol is packed with calories, and can slow down your metabolism considerably), perhaps you can avoid cocktail parties or social events where the focus is on drinking.  Perhaps replace those events with activities such as going to the movies with friends, or hiking in a park.  Many studies have shown that people with obese friends have a high risk of becoming obese. The reverse is true.  Why is this?  As humans, we like to do things that others around us are doing, a sort of evolutionary peer pressure.  So if your friends are getting ice cream, it would be difficult not to eat with them.  Obviously, if your goal for that week was to avoid sweets, you may have a hard time at the ice cream shop!  Recognize the challenge and find a way around it.
• Be creative.  Think about ways you can achieve your weekly goals.
• Enjoy each little “win” and let that provide motivation for you to keep going.  Perhaps, reward yourself in a healthy way!  Take time to look back every so often and see how far you’ve come and how great you feel.  In my own life, I’m shocked at how many changes in my life I have made over the years, from getting “hooked” on running to cutting out red meat,  and to cutting back on my food portions to name a few.  Again, these changes were over the course of years of continued improvement.  “Slow and steady wins the race!”

At the Academy Awards this year, the wrong movie was announced as the Best Picture which created a very awkward situation.  After a full investigation, the cause of the embarrassment was a distracted staff member who was using social media while he should have been fully focused on his job.

I was not surprised that social media and cell phone use caused this debacle.  Many major train crashes and derailments in recent years have been attributed to conductors who were not paying attention because they were looking at their phones.  Don’t get me wrong, I think phones and social media are not inherently “evil”.  Heck, you may be reading this article on your phone right now!

My concern is that we are no longer living in the moment and experiencing life now.  Humans can not “multitask”.  We are not designed to deal with more than one task at once.  Meanwhile, while I’m writing this blog, I am drinking my morning cup of coffee and listening to music.  Isn’t that multitasking?  Yes, an observer may think that I am doing three things at once but I’m actually not.  I’m typing for a few seconds, then my attention goes to reach for the coffee mug, then it goes back to typing on the keyboard.  I am actually “toggling” between activities, albeit at a very fast pace.  I am not truly doing these three things at once.

If a task requires more concentration or I am doing more tasks at once, the “toggling” becomes more cumbersome and reaction/response time will increase.  My chance for error will also increase.  Hence, this is the root of the Oscar incident and many accidents.

While it is not entirely feasible to “disconnect” from our phones entirely in this digital age, I would recommend that we try to avoid the temptation to be staring at screens all the time.

Here are some tips to learn how to “live in the moment”.

• Create a dedicated “time out” from electronic devices each day.  I recommend putting the phone away when you are eating and at least one hour before bedtime.  Why?  Distracted eating can cause you to overeat.  Think about the last time you went to the movies and how much popcorn or candy you ate.  Looking at the news (especially nowadays!) and social media before bedtime can also lead to disrupted sleep.  Oftentimes when we sleep, we replay events or thoughts in our mind particularly things that occupied our minds just before falling asleep.
• Remove or hide “addictive” apps from the phone/tablet.  Games and shopping are great distractions and are not all bad.  They can sometimes give your mind a mini “mental coffee break”.  However, if you are finding they are taking up too much of your time, they can negatively impact your health.  That 20 minutes playing a “Candy” game could be better spent getting some fresh air outdoors or calling a friend you haven’t spoken to in a long time.
• Talk to people.  It’s amazing how little we talk to people even with our closest friends.  We text, instant message, snapchat, tweet, but we don’t talk to real people in real time as much as we should.  Pick up the phone and call someone today.
• Practice mindful eating or any other activity.  We need to experience things more completely.  Try this little experiment.  The next time you start to eat something, take one small bite of the food and close your eyes.  Take 2 full minutes to eat that piece of food.  Allow your taste buds and your mouth to fully sense the full texture, taste, and even sound produced.  You would be surprised how wildly complex and exciting one bite of food can be, but we don’t often realize it because we are eating too quickly and eating with distractions.  This often leads to overeating.  You can adapt this to any life experience.  I love to do this when I’m enjoying a beautiful sunset.
• Try an “Electronic Device Fast”.  Just like people stop eating food for certain religious holidays, I recommend a period of time where we live as we did 15 years ago.  Put away your tablets and/or phones for just one day or two.  Right now, most of us continue to check our electronic devices even while on vacation!  I am just as guilty of this myself.  However, on a recent trip to Cuba, where internet access is difficult, I was forced to disconnect for 3 days and it felt great.  When you first try the “fast”, you will notice that smartphones are like drugs, you will notice a sense of withdrawal.  However, after a while you will be much more mindful and focused on “real life” experiences rather than “screen” life.
• Meditate.  I can’t overemphasize how meditation is the best solution to counter the negative effects of information overload.  I think meditation is like the “reset” button for our brains, similar to pushing and holding the power button on the smartphone when you’ve opened too many apps and the phone freezes.

Per my gastroenterologist friends, “you can tell a lot about a person’s health by how they poop”.  I couldn’t agree more, but I often find patients are reluctant to discuss their bathroom habits or even to bring up issues such as hemorrhoids (enlarged veins in the anal area that often bleed or cause itching).  Our bowel movements are dictated by many different factors:  how much fiber we eat, how much water we drink, how much we exercise, and how long we sit on the toilet.  Here are some tips on how to improve your visits to the bathroom.

• Eat fiber and lots of it!  Fiber acts like a scrubber and removes cholesterol along your intestinal walls and pushes food forward.  It also causes the stool to clump up and come out in one piece.  Your bowel movement should look like a banana-  tapered at the front and back.  I recommend shooting for a goal of 25-35 grams per day.  Here is how to get there.
• Take probiotics found in foods.  Billions of bacteria live in our colon.  They serve to help us digest properly.  Yes, they sometimes do contribute to embarrassing gas, but overall they are the “good guys” and keep us healthy.
• Drink water.  Hard stools which lead to constipation, are often caused by inadequate hydration.
• Do not sit more than 2 minutes on the toilet.  There should be no email writing, reading of magazines, newspapers, or even novels on the toilet.  You should be practically running to the toilet to have a bowel movement.  If you sit for more than 2 minutes and nothing is happening, go do something.  Drink some water, or exercise to get your bowels moving.  Don’t worry, you WILL move your bowels at some point.
• Try a new way of sitting on the toilet.  A new product called Squatty Potty (which debuted on the TV show, Shark Tank) has been shown to improve hemorrhoids, straining, and reduce time on the toilet.  I have one and I absolutely swear by it!
• Exercise.  Yes, yet another reason to exercise.  Each time your body bounces up and down on a treadmill, exercise bike, or jumping rope your intestines also move food along.  Ultimately, this leads to the need to eliminate.
• Avoid or reduce medications which can cause constipation.  Narcotics (such as oxycodone, Percocet, codeine), antihistamines, and even calcium supplements or TUMS are well known culprits for causing constipation.  If you do take one of these, you may even want to take a laxative or increase your dietary fiber to avoid the resulting constipation which can sometimes be severe enough to require hospitalization!
• Keep track of your bowel movements.  We should all ideally be going to the toilet at least once every day or every two days.  If it gets more than that or your habits change suddenly, it may be time to check in with your primary care provider.  Colon cancer can manifest with sudden constipation.

I recently changed my exercise routine from five days a week to seven days a week.  Why the change?  I had a realization that doing things intermittently have a higher chance of failure (not likely to complete the full course) than every day.

How did I reach this epiphany?  I learned it by observing patients in my practice.  Typhoid is a an illness that is often acquired when traveling to underdeveloped countries and eating food or water contaminated with sewage.  There are two types of Typhoid vaccine which are recommended for travelers.  One is an inactivated vaccine in a injection “shot” form that is a one time deal and provides two years protection.  The other way to get immunity is to take a series of four capsules separated by 1 day in between.  So a person would swallow a capsule on day one, skip day two, take a capsule on day the, skip day four, etc.  I generally prefer the capsules since they provide five years of immunity and most people would prefer one less needle in the arm anyways!  Over the years, I have seen many people, including myself, mix up this routine with pills missing, misplaced, or just forgetting to take them on time. Why does such a simple task have a high failure rate?

It’s extremely difficult to keep on a schedule when it has an intermittent nature.  Imagine you have an exercise schedule or goal to go to the gym five times per week.  Your best friend calls and says she wants to go the movies since a great movie just opened, but that movie just happens to play when you were going to workout at the gym.  Wouldn’t it be easy to think you could move that workout to the Saturday?  But will you follow through when the weekend comes?  Possibly, but the chances are much less likely.

As I’ve said in my blog before, our bodies crave routine.  It does not like shifting bedtimes, eating habits, and alcohol habits.  Jet lag is one such example of how changing our lives too much can result in poor mental functioning.  Another example is being “Hangry”, which is a nickname for that short-tempered feeling when one is extremely hungry.

So what have I done with exercise?  I have been doing it daily for at least thirty minutes.  Sure, I may not always have time for a full gym workout, simple exercises such as the Seven Minute Workout could be just as good (if you have the luxury of more than seven minutes, you can do it twice or three times).  If I have more time on certain days, then I can indulge in a longer workout.  I consider even short intermittent bursts of exercise to be “placeholders” so at least I am consistent with my routine.  Be creative, even the stairs in your apartment building can be your personal “stair master”.  The most important thing is that you incorporate exercise into your life.  Need more convincing?  Read this blog.

Mr. Jen Yin Chiu, Dr. Kao Mei Chiu, and a very young Dr. Edward Chiu

I find it amusing that many people are turning to the “Paleo” diet for improved health and longevity.  Ironically, the people who lived in the “Paleo” age died at the average age of 25!  Granted they also had to deal with infections, the elements and animals trying to eat them.

My grandfather lived to be 101 years old.  I think it is much more logical to model my diet on what he ate to be healthy!  Let me tell you a little about him.  Mr. Jen Yin Chiu worked as a farmer and painted oil paintings as a hobby.  He got up early in the morning, and went to bed early each night.  He drank at least 4 large mugfuls of oolong tea each day.  He did 10 minutes of stretching every morning when he woke up, kind of a mix between tai chi and yoga with deep breathing exercises.  Throughout his life, he rarely ate processed foods having grown up in a farming village where fresh vegetables and fruits were always plentiful.

When I am trying a new food, I think to myself “would my grandfather recognize this as food?”  If the answer is “no” I avoid it.  A good example is cereal that comes in multicolored ring shapes.  Sure, the ingredients list things like wheat and corn, but if my grandfather saw fluorescent colored donuts that stain the milk a rainbow color, he probably would think this is a bowl of plastic beads.  No good.  The same goes with soda.  He only drank tea and water.  In general, anything that is overly processed would be out.  Anything that grows on a farm with the fewest steps between the field and your plate would be ok.

I suggest that rather than “fad diets”, try to avoid packaged foods.  When shopping at the grocery store, shop around the perimeter of the store, which includes the meat section, dairy case, and vegetables.  Avoid the inner aisles where there are packaged and processed foods galore.  The only exception would be the aisle with beans and whole grains.  Read the ingredients on food labels.  If you can’t  pronounce words like “sodium caseinate, disodium inosinate, maltodextrin, disodium guanylate” which I recently saw on a bag of orange colored, triangular shaped corn chips, I recommend you don’t eat it!

My grandfather never stepped foot in a gym to do workouts, but he did get plenty of exercise daily.  Most people burned more calories in previous generations during their daily routine.  Why?  Well, when my grandfather wanted to write a letter to a friend, he would write the letter out by hand and walk it to the post office 20 minutes away.  Today, we could sit at the kitchen counter and click “send” and the email is sent.  When my grandmother washed clothes, she did them by hand.  I estimate she probably burned a good 200-300 calories washing clothes for every half hour of laundry by hand every few days.  Today, when I do laundry, I burn zero calories as I just throw them in the machine and press start.  I’m not saying we should all be doing our laundry by hand again, but this means we MUST get some form of exercise in our day and not just sit at our desks, in our cars or on the couch for over 12 hours a day (and that’s not an exaggeration!).

To make things worse for us, our food portions are getting way out of control.  We are easily consuming 2-3 times the amount of calories that our grandparents ate and the fat content of our food is higher than ever.  Not convinced?  Check out the size of your dinner plate.

Currently, we are on course to a looming health catastrophe.  Already we are seeing Type 2 Diabetes emerge in children (Type 2 Diabetes usually does not appear until adulthood and is associated with obesity).  We are eating more calories than ever and burning less calories because of technological advances.  Healthy eating and regular exercise should be incorporated into everyone’s daily life.  If you have children, you should teach them healthy habits from the start.  Get them off the sofa, perhaps exercise together as a family.